Team Care Cuts Blood Pressure 16 mm Hg in Poor Patients
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- The NEJM study randomly assigned more than 1,200 patients with uncontrolled hypertension at 36 federally qualified health centers in Louisiana and Mississippi to either a team-based, protocol-driven approach or enhanced usual care, tracking them for 18 months through the COVID-19 pandemic.
- Team-supported care patients cut their top blood pressure number by an average of 16 mm Hg over 18 months, compared with a 9 mm Hg reduction in the control group, with the team arm also scoring higher on adherence to blood pressure management.
- Co-author Jiang He of UT Southwestern reported that 47.7% of patients in the team group achieved systolic blood pressure below 130 mm Hg — more than double the 22% rate in the U.S. general population — while the average implementation cost was $762 per patient.
- Tom Frieden, former CDC director and president of Resolve to Save Lives, praised the trial for translating SPRINT findings to groups that could benefit most but warned that the U.S. health care system's misaligned incentives mean such trials remain 'islands of progress in a sea of inaction.'
- An accompanying NEJM editorial by Sadiya Khan and Mark Huffman called the blood pressure difference between groups 'modest' and the effort 'costly,' framing the results as 'much-needed evidence for systems-based strategies' that can work in community health centers.
- Most participants were African American (nearly two-thirds), unemployed (three-quarters), and had family incomes under $25,000 per year; health coaches helped patients apply for medication assistance programs so they could afford their prescriptions.
Why it matters: If scaled beyond Louisiana and Mississippi, this protocol could narrow a stubborn racial and economic gap in hypertension control — nearly two-thirds of participants were African American and three-quarters earned under $25,000 — but the $762-per-patient cost and Frieden's warning that U.S. fee-for-service incentives still reward heart attacks over prevention mean replication depends on systemic reform, not just clinical willpower.
