Kudos to Bradi B. Granger, professor, and her entire team for the submission of their Alpha Phi Foundation Heart to Heart application entitled: "Improving the Visibility of Women: Patients as Partners in Management of Uncontrolled Hypertension." This proposal requests funding for a two-year period with a start date of September 1, 2021.

The objective of this study is to evaluate a community-based intervention designed to reduce disparities among adult women with high blood pressure (Healthy People 2030 quality measure 04) and to improve treatment equity, resulting in an increase in the proportion of women with hypertension in control (Healthy People 2030 quality measure 05), across racial and socio-economic groups. Specifically, we propose to empower women through peer-partnerships to manage and control their blood pressure (BP) and antihypertensive medications, reducing their risk of heart attack and stroke for a lifetime. In addition, we will evaluate how these life-skills translate to the children, families and neighborhoods that are influenced by these women.

Community-based interventions using peer partners and existing social-cultural infrastructure, such as barber shops, have been effective for reducing blood pressure in men.33,34 We propose a peer-partnership intervention tailored to women that will train women, as leaders in their homes, neighborhoods and communities, to adopt and sustain life-skills for lowering blood pressure and reducing heart attack and stroke risk.6 As women set the tone for health behaviors and lifestyle choices in the family, skills for self-monitoring blood pressure and sustaining optimal medication regimens to control blood pressure can be learned and integrated health behaviors. Improving women’s confidence in self-monitoring and medication management for hypertension may change the culture of BP self-management from burdensome tasks to liberating choices. Rather than a “black box” of medications, blood pressure equipment, and healthcare provider miscommunications, we propose a peer-partnership intervention to arm women with the knowledge, skills, and self-confidence to make choices, communicate clearly, and take control of BP goals that improve health for a lifetime.

The following hypotheses are proposed to test the patient partnership intervention in a population of low SES patients with uncontrolled hypertension:

(H1) Among the cohort of female patients with uncontrolled BP at LCHC, those engaging with a peer the Hypertension Heroes intervention (n=150) will demonstrate improved BP control at 6, 12 and 24 months after engagement (as measured by at least 3 patient-reported BP readings for each 3-month quarter at 140 mmHg systolic or less) as compared with a matched cohort of patients who choose not to engage (n=150).

(H2) Among the cohort LCHC participants with uncontrolled BP, those engaging with the Hypertension Heroes intervention (n=150) will demonstrate improved medication management skills (as measured by patient-reported BP-medication tracker in the patient portal of EPIC), accuracy of medication reconciliation (measured by Lincoln Pharmacist-calculated Medication Possession Ratio (MPR)), and patient-provider medication goal-concordance, communication and engagement at 6, 12 and 24 months (measured using the AHRQ SHARE tool).