Current funding makes possible the work of the ARPRC Core Units, which includes a research project that focuses on control of high blood pressure (also known as hypertension). The project consists of a demonstration of an innovative and cost-effective method to help control high blood pressure.
Blood Pressure Control: A Critical Health Issue for Arkansas
For its research project, the ARPRC chose to focus on high blood pressure because it plays a major role in overall health and because so many Arkansans (and Americans) have uncontrolled high blood pressure.
In overall health, Arkansas ranks 48th nationally. The state’s disease and death rates are among the highest in the nation for cardiovascular disease (heart disease and stroke), some cancers, and diabetes. These are chronic diseases, which are diseases that go on for a long time and in some cases are not easily cured.
Arkansas’ rates for risk factors that contribute to chronic disease, such as smoking, obesity, and hypertension, are also among the worst in the nation. Arkansas’s rate of smoking among adults is 27 percent, compared to 17.8 percent nationally.
In 2015, the state’s adult obesity rate was the nation’s highest at 35.9 percent. Being obese means one has a greater chance for developing other health conditions and diseases including high blood pressure, diabetes, heart disease, and some cancers. Nearly half of the state’s adult population has high blood pressure; in an estimated two-thirds of cases, the high blood pressure are uncontrolled.
Black Arkansans have higher rates of disease and death compared to white Arkansans. Blacks are more likely to have diabetes or cardiovascular disease and are more likely to die of a heart attack, diabetes, cancer, or a stroke than whites.
The racial and ethnic disparities in chronic disease and death rates are compounded by Arkansas being a predominantly rural state with more than two-thirds of its residents living outside urban areas.
Black people living in rural areas in the South, compared to those living in urban areas or white people, are more likely to experience conditions that harm health: poverty, fewer opportunities for education and job training, as well as fewer job opportunities, especially those which pay well. They are less likely to have health insurance or adequate access to health care, due to provider shortages. As a result, Southern rural blacks are less likely to get needed preventive care and are less likely to be diagnosed or treated for diabetes, cardiovascular disease and conditions such as high blood pressure.
High blood pressure, which is easily controlled with proper treatment, is a major risk factor for stroke and other chronic diseases, including heart disease and kidney disease. The Arkansas rate for stroke mortality among black Arkansans is one of the highest nationally. Sixty percent of black Arkansans have high blood pressure and for half of them, it is uncontrolled. Black adults are less likely to be aware that they have high blood pressure, compared to whites. Undiagnosed hypertension is highest among adults ages 18-59, particularly among males.
Adult Hypertension Rates for the US and Arkansas
|Percent with Hypertension||Percent with Uncontrolled Hypertension|
|Overall||30.4 %||16.3 %|
|White||30.2 %||15.5 %|
|African American||44.3 %||25.3 %|
|Mexican American||29.7 %||19.2 %|
|Overall||48.3 %||29.2 %|
|White||46.4 %||28.5 %|
|African American||59.9 %||33.6 %|
aHTN = mean DBP > 90mmHg, or mean SBP > 140mmHg, or currently taking medication for HTN; bLatino data not available for AR; cValderamma et al. MMWR 2013; dZohoori et al,. unpub.
Take Control: A Community Research Project to Control High Blood Pressure
Though hypertension is a relatively easy condition to control, it remains a major risk factor for a number of leading causes of disease and death. Hypertension, also known as high blood pressure, is the most common diagnoses made by U.S. primary doctors, affecting 76 million U.S. adults. While treatment is effective, current clinic-based approaches for hypertension care are not as effective as they might be, with more than half of the 76 million affected being uncontrolled. Uncontrolled hypertension is especially common in Arkansas. The percentage of U.S. adults with uncontrolled hypertension is higher in Arkansas than in the nation (29% vs. 16%) and even higher among African Americans in the state than whites (34% vs. 28%). The University of Arkansas Prevention Research Center plans to decrease rates of uncontrolled hypertension in a rural, under-served, predominately minority community, and identify cost-effective ways to better control hypertension.
Researchers are recruiting and training community health workers to deliver a stepped-care, community case management intervention. This program is designed to reduce uncontrolled hypertension in a rural, predominately African American community in Arkansas and minimize cost. The community health worker will provide lay education about blood pressure, help identify barriers to controlling it, and link participants to needed community services, such as insurance enrollment, medical services, and/or prescription assistance. The program includes three steps of support to help participants get their blood pressure under control. Each step is designed to be more intense than the previous step. Participants who still have uncontrolled hypertension after step 1, for instance, will be moved into step 2 and so forth. To test its effectiveness, researchers will randomly assign participants to the intervention group and a non-intervention group (usual care) and compare the outcomes.
A cost-effectiveness analysis will be conducted by comparing public health system costs and outcomes for participants in both the intervention and non-intervention groups. To inform this analysis, researchers plan to collect data from participants regarding doctor visits for hypertension management and hypertension medication, frequency of refills, and adherence. Costs associated with the resources used in the intervention to improve health outcomes will be calculated for each participant.
If proven effective in lowering uncontrolled hypertension rates and treatment costs, stepped-care, community case management intervention may be a hypertension control public health model to be replicated, not only across Arkansas, but the nation.
“People might think them videos don’t help, but I watched them and they helped. My blood pressure was out of whack when I started, but not it’s a whole lot better.”
“The program really helped my blood pressure. It got so good the doctor took me off all my blood pressure medicine.”
“This program has been the best thing that could have happened to me…I feel like I’m in control!”
Head Advisor Testimonial
“Every time I went in to check his blood pressure, it was elevated. He told me he’d been taking the same medication for 20 years. I stressed that he needed to become an active part of his treatment team. He believed he was ‘one of those people who just had high blood pressure readings all the time.’ I talked to him about how there are many different types of medication, that the medicine he was taking was not working and he should talk to his doctor about changing the prescription. After several visits of telling him the same thing and encouraging him to talk to his doctor, he finally did. At his last visit, he was happy to inform me that he had been taking a new medication for three days and was already seeing better readings than he’d ever seen since being diagnosed with high blood pressure. I congratulated him on becoming an active part of his treatment team and encouraged him to take his blood pressure readings in to his follow up appointment.”
“I just had a young man thank me for continuing to encourage him to see the doctor about changing his meds. He never wanted his BP checked because he said it was always high but today he let me check it. It was 118/79. He changed his meds WEDNESDAY. He was so happy that I had not given up and kept trying to get him to get a visit with his doctor and talk to him about the fact that his meds were not working for him. He had a huge smile on his face when he left and just kept thanking me. I feel so awesome right now!”
Community Committee Meetings
The Research Team is responsible for leading the ARPRC’s initiative on blood pressure control.
James Raczynski, Ph.D., ARPRC Director and Research Project Principal Investigator – Founding Dean and Professor, Health Behavior and Health Education, COPH
Martha Phillips, Ph.D., MPH, MBA, ARPRC Research Project Co-PI, Deputy Director for Administration, Evaluation Unit Director – Director, Office of Public Health Informatics and Associate Professor, Epidemiology, COPH
Joseph Bates, M.D., MS, Research Project Co-PI, Deputy Director for Practice Translation – Deputy State Health Officer and Chief Science Officer, ADH; Associate Dean for Public Health Practice, COPH
Appathurai Balamurugan, M.D., MPH, ARPRC Community Engagement and Partnerships Unit Co-Director – Family Practice Physician; Medical Director, Chronic Disease Branch and Associate Director for Science, Center for Health Improvement, ADH; Adjunct Assistant Professor, Epidemiology, COPH
Carol Cornell – Chair and Professor, Health Behavior and Health Education, COPH
James Selig, Ph.D. – Associate Professor, Biostatistics, COPH
Mick Tilford, Ph.D. – Chair and Professor, Health Policy and Management, COPH