Reducing Racial Disparities in HTN Control using an Equity-Centered Approach

IntroductionBlack Americans have the highest prevalence of hypertension among all racial or ethnic groups in the United States.1 They are 40% more likely to have uncontrolled blood pressure2 and are five times more likely to die from hypertension compared to non-Hispanic whites.3,4 Experiences of discrimination in healthcare, clinician and institutional bias, and socioeconomic and environmental inequities driven by structural racism contribute to uncontrolled hypertension in this population.3,5-8 Multilevel, multicomponent interventions have effectively improved blood pressure control among Black Americans but remain inadequately implemented in the clinical setting. An integrated nursing/public health quality improvement study was designed to address this gap between evidence and integration into clinical practice. MethodsUsing a one group pre/posttest design, we examined the effect of an innovative, evidence-based 12-week intervention on blood pressure among Black Americans with uncontrolled hypertension aged 18 and older in the primary care setting. Intervention components included remote blood pressure monitoring, weekly phone coaching with culturally congruent care, medication intensification, and a standardized hypertension protocol. ResultsThe average age of the participants (n=35) was 64 years, and two thirds (n=23) were female (66%). The mean difference in systolic blood pressure from pre to post intervention decreased significantly (M=23, SD=14.0), t(34)= -9.7, p < .001. A significant reduction in the mean difference in diastolic blood pressure from pre to post intervention was also observed (M=11, SD=11.8), t(34)= -5.5, p < .001. At 12 weeks, 87% of participants had achieved blood pressure control. The intervention also improved medication adherence and hypertension knowledge (p <.001). ConclusionA multicomponent, culturally congruent quality improvement intervention significantly improved blood pressure among Black Americans. Health Equity ImplicationsScaled up implementation of equity-centered, culturally congruent approaches are needed to reduce racial disparities in hypertension control.