Above: Dr. Monika Safford reads blood pressure of patient Taneisha Davis.

High blood pressure kills: Black Belt residents know this, nowhere more than in Wilcox County, which is among the nation’s poorest counties. Two-thirds of Black Belt residents are obese, and many have diabetes and high blood pressure.

This combination of risk factors and scarce healthcare resources put Black Belt residents at high risk of stroke and heart attacks. In fact, African-Americans are twice as likely as whites to die of heart disease.

The University of Alabama at Birmingham (UAB) seeks to change that reality, under the leadership of physician-researcher Dr. Monika Safford. On Sept. 28, UAB was awarded $9.4 million by the National Institutes of Health with funds from the Patient Centered Outcomes Research Institute to improve blood pressure control and the health of poor, rural African-Americans. Safford’s study is called “Collaboration to Improve Blood Pressure in the U.S. Black Belt – Addressing the Triple Threat.” UAB is collaborating with investigators and community partners, the University of North Carolina and East Carolina University.

“There are so many big health issues in Alabama’s Black Belt and across the Southeast where especially African-Americans have multiple risk factors for heart disease and stroke such as high blood pressure, high cholesterol, and diabetes,” said Safford, assistant dean for Continuing Medical Education and the inaugural Endowed Professor in Diabetes Prevention and Control at the UAB School of Medicine, where she has worked since 2003.

“The Black Belt doesn’t receive enough attention, with huge health problems and too few physicians,” Safford said. “It’s the perfect mismatch of needs and resources that have helped create a tremendous chronic disease burden.” She said African-Americans in the Black Belt are less likely to control their blood pressure than other Americans.

“Although we have made great strides in getting the word out in African-American communities about their high risks of high blood pressure, many do not achieve recommended targets to adequately reduce risks for heart attack and strokes,” Safford said. “Sometimes attention to blood pressure gets crowded out by more pressing health needs.”

Safford, who has practiced medicine in Pennsylvania, Rhode Island, Connecticut, New Jersey and Alabama, said that primary care doctors often juggle competing health conditions in the same patient, many times in just a few minutes during an office visit.

Dr. Monika Safford checks blood pressure on Taneshia Davis.

UAB recently received 9 million dollar grant from the National Institutes of Health (NIH) for blood pressure study.

Dr. Safford: “The Black Belt doesn’t receive enough attention, with huge health problems and too few physicians.”

Dr. Safford reviews blood pressure readings with Davis.

UAB’s study will examine the effects of “peer coaches” and of practice facilitation to help primary care doctors make high blood pressure care more systematic and patient-friendly. Peer coaches are trained community members who act as cheerleaders and help patients problem solve so they can follow a doctor’s full advice. Practice facilitation is a consultative service using a highly customized, staged approach to help implement process and structural changes to enhance the quality of healthcare, and improve patient and staff satisfaction.

The study will engage 50 primary healthcare practitioners in the Black Belt and 30 in North Carolina and, at each practice, 25 African-American patients with uncontrolled high blood pressure, to compare the effectiveness of peer coaching and practice facilitation to improve patients’ blood pressure and overall health. That totals 1,250 participants from Alabama and 750 from North Carolina.

“The practice facilitation activities will include teaching practice staff how to start doing proactive outreach to people with uncontrolled high blood pressure,” Safford said. As part of the study, for example, patients who miss appointments and whose blood pressure was not controlled at the last visit will receive blood pressure monitors for home use so that practitioners can phone them for home blood-pressure readings.

The use of peer coaches has been successful in improving heart disease risk factors in Black Belt communities.

“We’ve seen that patients are often more open with a peer coach than with their doctor,” Safford said. “Though they’re not healthcare professionals, peer coaches in our model come from the same communities as the patients, so they understand the problems patients face in trying to carry out a doctor’s full advice. Many people are afraid to tell their doctor they are having side effects or can’t afford the medicine; peer coaches can help patients communicate better with the healthcare practice. The medicine can’t help you if you are not taking it.”

The study team hopes to find whether doctor practice redesign and peer coaching, alone or in combination, can improve blood pressure control. The results may help Black Belt healthcare providers decide which approach is right for them, especially when there are not enough funds to support both.

The study team includes co-principal investigator Dr. Joshua Richman and investigators Dr. Mike Herrington, Tamela Turner, Susan Andreae, Lynn Andreae and Jean White of the UAB School of Medicine. Dr. George Howard, Joan Hilner and Richard Mailhot of UAB’s School of Public Health will also serve. The research will be conducted in Alabama in partnership with the Black Belt-based Livingston Health and Wellness Center and the West Central Alabama Health Improvement League, as well as the West Central and Southeast Alabama Area Health Education Centers.

In the long run, the study team hopes that Black Belt residents will have a better understanding about the importance of taking care of one’s health. That includes knowing their blood pressure numbers and what they indicate, Safford said.

“Knowing your numbers is the route to longevity and good health,” she said. “Good health is precious.”