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 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 on 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?

About 40 percent of African Americans in the United States have high blood pressure, a leading cause of stroke and heart disease. African Americans with high blood pressure who live on limited incomes in the rural southeast are more at risk of dying from stroke or heart disease than people in other parts of the country. Researchers are comparing four different ways of providing care to reduce high blood pressure in African Americans in the rural South.

Who can this research help?

Results from this study can help health clinic directors and primary care doctors choose ways to treat high blood pressure in rural African Americans with low incomes.

What is the research team doing?

Researchers are working with 80 rural primary care clinics in Alabama and North Carolina. At each clinic, 25 African Americans with high blood pressure are part of the study, for a total of 2,000 people.

The study team is assigning clinics by chance to one of four groups. In all of the groups, doctors, nurses, and other healthcare professionals receive education about how to correctly measure blood pressure. Each clinic also receives a laptop with access to online educational videos for patients about blood pressure treatments. In addition to these interventions, one group of clinics cares for people enrolled in the study in the same way they usually do. In a second group of clinics, a specialist consults with clinic staff to help them make changes in the way they take care of people with high blood pressure. Clinics might choose to create a registry to monitor patients’ blood pressure more closely, for example. This approach to helping clinics improve the care they provide is called practice facilitation. A third group of clinics matches patients with a peer coach to help them improve their high blood pressure. A peer coach is someone who works with patients to help them manage their health. The fourth group of clinics is using both practice facilitation and matching participants with a peer coach. At the beginning and end of one year, researchers are measuring each participant’s blood pressure to see if it improves.

The study team is gathering information about the processes the clinics use to change the way they provide care. They are holding focus groups and interviews with patients, peer coaches, facilitators, clinic staff, and doctors.

The researchers are working with primary care clinics, people with high blood pressure, peer coaches, and groups of patients to develop the plans for practice facilitation and peer coaching that are being tested in this study.

Research methods at a glance

Design Elements Description
Design Randomized controlled trial
Population African American adults ages 18–85 or older who have high blood pressure and get care at a clinic that has been invited to participate
  • Enhanced usual care for controlling high blood pressure
  • Enhanced usual care and practice facilitation
  • Enhanced usual care and peer coaching
  • Enhanced usual care, practice facilitation, and peer coaching

Primary: difference in blood pressure control between trial arms

Secondary: difference in change in blood pressure between baseline and follow-up; depressive symptoms; physical and mental functioning; patient, provider, and staff satisfaction

Timeframe 1-year follow-up for primary outcome

Project Information

Andrea Cherrington, 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.


Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
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
Research Priority Area
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: March 15, 2022