Getting to the Heart of Hypertension Disparities

Researchers address social risk factors for high blood pressure through a national study.

Nearly half of American adults have hypertension, and just one in four has their blood pressure under control. A healthy diet, exercise, and medication can help patients control hypertension, but unaddressed social needs can sometimes deter progress. Enter the Pressure Check study, a $19-million project funded by the Patient-Centered Outcomes Research Institute (PCORI). This multi-center, national study aims to reduce hypertension management disparities by addressing social needs in underserved patient populations via a novel telehealth, health advocate and community health worker model.

Social needs include access to:

Safe places to exercise

Affordable health care and medications

Nutritious food

Supportive social networks.

Led by Yale School of Medicine, the project involves close partnerships with Houston Methodist, Massachusetts General Hospital and Sentara Healthcare. The study is comprised of three phases to determine the most effective care model for blood pressure control. Phase one educates participants on blood pressure health and provides them with a remote blood pressure monitor and a referral to a primary care provider. Phase two adds telehealth visits to the resources provided in phase one, and phase three adds assistance from a community health worker to address participants’ outstanding social needs. Khurram Nasir, MD, MPH, and Zulqarnain Javed, MD, PhD, MPH, are leading Houston Methodist’s efforts in the multidisciplinary five-year project, which launched in 2022. “With each health system recruiting 300 to 350 patients, the Pressure Check study is one of the largest national hypertension trials to date,” explained Nasir, William A. Zoghbi, MD, Centennial Chair in Cardiovascular Health. “Of the four health system partners, Houston Methodist is proud to be a leader in patient recruitment thus far.”

Houston Methodist’s participation in the Pressure Check study is a prime example of leading medicine.

Zulqarnain Javed, MD, MPH, PhD

Assistant Professor, Population Health, Cardiology

Nasir attributes this patient recruitment success to Houston Methodist’s close collaboration with community partners, including Jometra Hawkins-Sneed, a health advocate at the African American Male Wellness Agency. Sneed’s expertise has been instrumental in establishing and sustaining partnerships with 10 community-based organizations (CBOs) in and around Houston where patient recruitment takes place.

Community-based organizations involved in the Pressure Check study include churches, barbershops, community centers, and other businesses/organizations that focus on health and wellbeing.

Jometra Hawkins-Sneed

“We go to these CBOs at least once a month to screen potential study participants,” Hawkins-Sneed said. “We also promote the study within the CBOs. Each CBO has a goal of enrolling at least two people for the study each month, which equals to 20 people per month.” Recruitment is focused on populations that are more susceptible to having high blood pressure due to unaddressed social needs. These social needs stem from inequitable conditions that impact health outcomes, including economic instability, lack of access to affordable health care and food insecurity. These non-clinical factors account for approximately 80% of health outcomes and are known broadly as the social determinants of health.

Social needs include access to:

Safe places to exercise

Affordable health care and medications

Nutritious food

Supportive social networks.

Unfortunately, social needs disproportionately impact communities of color, contributing to the hypertension disparities researchers hope to better understand and address through the Pressure Check study. Phase two of the study will address these social needs in early 2025. Study participants will be screened for more than 40 social needs that contribute to hypertension using a SDoH screening tool informed by validated social risk assessment indices, including the polysocial risk score tool pioneered by Javed, Assistant Professor of Population Health, Cardiology. Hawkins-Sneed’s team of community health workers will also address these social needs by navigating patients to community resources including Harris Health, Unite Us, Harris County Public Health, Texas 211, and others. “We’re hoping to mitigate social needs on the first try, but if not, we'll continue to work with community resources to help move study participants forward in their health,” Hawkins-Sneed said. Upon study completion, the four health systems will share experiences and data to determine the most effective care model for hypertension, as well as the effectiveness of community-based interventions across study sites.

The Pressure Check team at a recruitment event.

“Even though the core study intervention is the same across the four health systems, we do expect significant variation in how each health system engaged with community partners. How this may impact long-term patient experiences and study outcomes remains to be seen,” Javed explained. “This insight into community engagement and the study results can open more doors to further address disparities in hypertension and other conditions, such as obesity and diabetes, through community-based partnerships.” Nasir and Javed proudly support Houston Methodist’s leadership and commitment to improving population health. “Houston Methodist’s participation in the Pressure Check study is a prime example of leading medicine,” Javed said. “We are taking a national lead in collaborating with community partners to bridge the gap between social and clinical risk factors that impact health and wellbeing. We are honored and grateful to be a part of this vital initiative.”

Nasir K, Javed Z.

Callie Rainosek Wren, MS

January 2025

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