Low income residents of inner city Seattle especially African Americans, have significantly higher rates of cardiovascular mortality and morbidity than other Seattle residents. Hypertension is a major risk factor for these excess deaths. The prevalence of both hypertension and uncontrolled hypertension is also higher among low income and minority residents, especially young men. The objective of this project is therefore to implement and evaluate with a randomized, controlled trial interventions to improve control of hypertension among inner city low- income and minority residents of Seattle. We propose two interventions which will improve upon existing activities and strengthen the relationship between community and clinic-based hypertension control activities: (1) Improving the identification and entry into care of new and uncontrolled hypertensives in the community with an emphasis on bringing more young males (especially African American) through: (a) screening and education activities (b) a microcomputer-based client tracking system to follow persons with elevated blood pressure (c) an outreach system to improve follow-up into clinical care (2) Enhancing access to and compliance with hypertension care among patients using the participating clinics (both currently registered patients and new patients referred through community screening activities) through: (a) microcomputer-based patient tracking system at each clinic to identify nonadherent and other high risk patients (b) placing a hypertension patient care coordinator at each clinic who will create an individualized care plan for each patient and coordinate a wide range of services, including specific strategies to enhance compliance (c) making available outreach workers to assist in efforts to keep patients in care.
