Bring It Down: A Formative Evaluation of Reach and Effectiveness of a Blood Pressure Reduction Program in Detroit, Michigan USA

Hypertension is the most important contributor to the development of cardiovascular disease. The objective of the Bring it Down program was to examine the reach and effectiveness of linkage to primary care via community health workers (CHWs) to improve blood pressure control among people with undiagnosed or uncontrolled hypertension. Adults with systolic blood pressures ≥130 mmHg were initially recruited from four urban emergency departments that serve high-risk, socially vulnerable populations. Due to the COVID-19 pandemic, we also enrolled participants in the community who presented to mobile health units. CHWs facilitated follow-up blood pressure assessment within 1 year. Of 153 630 ED patient encounters during the evaluation period, 61% were eligible to participate in the BID program; of these, 3% were approached, and 16% (395/2476) agreed to participate. Compared to ED encounters, fewer patients presenting to MHUs were eligible to participate (42%, 1780/4211), all of whom were approached, and 7% (124/1780) agreed to participate in the BID program. Among participants with at least one follow-up encounter (n = 158), there was a statistically significant reduction in mean systolic BP (mean difference: −16 mmHg, 99% confidence intervals (CI): −21, −12 mmHg) with a median time between SBP measurements of 20 days (interquartile range [IQR]: 8, 53 days). Clinical and community recruitment paired with CHW connections to primary care may be a viable quality improvement strategy for improving blood pressure control in high-risk, socially vulnerable populations. However, additional research is needed to understand and improve participation and follow-up rates to establish program effectiveness.