The Achieving Blood Pressure Control Together (ACT) Study
Despite the availability of several efficacious pharmacologic and non-pharmacologic approaches to high blood pressure management in the U.S., many persons with hypertension have poor blood pressure control. African Americans represent a particularly vulnerable subgroup of persons with hypertension, as they are more likely than whites to have hypertension, equally likely to be aware of it and to be treated for it, but less likely to achieve blood pressure control while receiving treatment. African Americans are also more likely than whites to suffer end-organ damage as a result of hypertension. Patients’ self-management behaviors (including self-blood pressure monitoring, lifestyle changes, adherence to medications, and shared medical decision-making) represent a cornerstone of hypertension therapy.
Specific Aim 1: To develop a patient-, family- and community-level intervention to improve African-American hypertensive patients’ engagement in self-management behaviors using principles of community-based participatory research.
Hypothesis: Multi-level interventions to enhance patients’ engagement in health behaviors that positively impact blood pressure can be developed to be responsive to the needs of African-American persons with hypertension living in underserved communities.
Specific Aim 2: To study the effectiveness of the patient-, family- and community-level intervention to improve patient self-management behaviors and blood pressure.
Hypothesis: The multi-level intervention will result in African-American patients’ improved self-management behaviors and blood pressure control.
Specific Aim 3: To assess the long-term sustainability of the patient-, family- and community-level intervention.
Hypothesis: The multi-level intervention will result in a cost-effective approach to hypertension management and will be deemed sustainable by community stakeholders (including residents, health care providers, and health insurers).
Main study outcomes include:
- Primary: Blood pressure control over one year
- Secondary: Sustainability and cost of the interventions
Patients enrolled in the study will be randomized to receive either usual care or at least one of the following interventions:
- Community health worker support, a blood pressure cuff, and blood pressure self-monitoring training
- Communication with health care provider training
- Problem solving peer group sessions
To inform and assess the long-term sustainability of these interventions, we are conducting an environmental assessment utilizing the Community-Based Participatory Research (CBPR) and the Practical, Robust, Implementation and Sustainability Model (PRISM) frameworks.