Abstract Body: Introduction: Hypertension (HTN), a leading cause of preventable mortality, disproportionately affects marginalized communities due to persistent healthcare disparities and socioeconomic barriers. Less than half of patients with HTN achieve blood pressure (BP) control, with Black Americans experiencing lower rates of control (34.9%) than non-Hispanic White Americans (45.0%). This pilot study evaluates the effectiveness of a telephone-based outreach intervention designed to improve BP control through self-management in a historically underserved population.

Methods: A pre-post, single cohort telephone-based quality improvement study was conducted from August 2024 to January 2025 at a Federally Qualified Health Center (FQHC). Patients with uncontrolled hypertension were contacted by trained student ambassadors (SAs) who delivered Life's Essential 8 hypertension education, lifestyle goal-setting guidance, BP self-monitoring support, and facilitated referrals to address health-related social needs (HRSN) during a series of three calls. During in-person “Hypertension Heroes” classes, patients who requested them received BP monitors and education on self-monitoring BP and lifestyle modification.

Results: Of the 333 Black patients with uncontrolled hypertension (mean age = 58 years; 52.3% female, 47.7% male), 570 call attempts were made. Of these, 117 patients completed Call 1, 40 completed Call 2, and 13 completed Call 3. At baseline, 61 participants reported owning a BP cuff, while 36 expressed interest in obtaining one. The cohort’s mean systolic and diastolic blood pressures were 162.51 mmHg (SD = 13.00) and 90.75 mmHg (SD = 14.01), respectively. Among patients with complete post-intervention data (n=50, 43%), the mean systolic BP decreased from 161.62 mmHg to 146.14 mmHg (Δ = -15.48 mmHg, 95% CI -22.40 to -8.56) and diastolic BP decreased from 86.18 mmHg to 83.46 mmHg (Δ = -2.72 mmHg, 95% CI -7.63 to 2.19), suggesting meaningful systolic improvements. In addition, 60 referrals were placed to address HRSN, and 170 patients participated in one or more in-person hypertension-related events.

Conclusions: Results show that integrating telephone outreach, clinician-led classes, and resource navigation can meaningfully reduce BP among Black patients. Participants reported improvements in self-managing BP, achieving lifestyle goals, and obtaining resources for HRSN. Future research should assess long-term sustainability, engagement strategies, and cost-effectiveness.