PAL2 for High Blood Pressure
(LEAPHTN Trial)
Trial Summary
What is the purpose of this trial?
Brief Summary: Black adults have a higher incidence of hypertension (HTN) and a greater risk of HTN-related cardiovascular disease (CVD) compared with White adults. Even mild elevations in blood (BP) above 115/75 mm Hg are associated with increased CVD risk. Accordingly, emphasis is being placed on early interventions for high BP, particularly in those who are low cardiovascular risk(systolic BP 110-139 and diastolic BP \< 90 mm Hg), for participants lifestyle modification is recommended. Although lifestyle modifications are effective to lower BP, implementation is suboptimal in Black communities, especially those participants residing in low-income urban settings. Pervasive negative social determinants of health (SDoH), such as poor access to healthcare, food insecurity, limited availability of healthy foods, lack of safe places to engage in physical activity, and low health literacy are major drivers of inequities in HTN and a critical barrier to implementation of recommended lifestyle modifications in Black communities. To achieve health equity, effective strategies must address negative SDoH that are root causes of racial disparities in health outcomes as clearly demonstrated by the coronavirus disease (COVID-19) pandemic. Predominantly Black cities like Detroit, Michigan, where the mortality rate from heart disease is nearly twice the national average, have been devastated by COVID-19. To address this, the investigators developed an innovative mobile health unit (MHU) program that uses geospatial health and social vulnerability data to direct deployment of testing and vaccination services to communities with highest needs. Since April 2020, the investigators conducted 500 events with 220 community partners where 40,000 people have been tested or vaccinated for COVID in MHUs. Using a hybrid type I effectiveness-implementation design in the proposed Linkage, Empowerment, and Access to Prevent Hypertension (LEAP-HTN) study, the investigators will implement a novel approach that links low cardiovascular risk Black adult participants without stage-2 hypertension to collaborative care delivered in deprived neighborhoods by community health workers (CHWs) using a personalized, adaptable approach to lifestyle and life circumstance (PAL2) intervention. The investigators will leverage our MHU program, layering on top of existing services to streamline access for screening, recruitment and all ongoing follow-up throughout the study period. Our specific aims are: AIM 1: To compare the effect of PAL2 intervention versus usual care (MHU engagement without PAL2) on systolic BP reduction and prevention of stage 2 HTN (systolic BP ≥ 140 mm Hg and/or diastolic BP \>90 mm Hg) among 500 Black adults with baseline untreated systolic BPs below stage 2 (ranging 110-139 mm Hg) and a diastolic BP \< 90 mm Hg. Hypothesis (H) 1a: Systolic BP (primary outcome) will be reduced more in those randomized to PAL2 intervention versus usual care at 6 and 12 months. H1b: Diastolic BP levels and the incidence of stage 2 HTN (systolic BP ≥ 140 mm Hg and/or diastolic BP \>90 mmm Hg) at 6 and 12 months (secondary outcomes) will be lower in participants randomized to the PAL2 intervention versus usual care. AIM 2: To use the RE-AIM framework to assess the reach, adoption, effectiveness, sustainability and cost of LEAP-HTN at 12 months post-randomization. H2a: The rates of adoption and sustainability of the PAL2 intervention will increase from baseline to 12 and up to 24 months in subjects with available data, respectively. H2b: PAL2 intervention will be more cost-effective than usual care at 12 months and projected to be more cost-effective at 10 years. Health Equity Impact: Targeted deployment of MHUs and PAL2 can mitigate several key adverse SDoH. LEAP-HTN contributes to the RESTORE Network by testing a sustainable and scalable approach to advance health equity and prevent HTN in Black adults participants. If successful, the use of MHU can be easily implemented in similar urban Black communities across the U.S.
Will I have to stop taking my current medications?
The trial requires that participants are not currently taking medications for high blood pressure, diabetes, heart disease, or kidney disease. If you are on these medications, you would not be eligible to participate.
What data supports the effectiveness of the treatment PAL2 for high blood pressure?
What makes the PAL2 treatment for high blood pressure unique?
The PAL2 treatment for high blood pressure is unique because it involves a specific implementation intervention (PAL2-II) that may include components like telemonitoring or behavioral self-management, which are not typically part of standard care. This approach could offer a novel way to improve blood pressure control by integrating technology and lifestyle changes.14678
Research Team
Eligibility Criteria
This trial is for Black adults over 18 living in Detroit with low cardiovascular risk, meaning no diabetes, chronic kidney disease, or heart conditions. They should have slightly elevated blood pressure but not be taking hypertension medication. The study excludes those with serious health issues like heart failure or a life expectancy under 2 years.Inclusion Criteria
Exclusion Criteria
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
Treatment
Participants receive the PAL2 intervention or usual care, with BP monitoring at 6 and 12 months
Follow-up
Participants are monitored for sustainability and cost-effectiveness of the intervention
Extension
Long-term follow-up to assess cost-effectiveness projected at 10 years
Treatment Details
Interventions
- PAL2 (Behavioral Intervention)
Find a Clinic Near You
Who Is Running the Clinical Trial?
Wayne State University
Lead Sponsor
Amanda Bryant-Friedrich
Wayne State University
Chief Executive Officer since 2023
PhD in Pharmaceutical Sciences
Dr. Polsky
Wayne State University
Chief Medical Officer since 2023
MD from Wayne State University