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Global burden
Hypertension is a leading, largely preventable cause of stroke, heart disease and kidney failure. The World Health Organization (2025) estimates that 1.4 billion adults aged 30 to 79 had hypertension in 2024, that 44% of them were unaware of it, and that only 23% had it under control.
The local population
This plan focuses on adults in an urban U.S. county where, according to the county health assessment described here, hypertension prevalence and stroke deaths exceed state averages and are highest among Black residents. Under the current U.S. guideline, hypertension is diagnosed at 130/80 mm Hg or higher, and the treatment goal for most adults is below 130/80 mm Hg (Jones et al., 2025).
Social determinants of poor control
- Health care access: few primary care appointments and gaps in insurance coverage interrupt diagnosis and medication refills.
- Economic stability: medication costs and hourly jobs without paid leave make appointments hard to keep.
- Neighborhood and built environment: few full-service grocery stores and few safe places to exercise.
- Social and community context: mistrust of health care, rooted in historical and ongoing discrimination.
Evidence for a community-based approach
Bringing care to trusted community settings can close these gaps. In a cluster-randomized trial in Black-owned barbershops in Los Angeles County, pharmacists who met customers at the barbershop and prescribed medication under a collaborative practice agreement achieved a mean systolic blood pressure reduction 21.6 mm Hg greater than in the control group at six months (Victor et al., 2018).
Proposed intervention
The county health department partners with barbershops, salons and faith communities:
- Community health workers check blood pressure at partner sites and link people with high readings to care within the same week.
- A nurse practitioner and pharmacist team adjusts treatment using standardized protocols and validated home blood pressure monitors.
- Low-cost generic single-pill combinations and 90-day refills reduce cost and visit burden.
Evaluation
The primary outcome is the proportion of enrolled adults with blood pressure below 130/80 mm Hg at 12 months. Process measures include screenings completed, referrals kept and medication refill rates, reported quarterly by race and ethnicity to track equity.
References
Jones, D. W., Ferdinand, K. C., Taler, S. J., Johnson, H. M., Shimbo, D., Abdalla, M., Altieri, M. M., Bansal, N., Bello, N. A., Bress, A. P., Carter, J., Cohen, J. B., Collins, K. J., Commodore-Mensah, Y., Davis, L. L., Egan, B., Khan, S. S., Lloyd-Jones, D. M., Melnyk, B. M., . . . Williamson, J. D. (2025). 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM guideline for the prevention, detection, evaluation and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Hypertension, 82(10), e212–e316. https://doi.org/10.1161/HYP.0000000000000249
Victor, R. G., Lynch, K., Li, N., Blyler, C., Muhammad, E., Handler, J., Brettler, J., Rashid, M., Hsu, B., Foxx-Drew, D., Moy, N., Reid, A. E., & Elashoff, R. M. (2018). A cluster-randomized trial of blood-pressure reduction in Black barbershops. New England Journal of Medicine, 378(14), 1291–1301. https://doi.org/10.1056/NEJMoa1717250
World Health Organization. (2025, September 25). Hypertension [Fact sheet]. https://www.who.int/news-room/fact-sheets/detail/hypertension
