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Outcomes of a multi-community hypertension implementation study: the American Heart Association’s Check. Change. Control. program


Single-site, intensive, community-based blood pressure (BP) intervention programs have led to BP improvements. The authors examined the American Heart Association’s Check. Change. Control. (CCC) program (4069 patients/18 cities) to determine whether BP interventions can effectively be scaled to multiple communities, using a simplified template and local customization. Effectiveness was evaluated at each site via site percent enrollment goals, participant engagement, and BP change from first to last measurement. High-enrolling sites frequently recruited at senior residential institutions and service organizations held hypertension management classes and utilized established and new community partners. High-engagement sites regularly held hypertension education classes and followed up with participants. Top-performing sites commonly distributed BP cuffs, checked BP at engagement activities, and trained volunteers. CCC demonstrated that simplified community-based hypertension intervention programs may lead to BP improvements, but there was high outcomes variability among programs. Several factors were associated with BP improvement that may guide future program development.


Hypertension is the leading cause of cardiovascular disease in the United States, affecting more than 78 000 000 adults.[1] In 2010, the American Heart Association (AHA) set the ambitious goal of improving the cardiovascular health of all Americans by 20% and reducing deaths from cardiovascular disease and stroke by 20% by the year 2020.[2] Pivotal to this goal is the development of prevention strategies that are simple, cost-effective, sustainable, and scalable.

The AHA has recently supported two large-scale, multifaceted, quality improvement efforts designed to assess the impact of pharmacists and/or community health workers, as well as the signature Heart360 information health technology, on lowering people’s blood pressure (BP).[3, 4] Both of these academic-community partnership initiatives were effective; however, they were also resource-intensive in terms of cost and staffing, raising the question of whether such programs could be effective and scalable with less academic and financial support. Furthermore, it was unclear whether the findings from these initiatives could be generalized to other regions of the United States.

In 2013, the AHA launched the Check. Change. Control. (CCC) BP program, which was a multi-intervention community-based initiative to improve BP control in 18 cities in the United States. AHA staff and volunteers in each geographic area worked with businesses, institutions, and community partners to build health campaigns targeting BP self-management. Each city’s campaign had four mandatory implementation components: (1) the AHA’s multicultural director in each city oversaw the design of the community-based program; (2) community partners were utilized as a place for program implementation, volunteer health mentor recruitment, and/or participant recruitment; (3) volunteer health mentors (lay persons or health professionals who were trained by national and regional AHA staff leadership) provided education, followed participants, and/or provided assistance for BP uploads; and (4) the Heart360 online BP monitoring tool was used to track BP trends and uploads. In addition to these four strategies, all 18 sites were allowed to customize a campaign for their community setting. As a result, CCC presented a unique opportunity to evaluate 18 similar—albeit separate—simultaneous experiments in community-based BP control.

In order to assess the ability of the CCC program to reduce BP, we evaluated the program’s ability to: (1) enroll participants, (2) sustain participation, and (3) improve BP control. By comparing the differential features and outcomes of these 18 mini-campaigns, we gained insight into which campaign features most correlated with success.

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