Kioko Susan Mwikali, Council Christina, Tomori Cecilia
Rockville Internal Medicine Group, Rockville, Maryland, USA.
One Medical Group, Potomac, Maryland, USA.
Health Equity. 2025 Aug 27;9(1):416-424. doi: 10.1177/24731242251371424. eCollection 2025.
Black Americans have the highest prevalence of hypertension among all racial or ethnic groups in the United States. They are 40% more likely to have uncontrolled blood pressure (BP) and are five times more likely to die from hypertension compared with non-Hispanic Whites. Experiences of discrimination in health care, clinician and institutional bias, and socioeconomic and environmental inequities driven by structural racism contribute to uncontrolled hypertension in this population. Multilevel, multicomponent interventions have effectively improved BP control among Black Americans but remain inadequately implemented in the clinical setting. An integrated nursing/public health quality improvement study was designed to address this gap between evidence and integration into clinical practice.
Using a one group pre/posttest design, we examined the effect of an innovative, evidence-based 12-week intervention on BP among Black Americans with uncontrolled hypertension aged 18 and older in the primary care setting. Intervention components included remote BP monitoring, weekly phone coaching with culturally congruent care, medication intensification, and a standardized hypertension protocol.
The average age of the participants ( = 35) was 64 years, and two thirds ( = 23) were female (66%). The mean difference in systolic BP from pre to postintervention decreased significantly (M = 23, standard deviation [SD] = 14.0), = -9.7, < 0.001). A significant reduction in the mean difference in diastolic BP from pre to postintervention was also observed (M = 11, SD = 11.8), = -5.5, < 0.001). At 12 weeks, 87% of participants had achieved BP control. The intervention also improved medication adherence and hypertension knowledge ( < 0.001).
A multicomponent, culturally congruent quality improvement intervention may effectively improve BP among Black Americans.
Scaled up implementation of equity-centered, culturally congruent approaches is needed to reduce racial disparities in hypertension control.
在美国所有种族或族裔群体中，非裔美国人的高血压患病率最高。与非西班牙裔白人相比，他们血压控制不佳的可能性高出40%，死于高血压的可能性高出五倍。医疗保健中的歧视经历、临床医生和机构的偏见，以及结构性种族主义导致的社会经济和环境不平等，都导致了该人群高血压控制不佳。多层次、多成分干预措施有效地改善了非裔美国人的血压控制，但在临床环境中仍未得到充分实施。一项综合护理/公共卫生质量改进研究旨在解决证据与临床实践整合之间的这一差距。
采用单组前后测设计，我们在初级保健环境中研究了一项创新的、基于证据的12周干预措施对18岁及以上血压控制不佳的非裔美国人血压的影响。干预措施包括远程血压监测、每周一次的电话辅导以及符合文化习惯的护理、药物强化治疗和标准化高血压方案。
参与者的平均年龄（n = 35）为64岁，三分之二（n = 23）为女性（66%）。干预前后收缩压的平均差异显著降低（M = 23，标准差[SD] = 14.0），t = -9.7，p < 0.001）。干预前后舒张压的平均差异也显著降低（M = 11，SD = 11.8），t = -5.5，p < 0.001）。在12周时，87%的参与者实现了血压控制。该干预措施还提高了药物依从性和高血压知识（p < 0.001）。
多成分、符合文化习惯的质量改进干预措施可能有效地改善非裔美国人的血压。
需要扩大以公平为中心、符合文化习惯的方法的实施，以减少高血压控制方面的种族差异。
