A clinical trial funded by the National Institutes of Health (NIH) found that a scalable, team-based intervention strategy in federally qualified health centers (FQHCs) was able to significantly reduce systolic blood pressure for low-income participants. Scientists deployed team-based care, which included intensive blood-pressure management, blood pressure tracking and feedback to providers, health coaching on lifestyle changes and medication adherence, and home blood-pressure monitoring.
Uncontrolled high blood pressure, known as hypertension, is a major preventable risk factor for cardiovascular disease and death worldwide. According to the CDC, only 1 in 4 adults with high blood pressure has their blood pressure under control. 37 million U.S. adults with uncontrolled high blood pressure have a blood pressure of 140/90 mmHg or higher. Lower income Americans experience high prevalence of hypertension and low control rates, contributing to an increased disease burden.
"Evidence-based strategies to treat uncontrolled hypertension among low-income Americans are severely lacking, even though we know this condition is a huge risk factor for more serious heart complications," said NIH Director Jay Bhattacharya, M.D., Ph.D. "This study shows us that we can deploy an affordable, tested program to help reduce the burden of heart disease in this population."
The study took place at 36 HRSA-funded or designated FQHCs in Louisiana and Mississippi and enrolled more than 1,270 participants aged 40 or older. Participants qualified if they had systolic blood pressure of at least 140 mm Hg without medication or at least 130 mm Hg with medication. Compared with enhanced usual care, which included physician education on hypertension guidelines, the team-based approach reduced systolic blood pressure by more than 15 mm Hg versus about 9 mm Hg. Prior research suggests this difference could lead to a 10% reduction in cardiovascular events.
"Health centers play a critical role in chronic disease prevention and management, including preventing and managing hypertension," said Administrator Tom Engels of HRSA, which oversees the Health Center Program. "Because uncontrolled hypertension is a leading cause of death in the United States, the public health implications of this trial are significant."
At 18 months, a systolic blood pressure of less than 120 mm Hg was reported in 21.8% of patients in the intervention group and in 15.1% in the control group. A systolic blood pressure of less than 130 mm Hg was reported in 47.7% and 36.4% in the two groups, respectively. Researchers found that the cost of the team-based intervention averaged about $760 per patient, significantly less expensive than treating resultant heart conditions.
Most participants had long-standing, treated but uncontrolled hypertension, indicating the blood pressure reductions are achievable in real-world settings. The team-based model reduced provider burden, while home monitoring and health coaching supported patient self-management and treatment adherence. Researchers conclude these strategies can scale to other primary care settings and improve hypertension control in similarly underserved populations.
This clinical trial was led by researchers at University of Texas Southwestern Medical Center, Dallas, and Tulane University, New Orleans. The trial was supported by grants from NIH's National Heart, Lung, and Blood Institute (R01HL133790) and (UH3HL151309); the National Institute on Aging (R33AG068481); the National Institute of General Medical Sciences (P20GM109036); and the National Institute on Minority Health and Health Disparities (R01MD018193).
Part of the National Institutes of Health, the National Heart, Lung, and Blood Institute (NHLBI) plans, conducts, and supports research related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases; and sleep disorders. The Institute also administers national health education campaigns on women and heart disease, healthy weight for children, and other topics. NHLBI press releases and other materials are available online at https://www.nhlbi.nih.gov .
