# Identifying and testing a tailored strategy to achieve equity in blood pressure control in PACT

> **NIH VA I01** · VA SALT LAKE CITY HEALTHCARE SYSTEM · 2024 · —

## Abstract

Background: Hypertension and blood pressure (BP) control inequities are a leading modifiable risk factor for
the higher cardiovascular disease (CVD) morbidity and mortality experienced by racial/ethnic minority
Americans. Team based care, an evidence-based practice, may be effective in reducing BP control disparities.
However, despite VA Primary Aligned Care Team (PACT) implementation, BP control race/ethnic inequities
persist. This highlights a need tailored bundle of implementation strategies (i.e., playbook) to address the
unique needs of minority Veterans. The 2020 VA/DoD Hypertension Clinical Practice Guideline recommends a
threshold for medication initiation in high CVD-risk patients and for medication intensification in all hypertensive
patients be lowered by 10 mm Hg (vs older guidelines) to systolic BP 130 mm Hg (intensive BP control), if
aligned with clinical judgement and patient preference. Achieving and maintaining intensive BP control could
avert half a million CVD events in the US overall over 10 years, however there is a need for implementation
playbooks that ensure the known benefits of intensive BP control are experienced equally.
Significance: Our goal is to reduce hypertension-related morbidity and mortality disparities in VHA by
optimizing antihypertensive medication management in PACT. Achieving and maintaining intensive BP control
may avert half a million CVD events over 10 years in the US.
Innovation and Impact: Our study will leverage the VHA Office of Health Equity Primary Care Equity
Dashboard (PCED) launched in 2021, an audit feedback tool, may be an important strategy to a population
health management approach, to support team-based playbooks designed to mitigate hypertension disparities
and support evidence based practice update among race/ethnic minority Veterans.
Specific Aims: Aim 1) Contrast patient-, provider-, and facility-level factors associated with intensive
antihypertensive management (initiation, adherence, and intensification) and BP control by race/ethnicity; Aim
2) Using qualitative data, identify patient, provider- and facility-barriers and facilitators relevant to intensive
antihypertensive management (initiation, adherence, and intensification) and BP control by race/ethnicity; and
Aim 3) Codesign two intensive BP control population health management implementation playbooks tailored to
reduce BP inequities and prototype and pilot test the playbooks in PACT.
Methodology: In Aim 1, we will complete a hierarchical analysis of patient (e.g. sex, age, socio-demographics,
comorbidities, non-VA community and virtual healthcare use), provider (e.g. specialty, patient-provider visit
frequency), and facility (e.g. urban/rural status, geographic location, % racial minorities served, academic
affiliation, PACT implementation) factors associated with intensive BP management. In Aim 2, applying the
Theoretical Domains Framework in conjunction with the Chronic Care Model, we will collect and analyze semi-
structu...

## Key facts

- **NIH application ID:** 10830911
- **Project number:** 5I01HX003513-02
- **Recipient organization:** VA SALT LAKE CITY HEALTHCARE SYSTEM
- **Principal Investigator:** April F Mohanty
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2023-04-01 → 2027-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10830911

## Citation

> US National Institutes of Health, RePORTER application 10830911, Identifying and testing a tailored strategy to achieve equity in blood pressure control in PACT (5I01HX003513-02). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10830911. Licensed CC0.

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