Results Summary

What was the research about?

High blood pressure can cause health problems like stroke and heart disease. In the rural Southeast, Black Americans with high blood pressure who have lower incomes are more likely to die from these health problems than White Americans.

In this study, the research team compared four approaches to help Black patients control high blood pressure:

  • Usual care alone. Clinics received a laptop computer, with a program to educate patients, and home blood pressure monitors for patients. Clinics also received tips to help control patients’ blood pressure.
  • Practice facilitation plus usual care. The research team trained facilitators, who met with clinics monthly. The facilitator helped clinics improve teamwork, use their data to monitor patients’ progress on blood pressure control, and increase phone contact and education for patients.
  • Peer coaching plus usual care. Peer coaches met with patients once a week for eight weeks, then once a month for one year. They discussed blood pressure control, blood pressure medicine, healthy eating, and exercise.
  • Practice facilitation and peer coaching plus usual care. Clinics received practice facilitation, and patients received peer coaching.

What were the results?

After one year, the percentage of patients with controlled blood pressure increased in all approaches. The percentage of patients with controlled blood pressure didn’t differ between the approaches.

Compared with patients who received care at clinics with usual care alone:

  • Patients who received care at clinics with practice facilitation had worse quality of life related to physical health. They also had a higher chance of a hospital stay.
  • Patients who received peer coaching reported less stress.

The approaches didn’t differ in patients’:

  • Average change in blood pressure
  • Quality of life related to mental health
  • Number of emergency room visits

Who was in the study?

The study included 1,209 Black adults with high blood pressure. The average age was 58; 62 percent were women and 45 percent had an income less than $20,000 per year. All received care at one of 69 rural clinics in Alabama and North Carolina.

What did the research team do?

The research team assigned clinics by chance to one of the four approaches. All approaches included usual care.

At the start of the study and again 6 and 12 months later, the research team collected patients’ home blood pressure measurements. Patients also completed surveys about quality of life and stress. The team reviewed health records to track hospital and emergency room visits.

Patients with high blood pressure, health coaches, and doctors helped design the study.

What were the limits of the study?

Of patients who received peer coaching, 57 percent completed sessions. Results may have differed if more patients completed peer coaching. Also, the study didn’t capture the full impact of practice facilitation at each clinic.

Future research could explore ways to encourage patients to continue with peer coaching. Studies could also look at the effects of practice facilitation.

How can people use the results?

Clinics can use the results when considering how to help Black patients control their blood pressure.

Final Research Report

This project's final research report is expected to be available by November 2023.

Peer-Review Summary

The Peer-Review Summary for this project will be posted here soon.

Conflict of Interest Disclosures

Project Information

Andrea L. Cherrington, MD
Monika M. Safford, MD
University of Alabama at Birmingham
$9,584,626
Collaboration to Improve Blood Pressure in the US Black Belt-Addressing the Triple Threat

Key Dates

February 2023
2015
2023

Study Registration Information

*Monika M. Safford, MD, was the principal investigator of this study when it was funded.

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Last updated: February 1, 2023