Abstract
Background: Serious health disparities persist across the United States (US) whereby Black communities suffer a disproportionate burden of cardiovascular diseases. A higher prevalence of hypertension along with lower control rates are major contributing factors; while mounting evidence supports that negative social determinants of health (SDoH) play a causal role. Here, we describe a first-of-a-kind approach to reduce health disparities by focusing on preventing hypertension in Black adults with elevated blood pressure (BP) living in socially vulnerable communities. Methods and Results: LEAP-HTN (Linkage, Empowerment, and Access to Prevent Hypertension) is part of the RESTORE (Addressing Social Determinants to Prevent Hypertension) Health Equity Research Network, a $20 Million initiative funded by the American Heart Association. The trial will test if a novel intervention reduces systolic blood pressure (BP) (primary outcome) and prevents the onset of hypertension over one year versus usual care in 500 Black adults with elevated BP (systolic BP 120-129 mm Hg; diastolic BP <80 mm Hg) in Detroit, Michigan. LEAP-HTN improves access to health care by leveraging our groundbreaking platform using geospatial health and social vulnerability data to direct deployment of mobile health units (MHUs) to communities of greatest need. Preliminary data suggest that 10% of patients screened for HTN in the MHUs would meet BP inclusion criteria. All patients are referred to primary care providers. Trial participants in the active limb will receive additional collaborative care delivered remotely by community health workers using an innovative strategy termed PAL 2 (Pragmatic, Personalized, Adaptable Approaches to Lifestyle and Life Circumstance)(Figure). PAL 2 emphasizes the mitigation of negative SDoH, thereby reducing allostatic load while fostering greater success in achieving lifestyle changes. Conclusions: LEAP-HTN aims to lower BP and prevent hypertension by improving access and linkage to healthcare while mitigating negative SDoH. Through an innovative patient-centered intervention, PAL 2 , our program model may represent a sustainable and scalable strategy to help overcome persistent health disparities in socially vulnerable communities across the US.
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