Hypertension is a silent killer that disproportionately hurts patients in communities of color. But it’s also a condition we know how to get under control. 

That’s why Advocate Aurora Health has pulled together teams from across the system and partnered with community groups to try to close the uncontrolled hypertension gap help Black and Hispanic patients live well. So far, that gap has closed by 13% this year, a result they hope to double next year. Nearly 70% of patients enrolled in their remote BP monitoring have their blood pressure under control within six months.

AAH’s hypertension initiative is one component of the health care system’s larger strategy to address social determinants of health and establish health equity across communities. 

Tackling the uncontrolled hypertension problem required bringing together teams from across the health system and both states, including the medical group, nursing, pharmacy, population health and care management, DE&I, Research Institute, mission and spiritual care, community health, information technology, among many others. Together, they formed a Health Equity Council and eight driver teams, which put together a group of clear, measurable goals to work toward vigorously addressing this problem. 

Solutions for preventing and managing hypertension include remote and virtual patient monitoring by using blood pressure cuffs, health screenings at clinics, exercise and nutrition education, medication management, provider engagement and community partnerships. Health data has helped inform the geographic areas and people groups with the highest uncontrolled hypertension so Advocate Aurora can proactively reach out with mobile health resources to help them manage it and lessen risk for worsened health issues. They’ve worked with key partners, including the American Heart Association and Molina Health, which is piloting a Medicaid contract supporting care management and device funding.

In addition, the Advocate Aurora Research Institute is conducting the REDUCE-BP study to evaluate innovative electronic tools Advocate Aurora has designed to help primary care providers and their patients overcome health barriers common to people of color with hypertension. A major focus of this study are e-tools that support screening for social determinants of health, such as food insecurity, with referrals to available community resources for people at medium and high risk.