According to the Centers for Disease Control and Prevention, nearly half of the adults in the United States have high blood pressure, which is a leading cause of death and disability and a major risk factor for cardiovascular disease, stroke and cognitive decline. Unfortunately, more than half of people with high blood pressure do not have their blood pressure under control, and non-Hispanic Black people have significantly lower rates of blood pressure control than people from other racial and ethnic groups.
To help address this disparity, researchers at Atrium Health and Wake Forest University School of Medicine have been approved for a $9.9 million research funding award from the Patient-Centered Outcomes Research Institute (PCORI), for a five-year study called “Remote Hypertension Tracking Help and Management to Reduce Disparities in Black Patients (RHYTHM-B).”
“There is an urgent need to test innovative and targeted strategies to improve hypertension outcomes for Black patients and guide implementation of best practices,” said Yhenneko Taylor, Ph.D., assistant vice president of analytics and outcomes research at Atrium Health and adjunct associate professor of social sciences and health policy at Wake Forest University School of Medicine.
Taylor said the study is a product of multidisciplinary collaboration between population health, quality improvement, analytics, research and clinical teams, who formed a task force with a charge to take bold steps to improve blood pressure control and eradicate hypertension disparities.
Taylor will lead the study along with William B. Applegate, M.D., professor of gerontology and geriatric medicine at Wake Forest University School of Medicine, which is the academic core of Advocate Health, to study the effectiveness of two interventions in Black patients with uncontrolled high blood pressure.
Taylor and Applegate are collaborating with Aditi Gupta, M.D., professor of nephrology and hypertension, who will lead the implementation of the study at the Kansas University Medical Center.
One intervention (self-management support) will provide care to patients remotely through phone and video visits. A care team, including a pharmacist and community health worker, will also help give advice, reminders and education to patients. The second intervention will involve in-person visits or usual clinic-based care. All patients will receive training on how to measure their blood pressure at home using a home blood pressure monitor provided by the research team.
While telehealth is a viable approach to improving access to care, many questions remain about how to effectively implement it as a targeted strategy to improve outcomes among marginalized populations.
“As a learning health system, we are incredibly proud to partner with Dr. Taylor and Dr. Applegate to learn how to collectively improve hypertension outcomes for all the communities we serve,” said Jennifer Brady, M.D., chief medical officer for the Advocate Health Value Services Organization, which is designed to support Advocate Health’s clinically integrated networks and accountable care organizations.
Researchers plan to enroll 780 non-Hispanic Black patients at 18 doctor’s offices in North Carolina, South Carolina and Kansas. Participants will be randomized to one of the interventions and will remain in the study for 18 months. Researchers will compare the interventions to see which one helps more people control their blood pressure.
Taylor and Applegate said the research team will gather input from various partners, including patients, caregivers, doctors and pharmacists, about their experiences with self-management support. This will help to identify the best practices and strategies for implementing effective self-management support interventions in different settings.
“With funding support from PCORI, this research will help us understand the best strategies to help Black patients achieve better hypertension control,” Applegate said. “We hope to gain much-needed insight on how best to leverage telehealth and home blood pressure monitoring to ensure equitable hypertension care.”
PCORI is an independent, nonprofit organization authorized by Congress with a mission to fund patient-centered comparative clinical effectiveness research that provides patients, their caregivers and clinicians with the evidence-based information they need to make better informed health and health care decisions.
The funding award for the RHYTHM-B study has been approved pending the completion of a business and programmatic review by PCORI staff and the issuance of a formal award contract.
Media Contact: Myra Wright, mgwright@wakehealth.edu