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.