Outreach helps rural patients tackle high blood pressure at home

WILLIAMSON, West Virginia — Craig Warren's life revolved around sports when he was growing up. Football, basketball, baseball — "if they had it at school, I played it," he said.

But over the years, healthy activities like sports took a back seat to other demands. At 57, Warren has heart disease, kidney disease and diabetes. Ten years ago, he had a stroke. Three years ago, he received a kidney transplant.

These days, Warren checks his blood pressure four times a day, logging the numbers and reporting them to Melissa Justice, his community health worker and a nurse at the Williamson Health and Wellness Center. She showed Warren how to take his blood pressure and regularly checks in with him.

"Melissa calls to make sure my blood pressure is doing fine. If it isn't, she's in touch with the transplant clinic and they decide what I need to do," said Warren, who also sees Justice each week in his home in this once-thriving Appalachian coal town.

"It's so important for us to monitor his blood pressure now and keep it down, because if we don't, we could possibly lose the transplanted kidney," Justice said.

Key to Warren's ability to track his blood pressure is the monitor he's using, on loan from the Williamson Health and Wellness Center. It's one of more than 150 at-home, validated blood pressure devices the center has provided to community members who can't afford them — people whose health depends on their ability to routinely check their blood pressure to keep it under control.

Because insurance often won't cover the cost, the center provides these devices, thanks to a partnership with the American Heart Association and funding from the Pallottine Foundation of Huntington, West Virginia. Through similar partnerships at clinics and Federally Qualified Health Centers across the nation, the AHA helps put blood pressure cuffs on the arms of thousands of people who need them. Many, like Warren, live in rural areas with limited access to care.

High blood pressure's dangers

Nearly half of U.S. adults have high blood pressure, also called hypertension. Untreated, hypertension contributes to serious health conditions including heart attacks, heart failure, strokes, diabetes and kidney failure. Overall, only about one-fourth of U.S. adults with high blood pressure keep it properly controlled.

West Virginia has some of the highest rates of hypertension in the nation. Mingo County, where Warren lives, is no exception.

West Virginia also has nearly three times the national poverty rate. Many residents lack access to healthy foods and other resources that would make it easier to fight the multitude of chronic illnesses decimating the population.

Hypertension is only one of them, but it's a critical one to control. Research suggests that lowering blood pressure levels by just 10 mm Hg can reduce the risk for major cardiovascular events as much as 20%, stroke by 27% and death from any cause by 13%.

Studies show at-home blood pressure monitoring programs can successfully reduce hypertension rates. That's happening in Williamson, where the Wellness Center has been recognized by the AHA for achieving a greater than 70% hypertension control rate among the residents it serves. To date, 77% of its patients are maintaining blood pressure within the normal range.

The program lending out blood pressure devices came at a crucial time, Justice said. During 2020, the COVID-19 pandemic shut down many self-monitoring kiosks in local pharmacies. "No one had easy access to cuffs, and that's when the AHA stepped up. Especially during that time, it was very much appreciated."

What's more, the devices that the AHA helps provide are state-of-the-art, she said, noting that health insurance companies typically don't cover such devices.

Engaging the community

Holly Mitchell, the AHA's community impact director in West Virginia, who oversees the partnership, said seeing blood pressure numbers daily motivates people to lower them.

"When you give them the cuffs, you put power into their hands," Mitchell said. "It's almost like a game, how to get those numbers down. They start doing things like getting their weight down, exercising more."

Williamson isn't the only location benefiting from the program.

Using funds from the Pallottine Foundation grant, Mitchell said she's forged relationships with clinics that provide the blood pressure devices to dentists and libraries in several West Virginia counties, hoping to reach people who might otherwise be overlooked. All told, she's given out about 1,000 devices to programs across the state.

"We're trying to meet people where they are," she said. "They might not see a doctor that often, but they might go twice a year to get their teeth cleaned."

If a dentist discovers a patient has high blood pressure, that patient is referred to a local clinic for a medical consultation, she said. "This 'warm handoff' provides the critical clinical follow-up for folks who need hypertension care."

Libraries are another good place to reach people who don't always see a doctor, Mitchell said.

About 90 miles from Williamson, the Cabell County library system lends out blood pressure monitors as if they were books. The program operates through a partnership with Valley Health, which runs 40 health centers and public health programs across southwestern West Virginia and southern Ohio.

Cassie McCray, a medical assistant and community health professional for Valley Health, sets up a table at the Salt Rock public library in Cabell County during monthly events, showing people how to use the devices. She takes their blood pressure, explains what a healthy blood pressure level should be and talks to people about what foods to eat or avoid to keep blood pressure properly managed.

"Most of the people who stop to get their blood pressure taken are already on medication for it," said McCray. "But a lot of them don't have a way to check their blood pressure at home. They can take these monitors home, and that helps."

McCray recommends people see their doctor when their numbers are high. If they don't have a doctor, or if they don't have insurance, she refers them to a Valley Health clinic where they can pay based on what they can afford. Some are surprised to learn they have hypertension.

Mitchell would like to expand the program and is always looking for new ways to reach people who could benefit.

"We're always going to try," she said. "Hypertension really haunts us in West Virginia, and this has been really helpful."