ACHIEVE P1 - HTN

项目摘要 高血压是全球发病率和死亡率的主要危险因素。即使是轻微的血压升高 (BP)是有害的，因此患有第1阶段高血压的个体处于双重心血管风险中。黑人成年人 患有更高的患病率，更差的控制率，以及更频繁的高血压对健康的不良影响。 他们也处于从轻度到更严重的高血压的早期加速进展的高风险中。 在减轻与高血压相关的健康不公平方面进展甚微。黑人占多数的城市 底特律等城市的心脏病死亡率几乎是全国平均水平的两倍， 疾病越来越多的证据表明，普遍存在的负面社会健康决定因素（SDoH）是主要的 这些不平等的驱动因素，并代表了黑人高血压患者实现BP控制的关键障碍。核心 问题包括难以获得医疗保健和负担沉重的护理联系系统，特别是在 资源环境、健康教育和识字率低以及提供保健服务方面的结构性缺陷， 未能解决生活环境的范围，提高血压和阻碍采用有益的 生活方式的改变在ACHIEVE GREATER研究中心的项目1中，我们提出了一种创新的 在未确诊的黑人成年人的早期阶段识别和控制高血压的方法， 为实现终身健康公平带来巨大的好处。使用混合I型有效性-实现 和准实验设计，我们将利用我们的新的移动的健康联合（MHU）平台，以实现一个 该计划将患有1期高血压的低风险黑人成年人与非高血压患者提供的合作护理联系起来， 医生，社区卫生工作者（CHW）和药剂师，由个性化，适应性强， 生活方式和生活环境（PAL 2）干预12个月。PAL 2的核心特性包括 能够从一系列现成的干预措施中进行选择，以解决个人的负面SDoH， 具有文化敏感性的健康和生活方式教育，以及随着时间的推移，根据其接受程度， 有效性（家庭BP）和不断变化的患者需求。如果6个月后BP仍≥130/80 mm Hg， 增加药师指导的药物治疗算法，实现及时控制血压。计划优势 包括BP降低将在实施阶段（12个月）和维护阶段（1年）进行评估 2)在与医疗保健挂钩之后。我们的目标是证明项目1在12岁后降低家庭血压的有效性 在底特律的贫困社区生活的500名患有轻度1期高血压的黑人患者中， 到达目标人群。我们还旨在评估项目1的保真度和结果，并检查其 成本效益。通过战略性的MHU外展，加上加强合作， 护理，可以有效地消除障碍，减轻负SDoH和改善黑人成年人的血压控制， 高血压ACHIEVE GREATER中心的项目1代表了一种新颖且可扩展的模式， 促进美国各地城市黑人社区的健康公平，这些社区继续面临差异。

PROJECT SUMMARY Hypertension is the leading risk factor for global morbidity and mortality. Even mild elevations in blood pressure (BP) are harmful whereby individuals with stage 1 hypertension are at double cardiovascular risk. Black adults suffer from a higher prevalence, worse control rates, and more frequent adverse health effects from high BP. They are also at heightened risk for an earlier accelerated progression from mild to more severe hypertension. Little progress has been made in mitigating health inequities related to high BP. Predominantly Black cities such as Detroit disproportionately suffer from nearly twice the national average mortality rate due to heart disease. Mounting evidence shows that pervasive negative social determinants of heath (SDoH) are major drivers of these inequities and represent a critical barrier to achieving BP control in Black hypertensives. Core issues include poor access to healthcare and a burdensome system for care linkage especially in under- resourced settings, low health education and literacy, and structural inadequacies in care delivery including a failure to address the spectrum of life circumstances that elevate BP and hinder the adoption of salutary lifestyle changes. In PROJECT 1 of the ACHIEVE GREATER research center, we propose an innovative approach to identify and control hypertension at its earliest stages in undiagnosed Black adults, potentially yielding an enormous benefit towards lifetime health equity. Using a hybrid type I effectiveness-implementation and quasi-experimental design, we will leverage our novel mobile health unite (MHU) platform to implement a program that links low risk Black adults with stage 1 hypertension to collaborative care delivered by non- physicians, community health workers (CHWs) and pharmacists, consisting of a personalized, adaptable approach to lifestyle and life circumstance (PAL2) intervention for 12-months. Core features of PAL2 include the ability to choose from a menu of readily available interventions that address individual negative SDoH, culturally sensitive health and lifestyle education, and adaptability over time according to its acceptance, effectiveness (home BP), and evolving patient needs. If BP remains ≥130/80 mm Hg after 6 months, a pharmacist-directed medical treatment algorithm will be added to achieve timely BP control. Program benefits including BP-lowering will be assessed during the implementation (12-months) and maintenance phases (year 2) after linkage to medical care. We aim to show the effectiveness of project 1 to lower home BP after 12 months in 500 Black patients with mild stage 1 hypertension living in disadvantaged communities in Detroit and to reach the target population. We also aim to evaluate the fidelity and outcomes of project 1 and examine its cost effectiveness. Improving care access by strategic MHU outreach, coupled with enhanced collaborative care, can effectively remove barriers, mitigate negative SDoH and improve BP control in Black adults with hypertension. PROJECT 1 of the ACHIEVE GREATER center represents a novel and scalable model to advance health equity in urban Black communities across the United States that continue to face disparities.