HEALS-Med Tech hypertension control program: evaluating the sustainability of blood pressure reduction in health disparate African American communities
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Citation
Abstract
Hypertension (HTN) is a condition in which arterial blood pressure (BP) is chronically elevated. It is highly treatable and preventable, yet it affects nearly half of U.S. adults [1]. African Americans (AAs) are a unique minority group that experience HTN and its other implications such as cardiovascular disease (CVD) at a much higher rate and at a more severe level compared to other racial/ethnic counterparts [2]. Hampton Roads is the Southeastern Coastal region of Virginia (VA) that includes the municipalities of Norfolk, Suffolk, Virginia Beach, Portsmouth, Chesapeake, Tangier Island (part of Chesapeake Bay), Hampton, Williamsburg, Newport News and some of the surrounding counties of North Carolina. Further, it is one of the most under-sourced areas in VA and contains a large AA population. HEALS-Med Tech is an ongoing efficacy study, consisting of three different components (a 12-month lifestyle intervention (HEALS), HTN management through medication provided by physicians (Med), and a telehealth component (Tech)). Utilizing all three components should help encourage disease self-management, provide social support, and help participants adopt positive lifestyle modifications through community-based learning to decrease high BP in the AA community. For HEALS, intervention arm participants were required to attend 12 weekly sessions followed by monthly maintenance sessions for the remaining 9 months. Community Health Workers (CHWs) taught participants to implement lifestyle modifications such as healthy eating habits through food demonstrations and nutrition educational sessions following the Dietary Approaches to Stop Hypertensions (DASH) guidelines. Physical activity (PA) was reinforced through aerobic exercise sessions provided by a fitness instructor. Participants were also taught to track their daily anthropometric data (weight, BP, food diary, etc.) through a digital app (CAREMINDr). Pedometers, BP cuffs, and a HEALS workbook which offered tips to stay on track were also provided. Control group data was collected at follow up visits every 6 weeks for 12 months from baseline. BP, weight and waist measurements, and 24-hour dietary recalls were collected along with any changes in medication or medical history. Control participants were not advised on following DASH diet requirements and were not encouraged to participate in PA. Additionally, they did not have access to the CAREMINDr application.
This study illustrated that there was significant reduction in systolic blood pressure (SBP) (12.96 mmHg; p=0.01) and diastolic blood pressure (DBP) (4.2 mmHg; p= 0.04) for the intervention arm compared to the control arm of the study (SBP and DBP change of 7.82 mmHg and 0.31 mmHg), respectively, at 3-months. However, sustaining this reduction seemed to be a challenge for many participants following 3-months. DASH scores demonstrated a positive upward trend for both control and intervention arms. However, results indicated a higher score for the latter. Additional studies with careful considerations of the limitations described in the discussion section are needed to yield more accurate results.