Community programs for hypertension: A means of identification and intervention in the highest-risk population

The prevalence rate of hypertension among blacks in the United States currently exceeds 41 % and is among the highest in the world. Black men in particular have the greatest burden of death from hypertension (HTN), with death rates from hypertension being three times greater for black men compared to whites. A major reason for the disproportionate morbidity and mortality from HTN and its complications in blacks is suboptimal blood pressure (BP) control. In fact, the disparity in hypertension control between blacks and whites accounts for nearly 8,000 excess cardiovascular deaths annually for African Americans. Widespread hypertension control requires the engagement of patients and physicians and other clinical providers alike, and the involvement of individuals, health systems, and communities to facilitate two critical processes: (1) identification of individuals who have hypertension or at risk for developing hypertension and (2) therapeutic intervention to lower blood pressure and prevent complications of uncontrolled hypertension. Community-based hypertension programs have long been recognized as means to achieve these two requisite steps to achieve blood pressure control, particularly among high-risk populations such as black men who tend to underutilize primary care settings. In this chapter, we will briefly review the history of community-based hypertension control efforts and highlight selected community-based strategies from the peer-reviewed literature that have aimed to address blood pressure control in hypertensive African Americans.