Community Program Tied to 'Dramatic' Increase in BP Control

Megan Brooks

September 14, 2023

Community health centers participating in the National Hypertensive Control Initiative (NHCI) that introduced self-measured blood pressure (SMBP) and other interventions have achieved significant improvements in blood pressure control rates in their communities, early results show.

The results show that "dramatic improvements in blood pressure control — from 44% to 70% and beyond — are possible when providing care for patients facing social determinants of health and who are disproportionately impacted by hypertension," Eduardo J. Sanchez, MD, MPH, chief medical officer for prevention, American Heart Association (AHA), told | Medscape Cardiology.

"When patients and care teams work in partnership, self-measured blood pressure monitoring can help inform diagnosis, treatment, and lifestyle change to improve blood pressure control," Sanchez said.

The results were presented at the American Heart Association (AHA) Hypertension Scientific Sessions 2023 in Boston, Massachusetts.

Evidence-Based, Culturally Sensitive

The NHCI is a 3-year grant from the US Department of Health and Human Services' Health Resources and Services Administration (HRSA) and the Office of Minority Health.

The initiative funded the AHA to work with 350 HRSA-funded community health centers that had BP control rates < 58.9% in 2019 prior to the COVID-19 pandemic.

"With a particular emphasis on historically under-resourced communities in the United States, the comprehensive program supports healthcare teams at community health centers through regular blood pressure management training; technical assistance and resources that include the proper blood pressure measurement technique; SMBP monitoring and management; medication adherence; and healthy lifestyle services," Sanchez told | Medscape Cardiology.

The care teams use evidence-based, culturally sensitive interventions designed to address the needs of patients disproportionately affected by hypertension, specifically Black, Hispanic, and American Indian/Alaskan Native populations.

Patients are trained to accurately measure their blood pressure at home on a regular schedule, with a goal of twice in the morning and twice in the evening for 3 to 7 days. This sample of readings is then shared with the healthcare team to guide next steps.

"So far, the community health centers that participated with NHCI have achieved a 12.3% increase in blood pressure control from 2020 to 2022," lead author and presenter Allison Smith, MPH, RN, program director of Target: BP for the AHA and American Medical Association (AMA), said in a conference statement.

Smith cited three community health centers that successfully implemented SMBP programs using different designs and achieved notable improvements in BP control (defined by the performance measure < 140/90 mm Hg).

  • The SWLA Center for Health Services in southwest Louisiana established a team-based care model that emphasizes standardized processes, including an SMBP onboarding protocol and a BP treatment algorithm. The center increased BP control from 44% in January 2022 to 70% in July 2023.

  • Canyonlands Healthcare in rural Arizona coupled systematic in-clinic practices with American Indian/Alaska Native community health workers to reach patients from the Navajo Nation in a culturally relevant manner. Subsequently, BP control improved from 53% in 2021 to 66% in August 2023.

  • Via Care in Los Angeles, California, developed a collaborative practice model with their clinical pharmacists and clinicians for systematic medication management, SMBP and lifestyle education, and team-based visits. BP rates improved from 55% in the first quarter of 2021 to 74% in the fourth quarter of 2022.

"AHA's evaluation of the HRSA-funded community health centers' needs, practices, and performance has been ongoing since the beginning of the grant in 2021 and will continue through the end of the grant in December 2023," Sanchez told | Medscape Cardiology.

"The knowledge gained from working with 350 HRSA-funded health centers will be used to inform future hypertension control efforts by AHA and others," Sanchez added. "AHA intends to continue the relationships built over past 3 years with community health centers to further strengthen and sustain blood pressure control through national initiatives like Target: BP and local support efforts."

'Crucial' Program

Commenting on this research for | Medscape Cardiology, Wanpen Vongpatanasin, MD, clinical chair for the conference, said the NHCI is a "crucial program that improves self BP monitoring and BP control in the population at risk — including individuals from Black, Hispanic, and American Indian/Alaskan Native populations."

"Previous studies suggested that the most important factor for adopting self BP monitoring is doctors' recommendation, but we cannot wait for doctors to do all the work. We need community health workers to promote adoption," said Vongpatanasin, professor of internal medicine and director of the Hypertension Section, Cardiology Division, UT Southwestern Medical Center in Dallas, Texas.

"The early program success is very encouraging, and the effort must continue," she added.

The study had no commercial funding. Sanchez, Smith, and Vongpatanasin report no relevant financial relationships.

American Heart Association (AHA) Hypertension Scientific Sessions 2023. Abstract 753. Presented September 9, 2023.

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