Closing the Gap on Health Disparity and Treatment Outcomes in Hypertension (2020-2021)


Hypertension is a leading cause of death and disability in the United States and affects over 116 million adults, with direct costs projected to exceed $220 billion by 2035. More than a third of Americans with hypertension are not aware they have it. Despite interventions that have been proven effective, only 48% of those diagnosed have their illness controlled. To make matters worse, disparities are well documented in hypertension treatment, control and outcomes. The burden of hypertension is exacerbated among minorities; prevalence among blacks is much higher than non-Hispanic whites, and deaths attributable to hypertension are over twice as frequent among blacks as whites.

Durham County, North Carolina, is a mix of rural and urban geography that is an ideal community in which to test implementation strategies to reduce hypertension disparities and improve population health. The overall prevalence of hypertension in Durham County is 42%, with substantial geographic heterogeneity in prevalence among whites and blacks. There is a strong association with residential racial isolation, suggesting opportunities to intervene at the neighborhood level to reduce hypertension disparities and improve population health.

Project Description

This project team’s goal is to improve cardiovascular health outcomes in Durham County. The project team will start by defining barriers to effective care (screening and treatment) in the community through patient story narratives. Team members will define resources through geospatial mapping of targeted opportunities to access care regarding diet, exercise, blood pressure monitoring and medical management. The team will draw on evidence from population medical screenings for hypertension in low-resource settings, which will offer strategies for predicting and screening for hypertension in ways that could prevent further inequities.

Team members will then adapt proven strategies for blood pressure measurement and delivery of evidence-based interventions to the Durham community, including the use of community-based resources. They will design a plan for implementation and evaluation tailored to Durham County with patient and community stakeholders, with a focus on continuous quality improvement and monitoring throughout implementation. The team will replicate Kaiser-Permanente’s evidence-based strategy, which incorporates a comprehensive hypertension registry, development and sharing of performance metrics, evidence-based guidelines, medical assistant visits for blood pressure measurement and single-pill combination pharmacotherapy.

In addition, the team will develop a sustainability plan with common practices that are generalizable to other communities and regions. Methods for development of the sustainability plan will be designed with community members, including patients, families and stakeholders. Lastly, the team will evaluate current health policy and analyze the policy environment, including evaluation of exiting payer strategies. The team will then propose policy changes that may improve quality measurement and uptake, and will present these suggestions for change at both the state and national levels.

Anticipated Outputs

Six manuscripts; conference presentations


Summer 2020 – Spring 2021

  • Summer 2020 (optional): To be determined with team leaders
  • Fall 2020: Define barriers to effective care; meet with Duke-Margolis staff members; adapt proven strategies
  • Spring 2021: Continue meetings with Duke-Margolis staff members; design implementation and evaluation plan; develop sustainability plan; submit manuscripts; present at American Heart Association Scientific and National Academies of Health health policy sessions.


Image: Check your blood pressure yearly to help prevent hypertension, by Staff Sgt. Josie Walck/U.S. Air Force

Cuff reader.

Team Leaders

  • Holly Biola, School of Medicine-Medicine:Geriatrics
  • Bradi Granger, School of Nursing
  • L Kristin Newby, School of Medicine-Medicine: Cardiology
  • Neha Pagidipati, School of Medicine-Medicine: Cardiology

/graduate Team Members

  • Sandra Au, Medicine MD Second Year
  • Aline D'Angelo Campos, Masters of Public Policy
  • Evan Murray, Medicine MD Second Year
  • Daniel Tounsel III, Adult-Gerontology NP - MSN
  • Unique Whitehurst, Bachelors of Science - Nursing

/undergraduate Team Members

  • Beles Abebe, Sociology (AB), Psychology (AB2)
  • Arianna Buchanan
  • Dakota Douglas, Biology (BS)
  • Ashwin Gadiraju
  • Emily Gitlin
  • Rohan Gupta
  • Irene Jonathan
  • Adam Lin, Biology (BS)
  • Alexis Mandell, Public Policy Studies (AB), Global Health (AB2)
  • Isaiah Mason, Int Comparative Studies (AB)
  • Lily Orta
  • George Romero
  • Neha Shrishail, Neuroscience (BS)
  • Kamryn Stafford
  • Anthony Tarakji
  • Katie Xu, Cultural Anthropology (AB)

/yfaculty/staff Team Members

  • Hayden Bosworth, School of Medicine-Psychiatry and Behavioral Sciences
  • Maria Carroll, Duke University Health System
  • Amy Corneli, School of Medicine-Population Health Sciences
  • Howard Eisenson, School of Medicine-Family Medicine and Community Health: Diet and Fitness Center
  • Christopher Granger, School of Medicine-Medicine: Cardiology
  • Tara Kinard, Duke Population Health Management Office
  • Andrew Olson, School of Medicine-Duke Clinical Research Institute
  • Manesh Patel, School of Medicine-Medicine: Cardiology
  • Robert Saunders, Margolis Center for Health Policy
  • Sean Sondej, Duke University Hospital