Outcomes of a multi-community hypertension implementation study: the American Heart Association's Check. Change. Control. program

Leveraging Mobile Health and Wearable Technologies for the Prevention and Management of Atherosclerotic Cardiovascular Disease

PURPOSE OF REVIEW

This review aims to assess the role of mobile health (mHealth) interventions and wearable technologies in the prevention and management of atherosclerotic cardiovascular disease (ASCVD). We sought to explore the benefits, challenges, and equity implications of these digital health modalities, with a focus on improving patient outcomes and reducing ASCVD risk.

RECENT FINDINGS

Recent studies have shown that mHealth interventions and wearable devices effectively promote healthy behaviors, offer real-time physiological monitoring, and aid in the early prevention of ASCVD by targeting key risk factors such as metabolic syndrome and sedentary lifestyles. These technologies hold great potential for improving patient engagement and enabling timely interventions. However, challenges such as technological constraints, high costs, and gaps in digital literacy significantly hinder their broader adoption, particularly among disadvantaged populations. In summary, our findings highlight the critical need for accessible, affordable, and inclusive digital health solutions to prevent and manage ASCVD, promoting more equitable healthcare delivery. To maximize these benefits, future research should focus on harnessing artificial intelligence and digital markers to improve early event prediction and develop personalized preventive strategies.

More than Just a Number: Perspectives from Black Male Participants on Community-Based Interventions and Clinical Trials to Address Cardiovascular Health Disparities

BACKGROUND

Black Americans remain significantly underrepresented and understudied in research. Community-based interventions have been increasingly recognized as an effective model for reckoning with clinical trial participation challenges amongst underrepresented groups, yet a paucity of studies implement this approach. The present study sought to gain insight into Black male participants' perception of clinical trials before and after participating in a community-based team lifestyle intervention in the United States.

METHODS

Black Impact, a 24-week community-based lifestyle intervention, applied the American Heart Association's Life's Simple 7 (LS7) framework to assess changes in the cardiovascular health of seventy-four Black male participants partaking in weekly team-based physical activities and LS7-themed education and having their social needs addressed. A subset of twenty participants completed an exit survey via one of three semi-structured focus groups aimed at understanding the feasibility of interventions, including their perceptions of participating in clinical trials. Data were transcribed verbatim and analyzed using a content analysis, which involved systematically identifying, coding, categorizing, and interpreting the primary patterns of the data.

RESULTS

The participants reported a positive change in their perceptions of clinical trials based on their experience with a community-based lifestyle intervention. Three prominent themes regarding their perceptions of clinical trials prior to the intervention were as follows: (1) History of medical abuse; (2) Lack of diversity amongst research teams and participants; and (3) A positive experience with racially concordant research teams. Three themes noted to influence changes in their perception of clinical trials based on their participation in Black Impact were as follows: (1) Building trust with the research team; (2) Increasing awareness about clinical trials; and (3) Motivating participation through community engagement efforts.

CONCLUSIONS

Improved perceptions of participating in clinical trials were achieved after participation in a community-based intervention. This intervention may provide a framework by which to facilitate clinical trial participation among Black men, which must be made a priority so that Black men are "more than just a number" and no longer "receiving the short end of the stick".

"Blood pressure monitoring should be a habit": adaptation of the Check. Change. Control. program for Asian American older adults, from group-based in-person to one-on-one telephone delivery

Asian Americans have the lowest rate of awareness about hypertension, including controlled hypertension, among all racial/ethnic groups in the USA. A high proportion of Asian American older adults have limited English proficiency (LEP) and hypertension. This study adapted the Check. Change. Control. (CCC) program, a community-based intervention for hypertension control delivered in a face-to-face group setting, to phone-based delivery and evaluated the acceptability of the program among Asian American older adults with LEP. Thirteen participants received phone-based educational sessions on hypertension control over 4 months. After 4 months of interventions, we interviewed the 13 Asian American older adults and 4 counselors to examine the acceptability of the adapted CCC program. Both Asian American older adults and counselors found the phone-based delivery of the CCC program to be acceptable, and some participants recommended holding an in-person meeting before telephone delivery to review the program content and clarify information. Future study needs to explore the effectiveness of the phone-based delivery of the program on blood pressure management among larger groups of Asian American older adults.

Impact of self-measured blood pressure monitoring on hypertension management

BACKGROUND

An estimated 31% of adults in the USA have hypertension. The American Heart Association's Check. Change.

CONTROL

(CCC) program is an ongoing evidence-based hypertension management program that encourages participants to use remote blood pressure (BP) monitoring to take control of their cardiovascular health. The purpose of this study was to identify the effectiveness of self-measured blood pressure (SMBP) monitoring and tracking on high BP control among participants of the CCC program.

METHODS

We performed a retrospective cohort study among hypertensive men (n = 912) and women (n = 2021) using the 2016-2017 CCC national data. Demographics were examined among participants who checked their BP readings frequently, with a minimum of eight BP readings over four months, versus those who did not check their BP as often. Multivariable logistic regression evaluated the association of SMBP monitoring and BP reduction.

RESULTS

A greater proportion of participants who frequently checked their BP readings had BP reduction (17.7%), compared to participants who did not check their BP readings frequently (3.9%, P < 0.001). Men were 40% less likely to have BP reduction compared to women (P = 0.02); African Americans and Hispanic Americans were 63% (P < 0.0001) and 37% (P = 0.07) less likely to have BP reduction as compared to Caucasian Americans, respectively. After adjusting for sex and race/ethnicity, the odds of BP reduction was 4.88 times (95% confidence interval, 2.66-8.95) higher for participants who checked their BP readings frequently, compared to those who did not frequently check their BP readings.

CONCLUSION

Hypertensive participants who monitor their BP readings frequently using a self-management program have better BP control.

Effects of a Community Population Health Initiative on Blood Pressure Control in Latinos

Background

Hypertension remains one of the most important, modifiable cardiovascular risk factors. Yet, the largest minority ethnic group (Hispanics/Latinos) often have different health outcomes and behavior, making hypertension management more difficult. We explored the effects of an American Heart Association–sponsored population health intervention aimed at modifying behavior of Latinos living in Texas.

Methods and Results

We enrolled 8071 patients, and 5714 (65.7%) completed the 90‐day program (58.5 years ±11.7; 59% female) from July 2016 to June 2018. Navigators identified patients with risk factors; initial and final blood pressure (BP) readings were performed in the physician's office; and interim home measurements were recorded telephonically. The intervention incorporated home BP monitoring, fitness and nutritional counseling, and regular follow‐up. Primary outcomes were change in systolic BP and health‐related quality of life. Using a univariate paired‐samples pre–post design, we found an average 5.5% (7.6‐mm Hg) improvement in systolic BP (139.1 versus 131.5, t=10.32, P<0.001). Quality of life measured by the European quality of life 5‐dimension visual analog scale improved from 0.79 to 0.82 (t=31.03, P<0.001). After multivariate regression analyses, improvements in quality of life and overall body mass index were significantly associated with reductions in systolic BP.

Conclusions

A noninvasive, population health initiative that encourages routine engagement in patients’ own BP control was associated with improvements in systolic BP and quality of life for this largely Latino community.

Community Outreach to African-Americans: Implementations for Controlling Hypertension

PURPOSE OF REVIEW

The purpose of this review is to examine the impact and effectiveness of community interventions for controlling hypertension in African-Americans. The questions addressed are as follows: Which salient prior and current community efforts focus on African-Americans and are most effective in controlling hypertension and patient-related outcomes? How are these efforts implemented and possibly sustained?

RECENT FINDINGS

The integration of out-of-office blood pressure measurements, novel hypertension control centers (i.e., barbershops), and community health workers improve hypertension control and may reduce the excess hypertension-related complications in African-Americans. Several community-based interventions may assist effectiveness of clinical care teams, decrease care barriers, and improve adherence. A multifaceted, tailored, multidisciplinary community-based approach may effectively reduce barriers to blood pressure control among African-Americans. Future research should evaluate the long-term benefits of community health workers, barbershops as control centers, and out-of-office blood pressure monitoring upon control and eventually on morbidity and mortality.