Controlling a Silent Killer
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Controlling a Silent Killer
Lisa Cooper, who was recently named vice president for health care equity at Johns Hopkins Medicine, is leading efforts to improve hypertension control among African-American patients.
"Cardiovascular disease is the largest contributor to racial disparities in health and mortality."
— Lisa Cooper
At the Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, researchers are pushing for ways to improve control of hypertension among African-Americans, who are disproportionately affected by this silent killer.
“Cardiovascular disease is the largest contributor to racial disparities in health and mortality,” says Lisa Cooper, the center’s director and one of its 23 faculty members from Johns Hopkins’ schools of medicine, nursing and public health. About 44 percent of African-Americans have hypertension—compared with around 32 percent of Caucasians and 28 percent of Mexican-Americans—and they develop the condition earlier than other racial groups, according to the Centers for Disease Control and Prevention. “Even though we have evidence for how to treat hypertension, it doesn’t seem like we use a lot of it in practice. Our research studies those barriers and then tries to adapt programs accordingly,” Cooper says.
The center recently released findings for its study that focused in part on how using proven care management techniques can help control blood pressure in a clinical setting. In this five-year study involving 45,000 patients from all racial groups at six Johns Hopkins Community Physician sites, participants met with a registered dietitian—sometimes in combination with a pharmacist—for three sessions that totaled two hours. The dietician focused on teaching patients to make healthy lifestyle choices, while the pharmacist talked about proper medication usage.
After the care management intervention, both African-American and Caucasian participants showed significant improvement in their systolic blood pressure readings compared with their counterparts who did not finish the program. But while Caucasian participants lowered their numbers by 16 millimeters of mercury—the unit used to measure blood pressure—African-American participants saw a decrease of 8 millimeters of mercury.
More research is needed to find out why blood pressure scores improved more dramatically for Caucasians than African-Americans, as well as why only 25 percent of eligible patients enrolled in the program. “We suspect African-American patients and those who did not enroll had social barriers to engagement that were not adequately addressed by our clinic-based team,” Cooper says. “Our next study will take the lessons we have learned and push them further.” For example, researchers plan to add to the care team a community health worker who can address patients’ social and financial barriers and link them to appropriate resources in the community.