Pilot Program Improves BP Control in Indianapolis Communities | Cardiology Today

A pilot program in Indianapolis is showing promising results in addressing a critical health disparity: uncontrolled blood pressure within Black communities. The CHECK-IT program, detailed recently in NEJM Catalyst | Innovations in Care Delivery, leveraged community health workers and remote monitoring to improve blood pressure control in over half of participating individuals. This intervention highlights a potentially scalable model for tackling hypertension, a condition that disproportionately impacts Black adults and contributes to significant cardiovascular risks.

Addressing a Disparity in Hypertension Management

Hypertension, or high blood pressure, remains a major public health concern in the United States, with stark racial and socioeconomic disparities. Nearly half of all adults in the U.S. Are affected, but non-Hispanic Black individuals experience higher rates of the condition and are more likely to suffer severe consequences like heart disease and stroke. These disparities are often rooted in systemic barriers to healthcare access, education, stable employment, and safe housing, creating a complex web of challenges for effective hypertension management.

The CHECK-IT program, led by researchers at Indiana University School of Medicine, sought to address these challenges through a targeted, community-based approach. The program’s design centered on recognizing that clinical interventions alone are often insufficient to overcome the social determinants of health that contribute to uncontrolled blood pressure.

How the CHECK-IT Program Worked

The program enrolled 1,462 patients over a three-year period, expanding to nine clinics in Indianapolis anchor neighborhoods. Participants were identified through several pathways: during primary care appointments, referrals from their physicians, or direct outreach in clinic waiting rooms. Crucially, the program prioritized individuals with uncontrolled blood pressure who lacked a scheduled follow-up appointment, ensuring that those most in need received attention.

The initial phase involved an in-person visit from a community health worker. This visit served multiple purposes: providing a free blood pressure cuff and training on its proper use, offering social support, and conducting a comprehensive assessment of social determinants of health. The health worker then connected participants with relevant resources, such as grocery assistance or transportation support, to address identified needs.

Following the initial visit, the program transitioned to a virtual format. Participants used a smartphone app, Twistle, to regularly submit their blood pressure readings. The app provided automated text reminders and access to a four-month educational curriculum covering topics like low-sodium diets, sleep hygiene, physical activity, and stress management. Community health workers remained involved, addressing non-urgent needs through referrals and providing support. Urgent safety concerns, such as domestic violence, were immediately escalated to a virtual social perform team.

Results Demonstrate Significant Improvement

The results of the CHECK-IT program were encouraging. By the end of the four-month educational program, 63.9% of participants achieved blood pressure control, defined as readings below 140/90 mm Hg in 80% of app-logged measurements. This was a statistically significant improvement compared to eligible patients who did not enroll in the program (51.8%; P < .001). Participants in the program also experienced greater reductions in both systolic (11 mm Hg) and diastolic (6.9 mm Hg) blood pressure compared to the control group (5.4 mm Hg and 2.9 mm Hg, respectively; P < .001).

Notably, nearly 60% of participants who completed the initial four-month program reenrolled for an additional four months, suggesting high levels of satisfaction and perceived benefit. A preliminary cost-effectiveness analysis indicated potential savings of approximately $3,300 per patient enrolled in CHECK-IT over a two-year period.

Beyond Blood Pressure: Addressing Social Determinants

The researchers emphasize that the success of CHECK-IT stemmed from its holistic approach. “CHECK-IT moved beyond traditional one-size-fits-all healthy behavior programs by tailoring support to each participant’s real-world needs,” they wrote in their publication. The program’s focus on addressing social determinants of health, coupled with virtual pharmacist support for medication adjustments, enabled it to overcome both clinical and structural barriers to hypertension control.

The program’s success underscores the importance of community health workers in bridging the gap between healthcare systems and the populations they serve. These workers are uniquely positioned to understand the challenges faced by individuals in their communities and to connect them with the resources they need to improve their health. The Centers for Disease Control and Prevention (CDC) provides further information on the role of community health workers in improving health outcomes.

Implications for Future Hypertension Interventions

The CHECK-IT program offers valuable insights for developing and implementing future hypertension interventions. The researchers suggest that even implementing individual components of the program, such as community health worker-led social determinants of health navigation or virtual pharmacist support, could yield meaningful improvements in blood pressure outcomes. What we have is particularly relevant for health systems with limited resources.

The program’s findings also highlight the potential of remote patient monitoring technologies to enhance hypertension management. The use of the Twistle app allowed for frequent blood pressure readings and personalized feedback, empowering patients to take an active role in their health. The American Heart Association offers information on remote patient monitoring and its benefits.

Looking ahead, further research is needed to evaluate the long-term sustainability and scalability of the CHECK-IT model. Additional studies could explore the program’s effectiveness in diverse populations and settings, as well as its potential to address other chronic health conditions. The ongoing evaluation of programs like CHECK-IT will be crucial in refining strategies to reduce health disparities and improve the health of all communities.