The Innovative Cardiovascular Health Program

Objectives: This program purpose is referencing unequal socioeconomic conditions and unfair opportunity structures have long existed and contribute to poor health outcomes in minority and ethnic populations and geographically and economically disadvantaged communities. Poverty, inferior housing and health care, and other debilitating social conditions are endemic to some communities, including Non-Hispanic Black (NHB), Hispanic, and Native American communities. Research highlights the high prevalence of cardiovascular disease (CVD), including hypertension, high cholesterol, and stroke in these groups. CVD is the leading cause of death in the US and stroke is the 5th leading cause with an estimated 1 in 9 health care dollars spent treating CVD. Despite significant decreases in CVD rates in the last 20 years, NHB continue to have higher CVD mortality rates than Non-Hispanic Whites (NHW). In 2019, NHB women and men younger than 65 were 2.0 and 1.3 times more likely to experience premature death from CVD than their NHW counterparts. In 2020, NHB had the highest heart disease mortality rates at 228.6 per 100,000 and stroke at 56.8 per 100,000. Uncontrolled hypertension is the primary contributor to morbidity and mortality rate disparities in CVD between NHB and other racial and ethnic groups. In 2019, NHB had more than double the age-adjusted death rates (56.7) attributable primarily to hypertension compared to NHW (25.7). Of the 1 in 2 US adults with hypertension, only 26.1% have controlled blood pressure. By age 55, the cumulative incidence of hypertension reaches almost 76% in NHB men and women, compared to 54.5% and 40.0% among NHW men and women, respectively. Moreover, NHB had a 1.5 to 2 times higher risk for hypertension after adjustment for other factors, regardless of baseline blood pressure. Among NHB adults who did not report a hypertension diagnosis, a larger proportion (28%) were unaware of hypertension (BP ?140/90 mm Hg) compared to NHW adults (16%). Despite the similar rate of hypertension treatment, only one-third of NHB adults had their blood pressure controlled, in contrast to 45.0% of NHW adults. These data clearly indicate that NHB bear the greatest burden of CVD among US adults. The outcomes are as stark in other CVD-related illnesses. Although the prevalence of high cholesterol in NHB is comparable to or lower than in NHW, racial-ethnic disparities occur at every level of diagnosis and management. The disparities present in low screening rates, fewer prescriptions, and medication adherence. Unsatisfactory control of high cholesterol among NHB stems from the same adverse social conditions that hinder the control of hypertension. Interventions must include an understanding of individual and community factors that influence a healthy diet, losing weight, being physically active, and medication adherence to address the disparities and inequities. There is a need for equity-focused health system interventions to prevent, detect, control, and manage hypertension and high cholesterol. Building on lessons from the previous work, this program focuses on comprehensive efforts to identify and respond to health care disparities and improve CVD-related outcomes, specifically for those with hypertension and high cholesterol. Populations of focus for this program are adults aged 18 and older with a hypertension crude prevalence of 53% or higher, as shown by data specifically at the census tract level. Emphasis should be placed on achieving impact and reach across geographic locations where disparate populations can benefit from the strategies included in this program.