Reducing Racial and Ethnic Disparities in Hypertension Prevention and Control

What Will It Take to Translate Research into Practice and Policy?

Mueller, Michael
Purnell, Tanjala S.
Mensah, George A.
Cooper, Lisa A.

¹ Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA;
² Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA;
³ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA;
⁴ Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, Maryland, USA;
⁵ Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA;
⁶ Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA;
⁷ Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.

Correspondence: Lisa A. Cooper ([email protected]).

Received July 13, 2014

Accepted October 30, 2014

American Journal of Hypertension 28(6):p 699-716, June 2015. | DOI: 10.1093/ajh/hpu233

INTRODUCTION

Despite available, effective therapies, racial and ethnic disparities in care and outcomes of hypertension persist. Several interventions have been tested to reduce disparities; however, their translation into practice and policy is hampered by knowledge gaps and limited collaboration among stakeholders.

METHODS

We characterized factors influencing disparities in blood pressure (BP) control by levels of an ecological model. We then conducted a literature search using PubMed, Scopus, and CINAHL databases to identify interventions targeted toward reducing disparities in BP control, categorized them by the levels of the model at which they were primarily targeted, and summarized the evidence regarding their effectiveness.

RESULTS

We identified 39 interventions and several state and national policy initiatives targeted toward reducing racial and ethnic disparities in BP control, 5 of which are ongoing. Most had patient populations that were majority African-American. Of completed interventions, 27 demonstrated some improvement in BP control or related process measures, and 7 did not; of the 6 studies examining disparities, 3 reduced, 2 increased, and 1 had no effect on disparities.

CONCLUSIONS

Several effective interventions exist to improve BP in racial and ethnic minorities; however, evidence that they reduce disparities is limited, and many groups are understudied. To strengthen the evidence and translate it into practice and policy, we recommend rigorous evaluation of pragmatic, sustainable, multilevel interventions; institutional support for training implementation researchers and creating broad partnerships among payers, patients, providers, researchers, policymakers, and community-based organizations; and balance and alignment in the priorities and incentives of each stakeholder group.