High blood pressure is treated with medication and lifestyle changes, but it remains the leading cause of death in the United States. More than half of US adults have blood pressure higher than 130/80 mm Hg — the cutoff for hypertension — and the condition is especially prevalent in low-income communities.
A new study by Tulane University researchers found that a team-based program at community health clinics helped low-income patients lower their blood pressure more than standard care alone. The study, published in New England Journal of Medicinewas conducted at 36 federally certified health centers in Louisiana and Mississippi, nonprofit centers that provide primary care to many patients with limited incomes and limited access to care.
The multifaceted, team-based program gave patients more support than they would normally receive, including clinic teams who followed an evidence-based plan to treat high blood pressure and help patients stay on their medications. Health coaches also counseled patients, either in person or virtually, on healthy lifestyle habits such as diet and exercise and gave them the tools to monitor their blood pressure at home. Meanwhile, clinics in the enhanced standard care comparison group continued their usual approach, although doctors received training on blood pressure treatment guidelines.
After 18 months, patients in clinics using the group program saw their systolic blood pressure drop an average of 15.5 points, compared with 9.1 points in clinics providing enhanced usual care. Patients in the group-based program also showed greater adherence to hypertension treatment.
We have the tools to treat high blood pressure, but the challenge is to effectively implement these tools in primary care and help patients adhere to medications and lifestyle changes. This trial showed that a team-based approach to support and treat patients with uncontrolled blood pressure in low-income rural and urban areas can effectively reduce high blood pressure.”
Katherine Mills, lead author, professor of epidemiology at the Celia Scott Weatherhead School of Public Health and Tropical Medicine, Tulane University
The findings are important as hypertension is the main modifiable risk factor for cardiovascular disease, the leading cause of death in the US
The study included 1,272 patients aged 40 and over with uncontrolled high blood pressure, meaning that blood pressure remains high despite lifestyle changes or treatment.
“Many of these patients had long-standing hypertension, meaning the approach is effective in lowering blood pressure in difficult, real-world clinical settings,” said co-first author and one of the study’s principal investigators, Dr. MA “Tonette” Krousel-Wood, professor of medicine and epidemiology and Jack Aron Carlaneic University of Medary School of Private.
Nearly three-quarters of study participants reported household incomes of less than $25,000 per year, 63.4% were black, and 75.9% were unemployed, reflecting populations that often face the greatest barriers to blood pressure control, particularly in the southern states, which bear the highest burden of hypertension in the US.
Dr. Krousel-Wood said the study “demonstrated that blood pressure-lowering interventions can be successful in federally qualified health centers, serving patients who may be at greater risk for hypertension-related morbidity and mortality.”
With about 1,400 of these centers in the US, researchers hope this program can be implemented in clinics across the country.
“We found that this approach was more successful when the clinics took over the program,” Mills said. “The approach taken in this trial can be adopted in other primary care settings to provide support and improve blood pressure control for all people living with hypertension.”
