ACHIEVE Hypertension (HTN)
- Project Lead: Robert Brook, MD, Wayne State University
- Co-Investigator: Ijeoma Opara, MD, Wayne State University
- Project Coordinator: Katee Dawood, MBA, MS, BASc, Wayne State University
Hypertension is the leading risk factor for global morbidity and mortality. Even mild elevations in blood pressure (BP) are harmful whereby individuals with stage 1 hypertension are at double cardiovascular risk. Black adults suffer from a higher prevalence, worse control rates, and more frequent adverse health effects from high BP. They are also at heightened risk for an earlier accelerated progression from mild to more severe hypertension. Little progress has been made in mitigating health inequities related to high BP. Predominantly Black cities such as Detroit disproportionately suffer from nearly twice the national average mortality rate due to heart disease.
Mounting evidence shows that pervasive negative social determinants of heath (SDoH) are major drivers of these inequities and represent a critical barrier to achieving BP control in Black hypertensives. Core issues include poor access to healthcare and a burdensome system for care linkage especially in under-resourced settings, low health education and literacy, and structural inadequacies in care delivery including a failure to address the spectrum of life circumstances that elevate BP and hinder the adoption of salutary lifestyle changes.
In PROJECT 1 of the ACHIEVE GREATER research center, we propose an innovative approach to identify and control hypertension at its earliest stages in undiagnosed Black adults, potentially yielding an enormous benefit towards lifetime health equity. Using a hybrid type I effectiveness-implementation and quasi-experimental design, we will leverage our novel mobile health unite (MHU) platform to implement a program that links low risk Black adults with stage 1 hypertension to collaborative care delivered by non-physicians, community health workers (CHWs) and pharmacists, consisting of a personalized, adaptable approach to lifestyle and life circumstance (PAL2) intervention for 12-months. Core features of PAL2 include the ability to choose from a menu of readily available interventions that address individual negative SDoH, culturally sensitive health and lifestyle education, and adaptability over time according to its acceptance, effectiveness (home BP), and evolving patient needs. If BP remains ≥130/80 mm Hg after 6 months, a pharmacist-directed medical treatment algorithm will be added to achieve timely BP control. Program benefits including BP-lowering will be assessed during the implementation (12-months) and maintenance phases (year 2) after linkage to medical care. We aim to show the effectiveness of project 1 to lower home BP after 12 months in 500 Black patients with mild stage 1 hypertension living in disadvantaged communities in Detroit and to reach the target population. We also aim to evaluate the fidelity and outcomes of project 1 and examine its cost effectiveness. Improving care access by strategic MHU outreach, coupled with enhanced collaborative care, can effectively remove barriers, mitigate negative SDoH and improve BP control in Black adults with hypertension. PROJECT 1 of the ACHIEVE GREATER center represents a novel and scalable model to advance health equity in urban Black communities across the United States that continue to face disparities.
- Brook RD, Dawood K, Foster B, Foust RM, Gaughan C, Kurian P, Reed B, Jones AL, Vernon B, Levy PD. Utilizing Mobile Health Units for Mass Hypertension Screening in Socially Vulnerable Communities Across Detroit. Hypertension. 2022 Jun;79(6):e106-e108. doi: 10.1161/HYPERTENSIONAHA.122.19088. Epub 2022 Mar 16. PMID: 35291803; PMCID: PMC9093230.
- Brook RD, Scirica BM, Levy PD. "The Doctor Is Out": New Tactics and Soldiers for Our Losing Battle Against Hypertension. Circulation. 2022 May 31;145(22):1629-1631. doi: 10.1161/CIRCULATIONAHA.122.059674. Epub 2022 May 31. PMID: 35639852.