New $11 million grant for lowering stroke risk among black and young populations

A new $11 million grant to Kaiser Permanente Northern California and UC San Francisco will support a multifaceted research program aimed at lowering stroke risk among black populations and younger stroke victims by targeting high blood pressure, also known as hypertension.

"Hypertension is much more common in blacks than in whites and is less likely to be controlled. Despite dramatic improvements in blood pressure control among Kaiser Permanente members in Northern California over the past decade, there is currently a 5 percent disparity between our black and white members," said Stephen Sidney, MD, MPH, director of research clinics with the Kaiser Permanente Division of Research.

Sidney is director of the new Stroke Prevention/Intervention Research Program, awarded by the National Institute of Neurological Disorders and Stroke (NINDS), and principal investigator for Kaiser Permanente Northern California. "The goal of the first study in this research program is to decrease the disparity by 4 percent over one year," Sidney said.

"Hypertension is on the rise in the United States, despite the fact that we know what causes it, and we know how to treat it," said UCSF's Kirsten Bibbins-Domingo, PhD, MD, director of the UCSF Center for Vulnerable Populations at San Francisco General Hospital. Bibbins-Domingo is principal investigator of the research program for UCSF and lead investigator for two of the program's four main components.

In the United States, blacks are twice as likely as whites to experience a first stroke; blacks are also more likely to die as a result of a stroke.

Younger adults are also a major focus of the new grant. Recent studies suggest that strokes among younger adults are becoming more common, due to an increase in risk factors such as high blood pressure.

Adolescents increasingly are affected by high blood pressure, high cholesterol and diabetes. "We want to discover how these risk factors increase future stroke risk in different populations," Bibbins-Domingo said.

The new stroke research program includes the following components:

• Clinical study to close hypertension disparity: "Shake, Rattle & Roll" is a pragmatic, clustered randomized clinical trial led by Mai N. Nguyen-Huynh, MD, MAS, of the Kaiser Permanente Division of Research. The goal is to collaborate with black patients at Kaiser Permanente's Oakland Medical Center to close the disparity in blood pressure control rates between black and white members. Each primary-care physician is randomly assigned to provide all black patients with either: 1) usual care; 2) enhanced monitoring of blood pressure management; or 3) a culturally tailored healthy lifestyle and diet coaching intervention.
• Observational study to quantify stroke risk factors: Heather Fullerton, MD, pediatric stroke neurologist at UCSF, will lead an observational study among patients to better quantify disparities in stroke risk factors in young adulthood over time. Fullerton aims to identify unrecognized factors that may contribute to stroke risk and disparities in young adults.
• Modeling of stroke-risk trends: Bibbins-Domingo will lead studies using a computer simulation of stroke and heart disease in U.S. populations - the Cardiovascular Disease (CVD) Policy Model - to predict the national impact of stroke risk trends on stroke incidence and health disparities. With S. Claiborne Johnston, MD, PhD, UCSF stroke neurologist, they will use this model to estimate the impacts that the blood-pressure-control intervention first tested at Kaiser Permanente would have if implemented nationwide.
• Training future researchers: Bibbins-Domingo will lead efforts to expand training in the study of health disparities at UCSF. She will coordinate efforts to identify trainees interested in stroke and cardiovascular disease prevention and health disparities and foster collaborations between these trainees and other investigators in the research program. This work will also focus on increasing the numbers of under-represented minority trainees engaged in these efforts.

The grant to Kaiser Permanente and UCSF to reduce hypertension is one of four awarded nationwide to target stroke, to be funded with up to $40 million over five years.

"These research efforts will give us the traction we need to control the greatest modifiable stroke risk factor," said Walter J. Koroshetz, MD, deputy director of NINDS, which is part of the National Institutes of Health.