Uncontrolled hypertension, or high blood pressure, is a major health concern in underserved communities.The American Heart Association, the world’s leading voluntary organization dedicated to a world of longer, healthier lives, has awarded $20 million in grants to five scientific research teams to find new solutions for preventing high blood pressure. Researchers at the University of Alabama at Birmingham School of Medicine and School of Public Health are one of the teams.
The research projects will focus on hypertension prevention in underserved populations with historically the highest prevalence of this mostly preventable, but potentially deadly condition.
The Health Equity Research Network (HERN) on the Prevention of Hypertension is part of the multi-pronged approach of the American Heart Association’s unprecedented pledge to aggressively address social determinants of health while working to improve health equity for all communities.
In addition to UAB, teams of scientists from Beth Israel Deaconess Medical Center in Boston, Johns Hopkins University School of Nursing in Baltimore, NYU Grossman School of Medicine in New York City and Wayne State University in Detroit will lead the community engaged research projects. A separate team at NYU will serve as the coordinating center for the network to help train the next generation of hypertension health equity researchers, providing consultation and guidance, compiling data reports and coordinating the administration of the initiative.
“High blood pressure is a leading risk factor for heart disease and stroke that can often be prevented or managed if diagnosed and treated properly. However, there are significant racial and ethnic disparities in both the prevalence of hypertension and its management,” said Robert J. Dabal, M.D., president of the American Heart Association in Birmingham and chief of the section of congenital heart surgery at UAB and Children’s of Alabama. “Uncontrolled hypertension is particularly acute in communities of color. We are excited to launch this new research initiative to support the fast-track advancement of science to prevent hypertension with a focus on health equity.”
RESTORE (AddREssing Social Determinants TO pRevent hypErtension) Network is the name of the overarching research program. It will be managed by a multidisciplinary team from NYU Grossman School of Medicine in New York, led by Gbenga Ogedegbe, M.D., M.P.H., director of the Institute for Excellence in Health Equity. The coordinating center will oversee the establishment of, and provide support and resources to, the five research projects. The RESTORE Network will be testing multiple strategies to help people overcome the social determinants of health like poor access to care, food deserts and lack of places for exercise that is pervasive in Black communities.
The projects, which commence on Oct. 1, 2021, include:
Andrea Cherrington, M.D., M.P.H., professor in the Division of Preventive Medicine.EPIPHANY: Equity in Prevention and Progression of Hypertension by Addressing barriers to Nutrition and Physical Activity at the University of Alabama at Birmingham – led by Andrea Cherrington, M.D., M.P.H., professor in the Division of Preventive Medicine. This team will work with 16 churches in rural Alabama. From those churches, they’ll recruit Black adults with elevated blood pressure not treated for hypertension to take part in one of two interventions. People from eight of the churches will receive group health education and personal computer tablets to access online cooking shows and exercise classes. People in the other eight churches will receive group health education, access to online cooking shows and exercise classes, plus peer support from a trained Community Health Worker to help set and meet diet and physical activity goals. Churches randomized to peer support will also receive funding for community-level interventions to promote healthy foods and/or physical activity opportunities.
Other investigators at UAB are Suzanne Oparil, M.D., professor in the Department of Medicine, School of Medicine; Paul Muntner, Ph.D., associate dean for research, Shakia Hardy, Ph.D., assistant professor, Department of Epidemiology and Lonnie Hannon, Ph.D., associate professor, Department of Health Behavior, School of Public Health. The UAB team will also work in collaboration with investigators from Tuskegee University.
Groceries for Black Residents to Stop Hypertension (GOFRESH) at Beth Israel Deaconess Medical Center in Boston – led by Stephen P. Juraschek, M.D., Ph.D., this team will test using a virtual grocery list with weekly healthy food delivery to the homes of Black adults with elevated blood pressure not treated for hypertension in Boston neighborhoods with food deserts. Participants will receive enough groceries to share with their families. The groceries will be part of the healthy eating plan known as the DASH (Dietary Approaches to Stop Hypertension) diet, high in healthy food groups like fruit and vegetables and low in sodium. A dietitian will help participants order groceries they prefer by computer and provide tips and recipes on how to prepare foods in new ways. Researchers will evaluate the impact on blood pressure, cholesterol and food purchasing patterns over a 12-month period to explore the cost-effectiveness and scalability of the intervention for broader implementation.
Home Blood Pressure Telemonitoring Linked with Community Health Workers to Improve Blood Pressure (LINKED-BP Program) at Johns Hopkins University School of Nursing in Baltimore – led by Yvonne Commodore-Mensah, Ph.D., M.H.S., R.N., this team will implement its LINKED-BP Program to help people who receive care at community health centers. The program will provide some participants with a home blood pressure monitor, connections to a community health worker and a mobile health app. Others will be given the blood pressure monitor only. Over the course of 12 months, researchers will evaluate whether people in this study group lower their blood pressure, comparing the outcomes of the group of participants receiving multiple interventions to those with only the home blood pressure monitor.
Community-engaged Implementation Study of Hypertension Prevention and Navigation in Black Men at NYU Grossman School of Medicine - led by Joseph Ravenell, M.D., M.S., this team will engage 30 barbershops to screen Black men for high blood pressure, provide advice about a healthy lifestyle and link them to care, when needed. The team will expand their initiative, Community-to-Clinic Linkage Implementation Program, or CLIP, in three phases to test various strategies. In the first phase, they will learn about concerns barbershops may have about CLIP and help barbershops put the plan into practice. In the second phase, they will evaluate whether providing barbershops with support from expert facilitators for 12 months helps the shops adopt CLIP more quickly and if the facilitation leads to lower blood pressure in customers in the barbershop. In the third phase, they will determine whether the barbershops maintain CLIP six months after facilitation ends. They’ll also implement CLIP in barbershops without expert support and compare the effectiveness of the two strategies.
Linkage, Empowerment, and Access to Prevent Hypertension (LEAP-HTN) at Wayne State University in Detroit – led by Phillip Levy, M.D., M.P.H., this team will deploy mobile health units to provide direct, personalized health care and coaching to Black people with high blood pressure living in select under resourced neighborhoods in Detroit. Community health workers will help people in the study develop and follow a personalized, flexible health plan. Throughout the year, researchers will regularly compare hypertension and other health factors of people in the program to those of people in the community who also have high blood pressure but who didn’t take part in the personalized health plan. They anticipate people receiving care from the community health workers will have lowered or better controlled their blood pressure compared with those who were not.
The American Heart Association, the world's leading nonprofit organization focused on heart and brain health for all, is the largest not-for-profit funding source for cardiovascular and cerebrovascular disease research next to the federal government. Since 1949, the Association has invested more than $4.6 billion in cardiovascular, cerebrovascular and brain health research. New knowledge resulting from this funding benefits millions of lives in every corner of the U.S. and around the world.