• The American Heart Association issued a framework of necessary investments to improving BP control in the U.S.
• Investments included research, policy, education, clinical care and community.

The American Heart Association issued a science advisory statement outlining a framework for the investment of resources and funding to address the high prevalence of uncontrolled blood pressure in the U.S.

Investment in research and policy, education, clinical care and community and workplace were identified as the primary domains by which long-term change in the prevalence of uncontrolled BP can be affected, according to the scientific advisory published in Hypertension.

Approximately 122.4 million U.S. adults are estimated to have hypertension with only approximately 20.7% reaching BP control, according to the advisory.

“We have effective treatments and strong guidelines, so the gap is about delivering care consistently and reaching the people most affected. The American Heart Association already does a great deal of work in this space, through Target: BP — part of the National Hypertension Control Initiative — public awareness campaigns, policy advocacy and community partnerships. We wanted to show how these efforts fit together and how they are expected to lead to measurable improvements in BP control while giving other organizations a framework they can adapt,” Yvonne Commodore-Mensah, PhD, MHS, RN, FAHA, professor and associate dean for research at Johns Hopkins School of Nursing and Johns Hopkins Bloomberg School of Public Health, department of epidemiology (joint appointment), told Healio. “No single intervention will close the BP control gap. Clinical quality improvement is essential, but so are the conditions people live in, including access to care, medication costs, food insecurity and transportation. I hope health systems see that their work is strongest when connected to community partners, and that policymakers recognize how much policy matters. Medicaid coverage for home BP monitors and reimbursement for patient training, for example, still varies widely by state. Disparities in BP control are largely driven by modifiable factors, which means they can be addressed.”

The logic model is designed to outline what investment must be done, what each input in to each component produces and how those activities support short-, medium- and long-term changes in population-level BP control.

For the first step of the model, the authors identified the current BP situation in the U.S. — nearly half of adults have high BP and less than one-quarter have controlled BP — and items to prioritize: equitable health, culturally and linguistically appropriate interventions, multisector collaboration and community.

Next, the authors identified resources and capabilities, including staff and volunteers, research networks, scientific evidence and more, as well as funding sources that included philanthropies and corporate sponsors.

“Starting points will vary by setting, but the closest thing to a universal first step is knowing your own data,” Commodore-Mensah told Healio. “Look at your current BP control rate and break it down by race, ethnicity, age, insurance and geography to see where the gaps are. That baseline tells you where to focus. Then map what you are already doing onto the model’s four strategy areas: research and policy, education, clinical care, and community and workplace. Most organizations will find they are strong in one or two areas and thin in others, which shows where new investments or partnerships would add the most value.”

The authors identified four domains that may benefit from these inputs — research and policy, education, clinical care and community and workplace — and explained how their outputs could impact long-term outcomes in BP control.

“Organizations should define specific, measurable indicators for each outcome. ‘Improved BP control’ might mean the percentage of patients below 130/80 mm Hg, with a target such as 70% or higher and a timeline based on your starting point,” Commodore-Mensah told Healio. “The model also lets institutions track earlier progress, such as clinicians trained, adoption of treatment protocols, social needs screening, and use of home BP monitoring. This kind of measurement works: Health centers in the National Hypertension Control Initiative improved BP control by 9.8 percentage points from 2020 to 2023, compared with 6.9 points at other health centers. Institutions should also track results across population groups, since overall gains can mask persistent gaps.”

Investment of resources, capabilities and funding into BP research and policy could produce scientific publications, professional guidelines, policy recommendations and advocacy materials. In the long term, these outputs may institutionalize evidence-based policies, establish a supportive regulatory environment and create sustainable funding and change health system infrastructure, according to the advisory.

The authors added that investment in education could produce culturally and linguistically appropriate educational materials, public education campaigns and patient resources, which may lead to long-term changes such as sustained behavioral changes.

Investment in the domain of clinical care could lead to the creation of professional training programs, clinical toolkits, best-practice protocols, evidence-based guidelines, quality improvement initiatives and achievement awards. In the long term, these outcomes could result in increased hypertension control, reduced disparities and reduced CV events and CV mortality, according to the advisory.

The authors wrote that investment in community and workplace may produce community partnership programs and technical assistance resources that, together with investment in clinical care, may improve social needs screening and connect community with clinical care.

“BP control is a shared responsibility. Clinicians, including nurses, pharmacists and community health workers, can deliver team-based care. Public health professionals can lead population-level strategies, community organizations can build trust and connect people to care, employers can support wellness and funders can sustain what works,” Commodore-Mensah told Healio. “Prevention also needs to start early, beginning with maternal health and continuing through childhood. Finally, we still need to learn which strategies work best, for whom, and in what settings. I hope this model encourages organizations to measure, share what they learn, and build that evidence together.”

Yvonne Commodore-Mensah, PhD, MHS, RN, FAHA, can be reached at ycommod1@jhu.edu and on X at @ycommodore.