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.

PCORI identified high blood pressure as an important research topic. Patients, clinicians, and others wanted to learn: What are effective ways to improve blood pressure control, especially for people who are at high risk for heart disease and other problems related to high blood pressure? To help answer this question, PCORI launched an initiative in 2014 on Testing Multi-Level Interventions to Improve Blood Pressure Control in Minority Racial/Ethnic, Low Socioeconomic Status, and/or Rural Populations. The initiative funded this research project and one other.

Final Research Report

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

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:

  • The reviewers asked how generalizable the results of this study were to urban areas. The researchers expanded their discussion to note that although the project was conducted in a rural area, given the frequency of medication nonadherence and unhealthy lifestyle in urban as well as rural settings, the results may be generalizable to urban settings.
  • The reviewers asked why the researchers included perceived stress as a separate outcome domain rather than including it within the mental functioning domain, given the high correlation between stress, anxiety, and depression. The researchers acknowledged this high correlation but explained that their community partners wanted stress prioritized because many feel that blood pressure is directly related to stress.
  • The reviewers asked the researchers to discuss further their finding that peer coaching was effective for individuals under 60 with uncontrolled hypertension and to consider whether age concordance between the peer coaches and patients could have been a factor. The researchers considered this possible and extended their discussion of why peer coaching was more beneficial among younger patients in the discussion to include this hypothesis.

Conflict of Interest Disclosures

Project Information

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

Key Dates

February 2023

Study Registration Information

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


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Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
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Last updated: August 21, 2023