Abstract Body: Introduction: Black adults in the rural South have disproportionately higher rates of cardiovascular disease and hypertension compared to White and urban adults, largely due to socioeconomic and environmental barriers to a healthy lifestyle. These inequities highlight the need for targeted hypertension prevention programs.
Methods: Through partnerships with churches in the Black Belt region of Alabama, we are conducting a cluster randomized controlled trial to test the effectiveness of community-based education alone vs. education combined with individual plus community-level peer support on the prevention and progression of hypertension. Black adults with elevated blood pressure (BP) or stage 1 hypertension, with no history of cardiovascular or kidney disease, and no history of taking antihypertensive medication were recruited from partnering churches and the community.
Results: Recruitment was conducted from August 2022 to September 2024. We enrolled 30 churches from 20 counties in rural Alabama. We screened 1,270 adults, and 371 were enrolled. The most common reasons for exclusion were BP being too low, history of hypertension, and BP being too high. Randomized participants had a mean age of 41 years. Participants randomized to the intervention had a mean systolic BP of 126 mmHg and mean diastolic BP of 79 mmHg; 66% were female; 6% had less than a high school education; 83% had a Mediterranean Eating Pattern for Americans (MEPA) score of 4-11; and the median score for metabolic equivalent of task (MET) minutes per week was 728. At enrollment, 40% of intervention participants had a healthcare visit within the past year; 70% had a usual place to receive healthcare; and 9% had delayed medical care due to cost. Participants randomized to control had a mean systolic BP of 125 mmHg and mean diastolic BP of 78 mmHg; 64% were female; 3% had less than a high school education; 80% had a MEPA score of 4-11; and a median score of 954 MET minutes per week. At enrollment, 47% of control participants had a healthcare visit within the past year; 70% had a usual place to receive healthcare; and 13% had delayed medical care due to cost.
Conclusion: The EPIPHANY Trial randomized a rural, Black population of individuals with elevated BP or stage 1 hypertension. Most participants are female, have at least a high school education, have poor to moderate diet, are moderately active, and have regular access to healthcare.