Tulane study shows team approach improves hypertension treatment success

High blood pressure is treatable through medications and lifestyle changes but remains a leading cause of death in the United States. More than half of adults in the U.S. have blood pressure higher than 130/80 mm Hg – the threshold for hypertension – and the condition is especially prevalent in low-income communities.

A new study from Tulane University researchers found that a team-based program in community health clinics helped low-income patients reduce their blood pressure more than standard care alone. The study, published in the New England Journal of Medicine, was carried out in 36 federally qualified health centers in Louisiana and Mississippi, nonprofit centers providing primary care to many patients with limited incomes and limited access to care.

The multi-faceted, team-based program gave patients more support than they would usually receive, including clinic teams that followed an evidence-based plan to treat high blood pressure and help patients stay on their medications. Health coaches also advised patients, either in-person or virtually, on healthy lifestyle habits such as diet and exercise and gave them the tools to check their blood pressure at home. Meanwhile, clinics in the enhanced standard care comparison group continued their usual approach, though doctors did receive education on blood pressure treatment guidelines.

After 18 months, patients in clinics using the team-based program saw their systolic blood pressure drop by an average of 15.5 points, compared with 9.1 points in clinics providing enhanced usual care. Patients in the team-based program also showed more adherence to hypertension treatment.

We have the tools to treat high blood pressure, but the challenge is effectively implementing these tools in primary care and helping 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 low-income rural and urban areas can effectively lower high blood pressure."

Katherine Mills, lead author, professor of epidemiology at the Celia Scott Weatherhead School of Public Health and Tropical Medicine, Tulane University

The findings are significant as hypertension is the key modifiable risk factor for cardiovascular disease, the leading cause of death in the U.S.

The study included 1,272 patients age 40 and older with uncontrolled high blood pressure, meaning blood pressure that remains high despite lifestyle changes or treatment.

"Many of these patients had long-standing and treated hypertension, meaning the approach is effective in lowering blood pressure in challenging, real-world clinical settings," said co-first author and one of the principal investigators of the study, Dr. M.A. "Tonette" Krousel-Wood, professor of medicine and epidemiology and the Jack Aron Chair in Primary Care Medicine at Tulane University School of Medicine.

Nearly three-quarters of the study's participants reported family incomes below $25,000 a year, 63.4% were Black and 75.9% were unemployed, reflecting the populations that often face the greatest barriers to controlling blood pressure, particularly in the Southern states, which bear the highest burden of hypertension in the U.S.

Dr. Krousel-Wood said the study "showed that blood pressure lowering interventions can be successful in federally qualified health centers, serving patients who may be most at risk for hypertension-related morbidity and mortality."

With approximately 1,400 of these centers across the US, the researchers hope this program can be implemented at clinics nationwide.

"We found that this approach was most successful when clinics took 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."