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  • Research & Results
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  • Comparing Ways to Reduce High Blood P...

Comparing Ways to Reduce High Blood Pressure in People from Different Backgrounds -- The RICH LIFE Study

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Project Summary  

PCORI has identified high blood pressure as an important research topic. Patients, clinicians, and others want to learn: What are effective ways to improve blood pressure control, especially for people from minority racial/ethnic groups, individuals with low socioeconomic status, and residents of rural areas? To help answer this question, PCORI launched a funding initiative in 2014, Testing Multi-Level Interventions to Improve Blood Pressure Control in Minority Racial/Ethnic, Low Socioeconomic Status, and/or Rural Populations. This research project is one of the studies PCORI awarded as part of this program.

This research project is in progress. PCORI will post the research findings on this page within 90 days after the results are final.

What is the research about?

According to the Centers for Disease Control and Prevention, almost 30 percent of the US population has high blood pressure. High blood pressure is more common among some groups, such as people from ethnic minorities, people with low incomes, and people who live in rural areas. People may be more likely to have high blood pressure because of where they live or work; their ability to pay for food, medicine, and other living expenses; and their access to good health care. These factors can make it hard for patients to control high blood pressure.

This study is comparing two ways to treat high blood pressure. The first focuses on improving the way clinic staff measure and track patients’ blood pressure. The second way treats patients while taking into account community factors that might make their blood pressure harder to control.

Who can this research help?

This study can help health clinic directors and primary care doctors choose how to care for people who have high blood pressure. This study could be helpful in communities that have high rates of this condition and limited access to health care.

What is the research team doing?

Researchers are working with 30 primary care clinics in Maryland and Pennsylvania. At each clinic, the study is enrolling 63 people who have high blood pressure that is not controlled. Some people in the study also have diabetes, high cholesterol, depression, or heart disease, and some are current smokers. The research team is enrolling 1,890 people.

The researchers are assigning each clinic by chance to one of two groups. Staff members at both groups of clinics are getting training in correctly measuring blood pressure. They are also getting feedback about how well their patients’ blood pressure is being kept at a healthy level. The staff members are taking part in web-based training about taking care of people with high blood pressure, especially people who are at risk for poor health.

In one group of clinics, primary care doctors and nurses care for people in the study. This is the way the clinics usually provide care, but these clinics are also training staff on treating high blood pressure.

Staff members at the second group of clinics are getting more in-depth training. They are also focusing on factors that cause some groups of people to have a high risk of uncontrolled blood pressure. This group is using a team approach to providing care. Primary care doctors, nurse care managers, community health workers, pharmacists, cardiologists, nutritionists, and community health workers are working together to take care of people who have high blood pressure.

Some patients in the second group get home visits from community health workers. They may also get one-on-one education to help them take care of their health. Some patients may have a group of specialists review their treatment plans and give them tips to control their high blood pressure. These specialists include experts in heart and kidney diseases, diabetes, mental health, quitting smoking, and high blood pressure.

At the start and end of the two-year study, researchers measure each patient’s blood pressure and how many patients have blood pressure that is normal. Researchers also look at patients’ quality of life and their ability to reach personal health goals.

The researchers are working with people with high blood pressure, their doctors, and other team members to develop study guidelines and materials.

Research methods at a glance

Design Element Description
Design Randomized controlled trial
Population Adults aged 21 to 100 who are non-Hispanic black, non-Hispanic white, or Hispanic, and have high blood pressure that is not controlled. Participants may have additional conditions such as diabetes, high cholesterol, heart disease, depression. Participants may be current tobacco smokers.
Interventions/
Comparators
  • Collaborative care
  • Enhanced usual care for controlling high blood pressure
Outcomes

Primary: change in average blood pressure, ability to control blood pressure, quality of life, ability to reach personal health goals

Secondary: change in overall risk of heart disease, cholesterol levels (average total cholesterol, LDL, HDL), ability to control cholesterol, average hemoglobin A1c levels, ability to keep A1c under 7.0, patient-reported outcome measures

Timeframe 2-year follow-up for primary outcomes

Related Articles

Ethnicity & Disease

Discrimination Is Associated with Elevated Cardiovascular Disease Risk among African Immigrants in the African Immigrant Health Study

American Heart Journal

The RICH LIFE Project: A cluster randomized pragmatic trial comparing the effectiveness of health system only vs. health system Plus a collaborative/stepped care intervention to reduce hypertension disparities

More on this Project  

Videos

Comparing Ways to Reduce High Blood Pressure in Disadvantaged Populations (Right)
Lisa Cooper of Johns Hopkins School of Medicine and Bloomberg School of Public Health describes the work and potential impact of her PCORI-funded project, which compared ways to help patients from disadvantaged populations in Maryland and Pennsylvania better control high blood pressure.

Training Is Key to Helping Improve Blood Pressure Measurements
Lisa Cooper of Johns Hopkins School of Medicine and Bloomberg School of Public Health says training clinical staff and community health workers was an important component of her PCORI-funded project that sought to help patients from disadvantaged populations better control their high blood pressure.

Project Details

Principal Investigator
Lisa A. Cooper, MD, MPH
Project Status
Awarded; In progress
Project Title
Comparative Effectiveness of Health System vs. Multi-level Interventions to Reduce Hypertension Disparities
Project End Date
September 2020
Organization
Johns Hopkins University
Year Awarded
2015
State
Maryland
Project Type
Research Project
Health Conditions  
Cardiovascular Diseases
Hypertension
Coronary or Ischemic Heart Disease
Kidney Diseases
Chronic Kidney Disease
Mental/Behavioral Health
Depression
Tobacco Cessation
Multiple/Comorbid Chronic Conditions
Nutritional and Metabolic Disorders
Diabetes
Intervention Strategies
Behavioral Interventions
Other Clinical Interventions
Care Coordination
Patient Navigation
Other Health Services Interventions
Incentives for Behavior Change
Policy Interventions
Technology Interventions
Training and Education Interventions
Populations
Low Income
Racial/Ethnic Minorities
Rural
Urban
Funding Announcement
Testing Multi-Level Interventions to Improve Blood Pressure Control in Minority Racial/Ethnic, Low Socioeconomic Status, and/or Rural Populations (UH2/UH3)
Project Budget
$12,500,000
Study Registration Information
HSRP20162130
NCT02674464
Page Last Updated: 
February 21, 2020

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Meetings & Events

March 2
Cycle 1 2021 PCORnet Phase 3 Applicant Town Hall
March 8
Engagement Awards 2021 Special Cycle -- Applicant Office Hours (One)
March 15
Priorities on the Health Horizon: Informing PCORI's Strategic Plan (Webinar)

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