Although high blood pressure is treatable with medication and lifestyle changes, it remains a leading cause of death in the United States. More than half of adults in the United States have blood pressure above 130/80 mmHg, the threshold for hypertension, and the condition is particularly prevalent in low-income areas.
A new study by Tulane University researchers found that a team-based program in community clinics was more effective at lowering blood pressure in low-income patients than standard care alone. This research New England Medical JournalThe study was conducted at 36 federally qualified health centers in Louisiana and Mississippi. These nonprofit centers provide primary care to many patients with limited income and limited access to care.
The multifaceted team-based program provided patients with more support than usual, including a clinic team following an evidence-based plan to treat high blood pressure and help patients stick to their medications. Health coaches also advised patients in person or online about healthy lifestyle habits such as diet and exercise, and provided them with tools to check their blood pressure at home. Meanwhile, clinics in the enhanced standard care comparison group continued with their usual approach, but their physicians received education on blood pressure treatment guidelines.
After 18 months, patients in clinics using the team-based program had an average decrease in systolic blood pressure of 15.5 points, compared with 9.1 points in clinics providing enhanced usual care. Patients who participated in the team-based program also had higher rates of adherence to hypertension treatment.
We have the tools to treat hypertension, but the challenge is to effectively implement these tools into primary care and help patients adhere to medications and lifestyle changes. This trial showed that a team-based approach to supporting and treating patients with uncontrolled blood pressure in rural and low-income urban areas can effectively lower high blood pressure. ”
Katherine Mills, first author, Professor of Epidemiology, Celia Scott Weatherhead School of Public Health and Tropical Medicine, Tulane University
This finding is important because hypertension is a major modifiable risk factor for cardiovascular disease, the leading cause of death in the United States.
The study involved 1,272 patients over the age of 40 who had uncontrolled hypertension, meaning their blood pressure remained high despite lifestyle changes and treatment.
“Many of these patients had had high blood pressure and had been receiving treatment for many years, meaning that this approach would be effective in lowering blood pressure in a difficult real-world clinical setting,” said the study’s co-lead author and one of the principal investigators, MA “Tonette” Cruselwood, Ph.D., Jack Aaron Professor of Primary Care Medicine and Professor of Medical Epidemiology at Tulane University School of Medicine.
Nearly three-quarters of study participants reported a household income of less than $25,000 per year, 63.4% were Black, and 75.9% were unemployed, reflecting a population that often faces the greatest barriers to blood pressure control, especially in southern states with the highest burden of hypertension in the United States.
Dr. Cruselwood said the study “demonstrates that blood pressure lowering interventions can be successfully implemented in federally qualified health centers to serve patients considered to be at highest risk for hypertension-related morbidity and mortality.”
There are about 1,400 of these centers across the United States, and researchers hope the program can be implemented in clinics across the country.
“We find this approach is most successful when clinics take ownership of the program,” Mills said. “The approach taken in this trial can be adopted in other primary care settings to provide support and improve blood pressure control for all people living with hypertension.”
sauce:
Reference magazines:
KT Mills, Others. (2026). Multifaceted strategies for hypertension management in low-income patients. New England Medical Journal. DOI: 10.1056/NEJMoa2504068. https://www.nejm.org/doi/10.1056/NEJMoa2504068
