Hypertension Management in Minority and Low-income Populations

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DESCRIPTION (provided by applicant): The overarching goal of this proposal is to develop, adapt, implement, and evaluate hypertension control interventions in safety-net settings caring for race/ethnic minority patients with complex co-morbid conditions including chronic kidney disease (CKD) and diabetes. Dr. Bibbins-Domingo is the joint PI of a U54 collaborative grant that evaluates a clinically-delivered hypertension control intervention consisting of a clinical blood pressure control algorithm, as well as a culturally-tailored dietary intervention aimed at sustained blood pressure control delivered in an integrated health delivery system; these interventions will form the basis for the adapted interventions studied here. The proposal addresses the following aims: Aim 1. To adapt, implement, and evaluate hypertension interventions developed in the U54 to resource- limited, safety net settings in across California, and Aim 2. To use a new micro-simulation computer model to determine essential elements of effective hypertension interventions and an established population-based computer model (the CVD Policy Model) to project population impact of such interventions on health disparities. This proposal will enhance Dr. Bibbins-Domingo's career goals to pursue didactic and experiential training in implementation science methodologies, to develop multi-disciplinary teams of researchers (including nephrologists, cardiologists, and implementation scientists) capable of developing effective prevention interventions for delivery in resource-limited settings caring for complex patients, and to integrate her prior computer modeling work in the analysis of new clinically-based interventions. She will conduct the work described here through mentored studies involving trainees from a broad set of disciplines. Dr. Bibbins- Domingo is the Director of the UCSF Center for Vulnerable Populations at San Francisco General Hospital and the Director of the Clinical and Translational Sciences Institute K Scholars Program that mentors junior faculty with career development awards. She has a long track record of mentoring trainees and junior faculty, including sub-specialists (i.e. nephrologist, cardiologists, endocrinologists) and several individuals from URM backgrounds. This proposal will develop new science while providing a rich training environment for junior investigators and furthering Dr. Bibbins-Domingo's own career development.