Hypertension is largely responsible for AAs living 5.5 fewer years than whites. Over half (55%) of AA adults now have hypertension and 45% have uncontrolled blood pressure (BP). Improving BP control in AAs is critical to improving health equity for AAs. A reduction of 10 mmHg in systolic BP is associated with 28% reduced risk of heart failure, 27% risk reduction for stroke, 20% for major cardiovascular events, 17% for coronary heart disease. Medication and diet change are the most effective strategies for reducing blood pressure, but adherence to both is especially low in AAs. Low trust, cultural preference for unhealthy foods, and logistical barriers due to poor access are underlying causes of poor adherence. Church-based interventions for individuals with uncontrolled BP have potential to increase adherence among AAs because the church is a trusted setting with strong social support. The proposed church-based intervention consists of a 9-month group-based Basic intervention for all participants, supplemented by a 3-month individualized CHW intervention for participants that do not achieve BP reduction milestones at 3 and 6 months. The Basic intervention is a culturally-tailored, group-based BP education intervention that consists of two components: a Bible study, led by the Pastor, to encourage a link between healthy lifestyle and spiritual values, and Behavior Change small groups, led by a trained church member, to promote behavior change strategies (education, goal-setting, self-monitoring, problem-solving). The CHW intervention consists of one-on-one meetings between participants and a CHW twice per month for 3-months, focused on addressing individual barriers to medication adherence and healthy diet. CHWs will also connect participants to community resources to address barriers, as needed. We propose to conduct a 24-month behavioral cluster randomized controlled trial in which 18 churches (n=342) are randomized to one of two arms. The intervention arm will receive the Alive BP intervention in the first year and Money Smart, a financial education intervention, in the second year. The comparator (control) arm will receive the two interventions in the reverse order. The primary aim is to compare African American church members with uncontrolled BP in the intervention churches with those in the comparator churches on mean change in systolic BP at 12 months. The secondary aim is to evaluate the effect of the intervention on diet quality, medication adherence, self-efficacy, intrinsic motivation, social support, knowledge, beliefs about medications, and barriers to medication use. An exploratory aim is to evaluate sustainability of change in SBP at 24 months post-intervention in the intervention arm.

Improving blood pressure control in African Americans is critical to improving health equity for African Americans. This study tests a novel church-based intervention to improve blood pressure control in African Americans by improving healthy diet and medication adherence.