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Hypertension, a leading cause of cardiovascular disease and premature death, affects nearly one in three adults in the United States. Despite the effectiveness of current treatments, only about half of people with hypertension have it under safe control. Of particular concern are disparities in the prevalence, diagnosis, and treatment of hypertension for high-risk groups, including racial and ethnic minorities and low-income and rural populations.

The magnitude of this problem, and its disproportional impact on particular populations, makes it a perfect fit for PCORI’s patient-centered comparative clinical effectiveness research. We’ve already funded several studies on this topic, and we recently announced a major joint PCORI–National Institutes of Health (NIH) initiative to investigate how best to reduce the disparities we see in outcomes in hypertension treatment. Now, I am pleased to report the latest step in this collaboration—a funding opportunity just announced by NIH for trials of up to five years. PCORI is providing $25 million through the Hypertension Disparities Reduction Program Partnership, a collaboration between PCORI and two NIH institutes—the National Heart, Lung and Blood Institute and the National Institute of Neurological Diseases and Stroke. Applications will be due in January.

What Will Be Funded

The partnership is planning to fund up to two innovative, randomized trials that compare evidence-based approaches for improving control of hypertension among high-risk populations, which may be treated in healthcare facilities that see a high rate of uncontrolled hypertension. Trial participants are likely to include many patients insured through Medicaid and those treated at Federally Qualified Health Centers and community clinics.

Any trial funded will compare a multi-component intervention against the current standard of care and perhaps other treatments. The intervention must be based on evidence from previous trials and involve healthcare system leadership, clinicians, patients, and community-based organizations. It should address obstacles that people in high-risk populations experience in controlling their blood pressure and be tailored to take into account patient factors such as preferences and language. The intervention must be feasible for broad implementation, so if the trial shows it to be beneficial, it can have a major impact on health across the country.

To increase the likelihood that the results will prove useful, patients, clinicians, and other healthcare stakeholders will play a meaningful role—as in other PCORI-funded research—in the planning, implementation, dissemination, and other aspects of the trial.

How PCORI Chose This Topic

Addressing disparities in health and health care is one of PCORI’s five National Priorities. Our multi-stakeholder Advisory Panel on Addressing Disparities ranked hypertension disparities as one of the top three topics for which PCORI should fund comparative effectiveness research.

To this end, the Addressing Disparities program worked with Million Hearts®, a national initiative co-led by the Centers for Medicaid and Medicare Services and the Centers for Disease Control and Prevention, to prevent 1 million heart attacks and strokes by 2017. The team identified high-priority topics related to disparities in hypertension care and outcomes. A multi-stakeholder workgroup helped identify important gaps in knowledge about how to improve hypertension diagnosis, treatment, and outcomes among high-risk populations. Among their three top-priority research questions, the workgroup included a comparison of the effectiveness of multilevel interventions to promote self-management and reduce disparities in hypertension outcomes across diverse populations.

That is what the PCORI-NIH partnership will now fund. The results of the trials will likely have a large impact on the nation’s health because even small drops in blood pressure significantly reduce risk of heart attacks, strokes, and premature deaths.

Janet Wright, MD, FACC, the Executive Director of Million Hearts®, says, “Million Hearts is thrilled that PCORI and NIH are committing much needed resources to help address and eliminate disparities in hypertension control. Preventing a million heart attacks and strokes starts with better blood pressure control for all.”

Hasnain-Wynia is the Program Director of PCORI’s Addressing Disparities program.

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