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

Project Information

Lisa A. Cooper, MD, MPH
Johns Hopkins University
$12,626,669
Comparative Effectiveness of Health System vs. Multi-level Interventions to Reduce Hypertension Disparities

Key Dates

February 2023
2015

Study Registration Information

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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.

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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.

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Last updated: January 16, 2022