Research Network to Address Hypertension in Underrepresented Populations
In the United States, more than 40 percent of Black men and women are living with high blood pressure—the highest rate in the country. The American Heart Association has awarded $20 million in grant funding to eight universities to study high blood pressure prevention in underrepresented populations.
This new initiative, called The RESTORE (AddREssing Social Determinants TO pRevent hypErtension) Health Equity Research Network, comprises an interdisciplinary team of investigators from the NYU Grossman School of Medicine; University of Alabama at Birmingham; Columbia University; Johns Hopkins University; Beth Israel Deaconess Medical Center; Wayne State University; Tuskegee University; and University of California, San Francisco.
NYU Langone’s Institute for Excellence in Health Equity (IEHE) will serve as the coordinating center for The RESTORE Network. The coordinating center will oversee the establishment of five cores that will provide resources to the projects: blood pressure measurement (Columbia University); statistical and cost-effectiveness (University of Alabama at Birmingham, Columbia University, and University of California, San Francisco); intervention (NYU Grossman School of Medicine); community engagement (Johns Hopkins University); and training (Columbia University).
“It is an honor to help lead this endeavor and work with some of the most talented scientists in the country who have dedicated their careers to tackling racial inequities in health,” said Gbenga Ogedegbe, M.D., M.P.H., the Dr. Adolph and Margaret Berger Professor of Medicine and Population Health and director of the Institute for Excellence in Health Equity, at NYU, in a statement. “There is no biological basis for the glaring racial disparities we see in hypertension and cardiovascular disease outcomes, especially the disturbingly high rates in Black populations. By mitigating the impact of social determinants of health on hypertension among Black adults, it is our goal to build a society where every person lives a healthy life free of high blood pressure and heart disease.”
To prevent hypertension in Black communities, the RESTORE Network will:
• Partner with Black communities across the United States to reduce negative impacts of social determinants of health on blood pressure;
• Develop and evaluate strategies to implement evidence-based lifestyle interventions in Black communities;
• Disseminate findings to policymakers and stakeholders to ensure sustainability of hypertension prevention strategies; and
• Train the next generation of early career investigators in health equity and hypertension research.
The RESTORE Network will use a community-engaged and implementation science framework to guide five hypertension prevention projects in Black communities. Each will test a different implementation strategy to overcome adverse social determinants of health, such as poor access to healthcare and food insecurity. Each of the five projects tests an implementation strategy that engages individuals in community-based settings, as well as healthcare settings such as Federally Qualified Health Centers.
The RESTORE Network will be testing multiple approaches to helping people overcome the barriers to health faced by many living in neighborhoods with poor access to health care, healthy foods and places to exercise.
• Effects of DASH Groceries on Blood Pressure in Black Residents of Urban Food Deserts at Beth Israel Deaconess Medical Center in Boston, led by Stephen P. Juraschek, M.D., M.P.H., will test the use of a virtual grocery list with weekly healthy food delivery to the homes of Black adults with high blood pressure in Boston neighborhoods. The groceries will be balanced as part of the healthy eating plan known as the DASH (Dietary Approaches to Stop Hypertension) diet, known to be high in important nutrients and low in sodium. A dietitian will help study participants order the groceries they prefer by computer, as well as providing them with tips and recipes on how to prepare foods in new ways. Over the course of the three-month clinical trial, the researchers will evaluate the impact of grocery delivery on blood pressure and cholesterol.
• 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, 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 machine, 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 who receive these interventions were able to lower their blood pressure and will compare the outcomes of the higher intervention group to the one with only the home blood pressure monitor.
• Community-engaged Implementation Study of Hypertension Prevention and Navigation in Black Men at New York University School of Medicine - Led by Joseph Ravenell, M.D., this team will engage 30 barbershops in their study to screen Black men for high blood pressure, give them advice about a healthy lifestyle and link them to health care when needed. The team will expand their initiative, called Community-to-Clinic Linkage Implementation Program (CLIP), in three phases to test various interventions. 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 giving the barbershops “expert help” for 12 months helps the shops adopt CLIP more quickly and if the expert help leads to lower blood pressure in customers. In the third phase, they will determine whether the shops still have CLIP in place six months after expert help ends. They will also put CLIP into place in barbershops without expert help and compare the effectiveness of the two different ways to implement the program.
• 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 people with high blood pressure living in Black neighborhoods of 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.
• 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., this team will work with 16 churches in rural Alabama to recruit Black adults with elevated but unmedicated high blood pressure to take part in one of two interventions. People from eight of the churches will receive group health education and personal tablets to access online cooking shows and exercise classes. People in the other eight churches will get support from a health coach over the telephone to help set and meet diet and physical activity goals. These participants will also receive the group health education and tablets to access online cooking shows and exercise classes and some of them will be encouraged to sign up as health coaches. The churches will also receive funds to help bring healthy foods and/or physical activity opportunities to their communities.
