NEW YORK (Reuters Health) — A combination of medication and education can help lower blood pressure among low-income black men — a group at particular risk of heart disease and other complications of high blood pressure.That’s the finding of a five-year study that followed 309 inner-city African American men with high blood pressure, or hypertension.

At the beginning of the study, half of the men were randomly assigned to an intensive programme that combined free medication, health education and social support such as job interview training. The rest were placed in a less intensive programme of education and help with finding care for their high blood pressure.

Over five years, researchers found, men in both groups were able to lower their average blood pressure levels. The intense intervention was more effective, however, and it helped reduce the rate of left ventricular hypertrophy, an enlargement of the heart that results from uncontrolled high blood pressure.

On the other hand, both programmes failed to cut the risk of several other conditions that often go hand-in-hand with high blood pressure, including diabetes and obesity.

Even more concerning, the men’s death rate during the study was alarmingly high, the researchers report in the American Journal of Hypertension.

Substance abuse was the most common cause of death, while cardiovascular disease followed close behind.

“The findings are encouraging in that we saw improvements in blood pressure in both groups,” said lead study author Dr. Cheryl R. Dennison of Johns Hopkins University School of Nursing in Baltimore.

However, she told Reuters Health, “they’re very alarming in terms of mortality”.

Though the study patients were only 21 to 54 years old at the outset, 17 percent died over the next five years.

Men in the intensive therapy group received far more attention for their high blood pressure than this low-income, often uninsured group otherwise would, according to the researchers.

They got free blood pressure medication from a nurse practitioner who saw them regularly and, in consultation with a doctor, managed their care. In addition, community health workers visited the men’s homes and helped connect them to social services, including job skills training.

But the mixed findings show that even such intensive blood pressure therapy is not enough, according to Dennison.

Many of these men need substance abuse treatment, or jobs and health insurance, to improve their overall health, she pointed out.

“We have to address more than hypertension,” Dennison said.

“We’re going to have to address the social and economic issues.”