Summary Proceedings From The American Heart Association Western Affiliate Commission Of Blood Pressure Task Force: Statement On Institutional And Population Health Strategies To Achieve Blood Pressure Control In Diverse Communities.

Objective: The AHA Western States Affiliate (WSA) Commission of Blood Pressure Task Force (TF) sought to establish an evidence base to guide health and population health strategies for blood pressure (BP) control across diverse communities, namely: (1) team care strategies such as pharmacist intervention, engagement of at-risk populations by community pharmacists, and medication management in the neighborhood setting; (2) self-care approaches such as self-monitoring interventions; (3) culturally-tailored diet modification, including DASH and sodium reduction; and (4) social conditions and other factors that may impede or facilitate medication adherence. Methods: Along with TF proceedings, a series of systematic reviews were conducted to examine 4 categories of intervention, yielding 51 articles and summary reviews on the impact and implementation contexts of these interventions. Search terms included “hypertension”, “blood pressure”, “team-based care”, “self-monitoring” and “home-monitoring”. Synthesis of the evidence is being carried out by a panel of experts who are rating the strength of each identified study using the American Academy of Family Physicians’ Strength of Recommendation Taxonomy (SORT) system. SORT is a patient-centered approach to grading evidence in medical literature, offering interpretation of data applicable to practice settings. Results: WSA reaches 70 million adults comprising 50% diverse adults. The multi-layer review and synthesis of the evidence suggests pharmacist strategies such as coordinated medication therapy management and BP self-monitoring in diverse communities have beneficial impact on helping patients reach AHA/ACC and JNC7 target BP goals. The TF also found that strategy implementation to fidelity can be difficult to achieve in real world settings. Conclusions: Results from the TF proceedings and synthesis suggest all 4 categories of intervention showed promising outcomes; however, more research is needed to demonstrate their impact collectively or in combination. Additionally, barriers and facilitators to effective use of these interventions may require novel study using emerging models of complex systems and dissemination, implementation, and improvement (DII) sciences.