OBJECTIVES: African American men have lower hypertension control rates and higher cardiovascular disease mortality rates than those of Caucasian males. We examined how a peer approach to hypertension management could improve blood pressure control for participants, mostly minority males.   METHODS: This is a longitudinal cohort study. Patients in the intervention group enrolled relatives or friends in the hypertension education program and attended as teams, the monthly education sessions. Patients in the control group followed standard of care. Blood pressure was taken by a nurse, at baseline and every 3 months, for up to 15 months. Other clinical and behavioral information was obtained from medical charts and surveys at baseline and follow-up visits. We used survival analysis to compare time to achieve the defined goal (patients without diabetes: systolic blood pressure (SBP) <140, patients with diabetes: SBP <130) between the two groups controlling for confounders and clusters of patients. RESULTS: A total of 250 subjects were included in the study; half in the intervention group. Approximately 90% of the participants were African American and 60% were males. The baseline blood pressure levels were 149/88 mmHg and 146/88 mmHg in the control and intervention group (p > 0.25). After controlling baseline blood pressure, gender, race, age, diabetes, smoking and patient clusters, we found that patients in the intervention group reached goal at a rate 4.97 times (95% CI: 2.02-12.25) higher than the rate in the control group. However, higher baseline SBP (HR=0.96, 95% CI: 0.93-0.98), males (HR=0.54, 95% CI: 0.31-0.95) and smoking (HR=0.39, 95% CI: 0.20-0.77) were significantly associated with longer time to achieve the goal. CONCLUSIONS: Patients who approached hypertension management with their peers were much more likely to achieve blood pressure control in a shorter time than patients in standard of care. These findings have implications for clinical and public health interventions.