Key result
The Bring it Down program, utilizing community health workers to link patients to primary care, reduced mean systolic blood pressure by 16 mmHg (99% CI -21 to -12) among those with follow-up.
Why the study?
Hypertension is the primary contributor to cardiovascular disease, but the reach and effectiveness of using community health workers to link patients with undiagnosed or uncontrolled hypertension to primary care needed evaluation.
Does linkage to primary care via community health workers reduce systolic blood pressure in adults with undiagnosed or uncontrolled hypertension?
Observational (n=519)
Yes
Does linkage to primary care via community health workers reduce systolic blood pressure in adults with undiagnosed or uncontrolled hypertension?
Mean Difference: -16 (95% CI -21–-12)
A community health worker-led program linking emergency department and mobile health unit patients to primary care significantly reduced systolic blood pressure in a socially vulnerable population, though participation and follow-up rates were low.
CHW linkage from EDs was associated with SBP reduction among followed participants; leaves open effectiveness given low reach and need for RCTs.
Hypertension is the most important contributor to the development of cardiovascular disease. The objective of the Bring it Down program was to examine the reach and effectiveness of linkage to primary care via community health workers (CHWs) to improve blood pressure control among people with undiagnosed or uncontrolled hypertension. Adults with systolic blood pressures ≥130 mmHg were initially recruited from four urban emergency departments that serve high-risk, socially vulnerable populations. Due to the COVID-19 pandemic, we also enrolled participants in the community who presented to mobile health units. CHWs facilitated follow-up blood pressure assessment within 1 year. Of 153 630 ED patient encounters during the evaluation period, 61% were eligible to participate in the BID program; of these, 3% were approached, and 16% (395/2476) agreed to participate. Compared to ED encounters, fewer patients presenting to MHUs were eligible to participate (42%, 1780/4211), all of whom were approached, and 7% (124/1780) agreed to participate in the BID program. Among participants with at least one follow-up encounter (n = 158), there was a statistically significant reduction in mean systolic BP (mean difference: -16 mmHg, 99% confidence intervals (CI): -21, -12 mmHg) with a median time between SBP measurements of 20 days (interquartile range [IQR]: 8, 53 days). Clinical and community recruitment paired with CHW connections to primary care may be a viable quality improvement strategy for improving blood pressure control in high-risk, socially vulnerable populations. However, additional research is needed to understand and improve participation and follow-up rates to establish program effectiveness.
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Foster et al. (2025) conducted an observational in undiagnosed or uncontrolled hypertension (n=519). Bring it Down program (linkage to primary care via community health workers) was evaluated on reduction in mean systolic BP (MD -16 mmHg, 95% CI -21 to -12). The Bring it Down program, utilizing community health workers to link patients to primary care, reduced mean systolic blood pressure by 16 mmHg (99% CI -21 to -12) among those with follow-up.
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