Project Summary

Hypertension affects almost half of adults in the United States. Hypertension increases the risk of other problems such as heart disease, kidney disease or stroke. There are treatments that can help people control their blood pressure (BP) and reduce the risk of future medical problems. 

Many people with hypertension do not have their BP in control, and studies have shown disparities in hypertension treatment, meaning patients from certain racial or ethnic groups are less likely to receive effective treatment and less likely to have their BP in control. Interventions to reduce these disparities could improve health and increase equity. 

Safety net health systems need information to decide where to focus efforts to improve the treatment of hypertension and reduce disparities. Developing this information requires research comparing practical options in real-world settings, so that the results of the research can be used directly by other health systems. 

The Boston Hypertension Equity Alliance in Treatment, or BHEAT, study will compare two system-level interventions—changes that are put in place for an entire clinic or medical practice. Each intervention is designed to address one cause of disparities in hypertension treatment. Researchers will compare: 

  • How the interventions affect BP 
  • How interventions are implemented 
  • How patients’ experiences change when the interventions are in place 

The study has three specific aims. 
Aim 1: Compare the effect on BP of two interventions, one that supports patients in using remote monitoring systems to manage their BP and one that combines health-system actions to help clinicians and patients adjust treatment when patient’s BP is not controlled. 
Aim 2: Compare the details of how the two interventions are put into place to understand how other systems can use similar approaches.
Aim 3: Evaluate how patients’ experiences of being treated for hypertension are affected by the two interventions 

The study team includes nine primary care sites in an urban safety-net system. All sites will begin with the remote monitoring intervention and then be randomly assigned to add the second intervention at three different points in time. The team will compare how the interventions affect patients’ hypertension, examine details of how sites put the interventions in place and gather data from patients on their experiences with hypertension treatment. 

Patients with hypertension will benefit from the knowledge generated about which interventions can be more effective when used in primary care. Clinicians will benefit from having more effective systems for taking care of patients. Healthcare systems will benefit by identifying which methods for treating hypertension are more efficient and lead to better outcomes across their patient populations. 

This study will include patients from nine primary care sites in an urban safety-net system. These sites serve more than 16,000 adult patients with uncontrolled hypertension, of whom 43 percent are Black, 22 percent are Hispanic/Latino and 22 percent are white. Researchers will compare two interventions. One uses remote BP monitoring to help patients connect with their primary care team so their BP can be tracked more often and more accurately, which can help then get BP into control. The other intervention uses tools for the clinical team and patients to support them in adjusting treatment and making sure patients whose BP is not in control are offered new or different options. 

The study’s main outcome will be the improvement in BP for patients who start the study with their BP uncontrolled. Other outcomes will measure how effectively sites implement the two interventions. The research team will collect patient-reported outcomes to measure how activated they feel to manage their own health, how patients take their medications and experiences of trust with their provider. 

The study team held meetings and focus groups with more than 50 Boston residents to discuss their experiences with hypertension as patients or caregivers, and several of those participants will form the patient advisory group for this study. The team also engaged with stakeholders from healthcare systems, public health, private insurers and hospitals to ensure the study represents a wide range of perspectives in its design and in communicating the results.

Project Information

Michael Fischer, M.D., MS
Tracy Battaglia, M.D., MPH
Boston Medical Center Corporation
$19,394,758 *

Key Dates

60 months *
April 2024
2024

*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.

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Last updated: April 23, 2024