Reducing Blood Pressure in Patients With High Cardiovascular Risk in the Safety-Net

BP-REACH is a study of a team-based (pharmacist and health coach) program for lowering blood pressure for people with a prior stroke or heart attack in the Los Angeles Department of Health Services public healthcare system.

The goal of this clinical trial is to test if this team based program is better at helping people reduce their blood pressure than usual care for people with prior heart attack or stroke. The main questions it aims to answer are:

• Do people in the REACH BP program have lower blood pressure at 12 months compared to those getting usual care?
• Do people in the REACH BP program have better Life's Essential 8 scores and patient experience compared to those getting usual care?

Half the participants will be randomly assigned to usual care and half will be assigned to the program.

Those assigned to the program will receive a blood pressure cuff to check their blood pressure at home, educational materials, monthly phone calls from a health coach and regular follow up with a pharmacist who will prescribe medications, adjust them, and answer any questions and concerns. The health coach will teach the participants how to log on to the patient portal and access educational materials on an app.

Those assigned to usual care will continue seeing their providers.

All participants will be asked survey questions once they enroll, at 3 months and at 12 months.

Hypertension is the leading contributor to preventable death and a major risk factor for recurrent cardiovascular events. To enhance BP control after stroke or myocardial infarction (MI), multilevel interventions are needed that incorporate health system, patient, and community level factors.

BP-REACH aims to test the impact of an intervention on systolic blood pressure (SBP) for individuals with a history of stroke or MI in a randomized controlled trial in the Los Angeles Department of Health Services public healthcare system. The primary outcome will be change in SBP at 12 months.

Hypothesis: Patients randomized to the intervention will achieve >2.4 mm Hg greater reduction in SBP at 1 year versus those randomized to usual care.

The study population will include participants from the inpatient and outpatient settings in Los Angeles County Department of Health Services health centers. The participants will be randomized in a 1:1 fashion to usual care or intervention, stratified by site, language and cardiovascular event (myocardial infarction, stroke). Outcomes will be collected from all participants at Baseline, 3 month and 12 month timepoints. The primary outcome is SBP.

Participants randomized to the intervention arm will receive additional a home blood pressure monitor, monthly phone calls from a health coach, and medication initiation and titration by a clinical pharmacist. The pharmacist will follow Los Angeles County Department of Health Services expected practices, which align with the ACC/AHA guidelines for blood pressure control and AHA guidelines for Secondary Stroke Prevention.