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Principal Investigator: ALEJANDRA CASILLAS
Organization: UNIVERSITY OF CALIFORNIA LOS ANGELES
Fiscal Year: 2024
Award: $26,796
Funding agency: National Institute on Minority Health and Health Disparities
Project Summary/Abstract - P50 Study #1 (BP REACH)
Hypertension (HTN) is the leading contributor to preventable death, and a major risk factor for cardiovascular
(CV) events. Suboptimal blood pressure (BP) control is the most common attributable CV risk factor, accounting
for 56% of the burden of ischemic heart disease and 57% of stroke burden. BP control is also critical for reducing
risk of recurrent CV events and improving outcomes after stroke and myocardial infarction (MI), yet control rates
in these patients remain suboptimal, particularly for racial/ethnic minority populations served by safety net health
systems. In addition to a higher burden of HTN and poor awareness, treatment, and control rates for these
vulnerable communities, social determinants of health (SDOH) like low socioeconomic status (SES), limited
English proficiency (LEP), and underinsurance- pose additional challenges to BP control. Thus, to reduce
racial/ethnic and SDOH-rooted disparities in BP control after stroke or MI, innovative interventions are needed,
addressing healthcare system, patient, and community level factors. Past health system interventions have been
effective, particularly those that utilize chronic care model-based interventions, pharmacist-led medication
management, and team-based management like community health workers (CHWs). Interventions that have
succeeded at the patient level include those designed to expand health care access (telehealth: patient portal,
remote BP self-monitoring), health literacy, and improve health behaviors (exercise and diet). Los Angeles
County, with a population of 11 million, is ethnically and racially diverse, with stark socioeconomic and health
disparities. Nearly half of adults are born outside the United States and 18% have incomes <100% federal
poverty level. The Los Angeles County Department of Health Services (LAC-DHS) system, the 2nd largest
municipal health system in the United States serves LAC's most vulnerable residents through 4 hospitals and
23 ambulatory care centers. We have conducted prior randomized controlled trials (RCTs) to improve post-stroke
BP control in this safety net, and are currently conducting a primary prevention trial among individuals with HTN.
Building upon our experience testing multilevel complex interventions for improving BP control in this low-income
multi-ethnic setting, we propose the BP REACH study (Blood Pressure disparities Reduction, Equity, and Access
among safety net patients with Cardiovascular Health risk) to: 1) Design a multilevel, culturally and linguistically
tailored, complex intervention that seeks health equity for vulnerable safety net patients by prioritizing
pharmacist-med medication management and CHW chronic disease education and outreach based in the
SDOH, to reduce BP among multi-racial, multi-ethnic individuals with a history of stroke or MI in the LAC-DHS
safety-net; 2) Test the impact of this intervention on SBP for individuals with a history of stroke or MI in a
randomized trial in LAC-DHS cardiology and neurology care clinics and 3) Determine the effect of mediators on
the primary outcome of systolic BP in the intervention.
Terms: <21+ years old><Accounting><Address><Adult><Adult Human><African American><Afro American><Afroamerican><Ambulatory Care><Analgesic Management><Apoplexy><Asian Americans><Asian group><Asian individual><Asian people><Asian population><Asians><Awareness><BP control><BP management><BP reduction><Black><Black Populations><Black group><Black individual><Black people><Black race><Blacks><Blood Pressure><Blood Pressure Monitors><Brain Vascular Accident><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Cardiac infarction><Cardiovascular><Cardiovascular Body System><Cardiovascular Organ System><Cardiovascular system><Caring><Cerebral Stroke><Cerebrovascular Apoplexy><Cerebrovascular Stroke><Chicanas><Chicanos><Chronic Disease><Chronic Illness><Clinic><Clinical><Communities><Community Health Aides><Complex><Continuous Sphygmomanometers><County><Data><Decrease disparity><Disease><Disorder><Disparities><Disparity><Drugs><Economic Income><Economical Income><Education><Education and Outreach><Educational Materials><Educational aspects><Equity><Ethnic Group><Ethnic Origin><Ethnic People><Ethnic Population><Ethnic individual><Ethnicity><Ethnicity People><Ethnicity Population><Event><Filipino American><Health><Health Care Systems><Health Services><Health behavior><Health system><Healthcare Systems><Heart Vascular><High Prevalence><Hispanic><History><Home Blood Pressure Monitoring><Hospitals><Hypertension><Income><Individual><Institutional Racism><Instruction and Outreach><Intervention><Intervention Strategies><Investigators><Ischemic Heart><Ischemic Heart Disease><Ischemic myocardium><Latino><Latino Population><Latino group><Latino individual><Latino people><Latinos><Limited English Proficiency><Linguistic><Linguistics><Los Angeles><Low income><Lower disparity><Mediator><Medication><Medication Management><Mexican Americans><Municipalities><Myocardial Infarct><Myocardial Infarction><Myocardial Ischemia><NHLBI><National Heart, Lung, and Blood Institute><Neurology><Outpatient Care><Participant><Patients><Pharmaceutical Preparations><Pharmacists><Pharmacologic Management><Population><Prevention trial><Primary Prevention><Public Health><Race><Races><Randomization trial><Randomized><Randomized, Controlled Trials><Recording of previous events><Recurrence><Recurrent><Research Personnel><Researchers><Risk><Risk Reduction><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><SES disparity><Self Blood Pressure Monitoring><Self Management><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Specialty><Stroke><System><Systematic Racism><Systemic Racism><Technology><Testing><Training and Outreach><Tutoring and Outreach><United States><Vascular Hypertensive Disease><Vascular Hypertensive Disorder><WiFi><access to health care><access to healthcare><accessibility of health care><accessibility to health care><accessibility to healthcare><adulthood><after stroke><blood pressure control><blood pressure management><blood pressure reduction><brain attack><cardiac infarct><cardiac ischemia><cardiological service><cardiology service><cardiometabolic><cardiometabolism><cardiovascular health><cardiovascular risk><cardiovascular risk factor><care as usual><cerebral vascular accident><cerebrovascular accident><chronic care model><chronic disorder><circulatory system><community factor><community health worker><community partnership><community-level factor><coronary attack><coronary infarct><coronary infarction><coronary ischemia><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><design><designing><diet and exercise><digital health><disparities in race><disparity due to race><disparity in ethnic><disparity in health><disparity reduction><drug adherence><drug compliance><drug/agent><ethnic based disparity><ethnic disadvantage><ethnic disparity><ethnic diversity><ethnic inequality><ethnic inequity><ethnic minority group><ethnic minority individual><ethnic minority people><ethnic minority population><ethnic subgroup><ethnically diverse><ethnicity disparity><ethnicity group><experience><federal poverty level><health care access><health care availability><health care service access><health care service availability><health disparity><health equity><health literacy><health related behavior><healthcare access><healthcare accessibility><healthcare availability><healthcare service access><healthcare service availability><heart attack><heart infarct><heart infarction><heart ischemia><high blood pressure><histories><hyperpiesia><hyperpiesis><hypertensive disease><hypertensive disorder><improved><improved outcome><incomes><inequality due to race><inequity due to race><innovate><innovation><innovative><interventional strategy><literacy><low SES><low socio-economic position><low socio-economic status><low socioeconomic position><low socioeconomic status><lower BP><lower blood pressure><lowers blood pressure><medical specialties><medication adherence><medication compliance><medication therapy management><mitigate disparity><mortality><multi-ethnic><multi-racial><multiethnic><multiracial><myocardial ischemia/hypoxia><myocardium ischemia><novel><operation><operations><outpatient treatment><patient level intervention><patient portal><post stroke><poststroke><preventable death><preventable mortality><primary outcome><race based disparity><race based inequality><race based inequity><race disparity><race related disparity><race related inequality><race related inequity><racial><racial background><racial disparity><racial diversity><racial inequality><racial inequity><racial minority group><racial minority individual><racial minority people><racial minority population><racial origin><racially diverse><racially unequal><randomisation><randomization><randomized control trial><randomized trial><randomly assigned><reduce BP><reduce blood pressure><reduce disparity><reduce risk><reduce risks><reduce that risk><reduce the risk><reduce these risks><reduces risk><reduces the risk><reducing risk><reducing the risk><reduction in BP><reduction in blood pressure><reduction in disparity><risk-reducing><safety net><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><skills><social health determinants><socio-economic disparity><socio-economic inequality><socio-economic inequity><socioeconomic disparity><socioeconomic inequality><socioeconomic inequity><stroked><strokes><team-based care><telehealth><traditional care><treatment as usual><usual care><video visit><vulnerable community><wi-fi><wireless fidelity>