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Multiple classes of antihypertensive medications are employed in treating hypertension. The most commonly recommended first-line treatments include:Thiazide Diuretics, such as chlorthalidone, increase sodium and water excretion from the body, reducing blood volume and blood pressure.Angiotensin-converting enzyme inhibitors, like lisinopril, block the conversion of angiotensin I to II, a potent vasoconstrictor lowering blood pressure.Angiotensin II Receptor Blockers (ARBs) prevent angiotensin II...
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Multifaceted Strategies for Hypertension Control in Low-Income Patients.

Katherine T Mills1,2, Marie Krousel-Wood1,2,3,4, Erin M Peacock3,4

  • 1Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans.

The New England Journal of Medicine
|April 8, 2026
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Summary
This summary is machine-generated.

A team-based strategy significantly lowered systolic blood pressure in low-income patients with uncontrolled hypertension. This approach improved adherence to blood pressure management compared to usual care.

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Area of Science:

  • Cardiology
  • Public Health
  • Health Services Research

Background:

  • Uncontrolled hypertension disproportionately impacts underserved populations with existing health disparities.
  • Limited data exists on effective, team-based strategies for hypertension control in low-income individuals.
  • Federally qualified health centers serve vulnerable populations, making them key sites for intervention.

Purpose of the Study:

  • To evaluate the effectiveness of a multifaceted, team-based implementation strategy for hypertension control among low-income patients.
  • To assess the impact of the strategy on systolic blood pressure reduction and adherence to management protocols.
  • To compare the intervention to enhanced usual care in a real-world clinical setting.

Main Methods:

  • Randomized controlled trial assigning federally qualified health center clinics to either a multifaceted implementation strategy or enhanced usual care.
  • Intervention included team-based care, intensive blood-pressure management, audit and feedback, health coaching, and home blood-pressure monitoring.
  • Enhanced usual care involved physician education on hypertension guidelines. Primary outcomes were systolic blood pressure change and adherence score over 18 months.

Main Results:

  • The multifaceted strategy led to a significantly greater reduction in systolic blood pressure (-15.5 mm Hg) compared to enhanced usual care (-9.1 mm Hg) (P<0.001).
  • Adherence to blood-pressure management was significantly higher in the intervention group (2.8) versus the control group (2.1) (P<0.001).
  • No significant difference in serious adverse events was observed between groups.

Conclusions:

  • A multifaceted, team-based implementation strategy significantly improves systolic blood pressure control in low-income hypertensive patients.
  • This approach enhances adherence to blood pressure management protocols, addressing a critical gap in care for vulnerable populations.
  • The findings support the scalability and effectiveness of team-based care models in community health centers for managing chronic conditions.