ACHIEVE EPI

P1 ACHIEVE-EPI SUMMARY
Hypertension remains a leading risk factor for morbidity and mortality in the United States (US). Blood pressure (BP) values above normal (120/80 mm Hg) account for more than half of all cardiovascular events. Urban predominantly Black communities, such as Detroit MI, are an epicenter for uncontrolled hypertension - with BP control rates <20%. In addition to higher rates of traditional/biological risk factors for hypertension (e.g., obesity, poor lifestyle) among Black patients, this may be additionally explained by contributing social factors or community circumstances (e.g., poor healthcare access). However, there is a key need to better understand the totality of responsible factors including risk modifiers, competing risks and the impact of cumulative exposures in order to develop more effective strategies to improve BP control and reduce health disparities in the future. To help address these issues our research group has developed the Wayne State/Wayne Health Mobile Health Unit (MHU) program. Employing a team of providers including nurses, pharmacists, and community health workers (CHWs), the MHU program performs 4-6 outreach events into communities across metro Detroit 6-7 days a week emphasizing BP and other screenings for chromic cardiometabolic disease. While our program has thus far been successful, this project aims to enhance our existing capacities by overcoming a number of current limitations. In aim 1, we seek to significantly improve our characterization of the social, community and biological factors in the population of patients attending our MHU events by acquiring permission for full access to patient medical information. In aim 2, we will prospectively evaluate the long-term impact of MHU outreach and engagement on follow-up BP control, social and health care service utilization, follow-up, and cardiovascular event rates. Our approach combines retrospective (aim 1) and prospective (aim 2) analytical approaches to characterize the population of patients with BP levels above normal attending MHU events to better understand key factors that determine baseline BP levels and drive subsequent health outcomes. During the consent process of aim 2, we will also ask 1000 consecutive people to enroll into a nested sub-study of home BP monitoring. Those who consent will receive a cellular signal enabled BP cuff and be asked to monitor home BP following a set schedule. Participants will be randomized to a group receiving text messaging reminders to check home BP versus control (no reminders). Home BPs, which are automatically transmitted and stored in a secured website portal in both groups, will be monitored until study completion at 12-months.

Grant Number: 5P50MD017351-05
NIH Institute/Center: NIH
Principal Investigator: Robert Brook