S-15-2: COMMUNITY-BASED APPROACHES TO PREVENTION AND MANAGEMENT OF HYPERTENSION

Abstract

There are multiple level factors that contribute to hypertension prevalence and control across various racial/ethnic populations. Hypertension rates in non-Hispanic Black (African American) adults in the USA are among the highest globally, impacted by the social determinants of health. Clinical approaches include team-based care, encouraging self-measured blood pressure, and strengthening community-clinical linkages. Prevention of new-onset hypertension and complications has been clearly demonstrated with community-level NaCl substitution in China and Peru. In the USA, Black population treatment approaches as community interventions include early initiatives from the Association of Black Cardiologists and the Healthy Heart Community Prevention Project (HHCPP) in New Orleans. The HHCPP was one of the early adopters of using barbers and hair stylists as hypertension control centers, working with faith-based institutions, and doing community education and outreach. Evidence-based approaches, now proven to be effective, include the faith-based treatment program for hypertension in New York, NY and a very successful in cluster-randomized trial demonstrating hypertension control in Black barbershops in Los Angeles, CA. The positive components of the Los Angeles barbershop intervention include trusted site of blood pressure intervention, physician-pharmacist collaboration, and effective anti-hypertensive medication including initial two drug protocol with amlodipine and a long-acting RAS blocker, and the appropriate use of aldosterone antagonists. Ongoing research include a small pilot study, simple text messaging and social support in New Orleans for medication adherence which will be reported at the AHA 2022 scientific sessions, and a large church-based health intervention study addressing primary prevention, including hypertension in New Orleans among 42 selected African American churches using community health workers in a combination of exercise weight-loss programs, self-monitoring blood pressure, glucose, and physical activity, and group education centers. In the USA, the American Heart Association in conjunction with the US Department of Health and Human services have initiated a national hypertension control initiative. Overarching strategies include patient and public education, community outreach and integration, and healthcare organization including provider and clinician training, as well as management evaluation of the project. This national program will engage community partners with federal health centers. In conclusion, hypertension can be controlled with evidence-based medicines, not only in clinical settings, but also with interventions in the community environment. Therapeutic lifestyle and evidence-based pharmacotherapy along with self-monitored blood pressure can lead to blood pressure control, especially in racial/ethnic populations.