Bring It Down is learning how to close the disparity between black and white people in high blood pressure control, with the ultimate goal of reducing stroke risk.
By Ann Wallace, Senior Communications Specialist, Kaiser Permanente Division of Research
When it comes to high blood pressure, Kaiser Permanente Northern California is very good at bringing it down. Nationally, only 54 percent of people with hypertension have it under control. In contrast, the rate of hypertension control among KPNC members is about 90 percent.
That’s the result of a Division of Research study that introduced a system-wide quality improvement program to increase the rates of blood pressure control. Between 2001 and 2011, the rate of hypertension control increased from 44 to 87 percent, and has continued to climb to 90 percent.
Now the Division is targeting the five percent disparity in hypertension control that persists between black and white members through Bring It Down, a multipart research program focusing on hypertension control among African Americans and stroke in the young, led by program director Stephen Sidney, MD, MPH.
Over the past year, 170 African American members of Kaiser Permanente Northern California with uncontrolled high blood pressure completed a lifestyle intervention program based on the DASH (Dietary Approaches to Stop Hypertension) eating plan, regular exercise and stress management — aided and encouraged by phone counseling and group meetings.
Small changes lead to success
“The program is about increasing awareness and empowering people,” says lifestyle coach Kimberly Whelan. “We give them the knowledge and the tools, but the participants set their own goals. Their success is based on their readiness and willingness to experiment with making small, gradual changes and building on that success. And sometimes the small change is simply a greater awareness.”
Helen Weaver, 66, an administrator with a demanding job, admits she was hesitant to commit to the year-long study, which included 16 counseling sessions by phone. “Initially, I thought that I wasn’t going to be able to get through it. But I wanted to learn more, so I rationalized that I just wouldn’t answer the phone if I didn’t feel like it.”
As it turned out, she says “I wouldn’t have made it without the coaching. Whelan explained that it wasn’t about her objectives and goals, but mine. You have to do this for yourself. Once I realized that I wasn’t going to get in trouble if I messed up, it took the pressure off.”
During the year, Weaver lost weight and her blood pressure dropped. She feels the program helped her answer “why” she needed to make changes and eat healthy foods, guided her in the right direction, and helped her take small steps to reaching goals. “Going to the grocery store is so much easier now,” she observes. “I just go around the perimeter for fresh produce and lean proteins and I’m done. I gave myself permission to spend money on the kind of food that’s good for me.”
Lafayette Hanible, 77, a retired nurse and hospital administrator, credits the program with changing his attitude toward aging. “You can’t let aging be a crutch for not making changes,” he states. “If you get into a routine and don’t add anything new to it, you can become outdated. There comes a time when you need to make some modifications.”
Hanible, who has had cardiac problems in the past and has a heart stent and pacemaker, is now working out seven days a week, reading product labels in the grocery store, scanning menus for low-salt, low-fat entrees when he dines out, and educating his children and grandchildren about the importance of eating right.
He appreciates that the program focused on African Americans, although participants represented a wide socioeconomic range. “From the black community perspective, this is very important,” he says. “There is hardship in our community due to isolation and economic and educational disadvantages that may make us more susceptible to hypertension and heart attacks. The lifestyle coaches — who were excellent — taught us how to look at things and make positive changes no matter what our circumstances.”
He would like to see this kind of health education offered to children. “It makes sense to work on preventive aspects and educate kids before these lifestyle-related health problems start,” he observes. “If we teach them about eating correctly and healthy lifestyles when they’re young, they can build on their early success throughout their lives.”
Lessons for clinical care
Mai Nguyen-Huynh, MD, MAS, principal investigator for this arm of the study, feels that researchers learned a lot from the study. “This is the first pragmatic study we’ve attempted in hypertension or stroke,” she notes. “We didn’t know how participants would react to what we asked of them, but more than 50 percent participated in all the sessions — more than we’ve ever seen elsewhere.”
When the results of the study are compiled this summer, Nguyen-Huynh and the study team will learn if they made a difference in bringing blood pressure under control. If so, she says, “we can build these lessons into clinical care and enhance patient satisfaction and their active participation in their own care.”
The second part of the Bring It Down research program, Stroke in the Young, is closely related to the first since the leading cause of stroke is hypertension. In this study, researchers are seeking to understand why stroke rates are rising in young adults (people under 50). Researchers are particularly interested in how typical risk factors for stroke — high blood pressure, diabetes, high cholesterol, obesity and smoking — are involved in stroke in the young, as well as why strokes happen more often in young African Americans.
For more information on hypertension and stroke, visit Bring It Down and follow the research program on Twitter at @Stokestudy.