Advancing Health Podcast

Encore: Fighting Hypertension Through Community Collaboration

Date: March 16, 2026
Host: Dr. Chris Dirienzo, Chief Physician at American Hospital Association
Guests:

• Anna Therakin, Lead Project Manager, Closing the Gap on Hypertension Disparities, Duke
• Professor Brady Granger, Duke University School of Nursing, Co-PI

Episode Overview

This encore episode spotlights innovative community-led strategies for reducing hypertension disparities in Durham County, North Carolina. Dr. Chris Dirienzo interviews Anna Therakin and Professor Brady Granger, who detail their collaborative project, which leverages community health workers, student ambassadors, and partnerships with local clinics to improve hypertension management, particularly among underserved populations.

Key Discussion Points & Insights

Understanding the Scale of Hypertension in Durham (00:48 - 04:51)

• Prevalence and Impact:

  • Over 50% of those diagnosed with hypertension in Durham County do not have their condition well-controlled.
  • “Despite the proven interventions…over 50% of patients that are diagnosed with hypertension kind of have their condition controlled. And…there’s a prevalence of hypertension of almost 42%.” — Anna Therakin (01:18)
  • Durham’s population is roughly 300,000. About 42-48% have hypertension, with high rates of unawareness or poor control. Disparities are notably higher among Black residents and other minorities.
    • "About 42 to 48% of the people in this county have hypertension. About half of those are uncontrolled or unaware...higher prevalence and the higher mortality and comorbidity...in the black population, which...is true throughout the South." — Prof. Granger (03:11)

• Settings:

  • Durham presents both urban and rural challenges within a compact geography, complicating outreach and care delivery.
    • "You are going from a very urban feel to a very rural feel quite quickly." — Dr. Dirienzo (04:51)

Approach: Community-Based Interventions (01:18 - 06:38)

• Collaboration and Structure:

  • The Duke project employed a quality improvement intervention centered on a telephone outreach program.
  • Partnerships include the local Federally Qualified Health Center (FQHC), Duke student ambassadors, and several safety net clinics.
  • Students conducted 3-4 structured calls with a cohort of approximately 300 patients:
    • Provided hypertension education tailored to lifestyles
    • Distributed free blood pressure cuffs
    • Helped patients develop "SMART" goals and establish accountability partners
    • Performed social needs assessments to address non-medical barriers

  “We distributed free blood pressure cups. We helped them create smart goals and accountability partners...trying to identify what are other things that are kind of getting in the way of your hypertension and health.” — Anna Therakin (01:18)

Amplifying Outreach: Role of Community Health Workers and Students (05:47 - 08:05)

• Bridging Gaps in Care:

  • Community health workers (CHWs) expand the reach beyond the clinic setting by addressing social determinants and building relationships during non-traditional hours.
  • Students serve as patient navigators, enabling outreach beyond clinical settings and hours, personalizing education, and empowering patients.

  “What really community health workers, and in our case students, were able to really fill that gap was...being able to take that time with patients when they had it…making sure outside clinic hours, where can we sit and really impact and make a change.” — Anna Therakin (06:38)

  • Examples include practical lifestyle advice tailored to individuals' daily challenges (e.g., integrating walking into childcare routines).

  “Really be their personal cheerleader and...instill in these, these small changes that can really make such a big difference in their blood pressure and hypertension.” — Anna Therakin (07:21)

Measurable Outcomes and Impact (08:05 - 11:22)

• Clinical Results:

  • Notable improvements in blood pressure control:
    • Average drop in systolic BP of over 15 mmHg among program participants
    • Enhanced self-management and frequent self-monitoring due to provision of blood pressure cuffs

  “Within our intervention this past year we saw a average drop in the systolic blood pressure of those that participated of over 15 milligrams of mercury, which is just a really huge kind of drop.” — Anna Therakin (08:40)

  • Empowerment through patient education, self-monitoring, and social needs assessments

• System Integration:

  • Strengthened linkages among patients, families, primary care, CHWs, and community organizations (e.g., food and housing assistance)
  • The model closes referral loops and tracks non-medical as well as medical needs
  • Project outcomes inform public policy, such as Medicaid expansion and Healthy Opportunities Pilots

  “Our real achievement...is...bringing the power to the patient to set their goals...effectively connect a patient to the primary care provider team, including the community Health worker and...community business organizations.” — Prof. Granger (09:21)

  “We have the evidence and the measurable outcomes to support new policies for expansion of those kinds of efforts in a community.” — Prof. Granger (10:52)

Practical Advice and Key Takeaways (11:22 - 12:56)

• For Health Care Teams:

  • Engage with primary care and show interest in collaborative hypertension management programs as partners, not just patients.

  “Communicate with your primary health care provider and let them know you're interested in joining our team as a patient expert in the hypertension management program.” — Prof. Granger (11:57)

• For Hospitals:

  • Community-focused interventions are achievable and can drive real, positive change.
  • Integrate CHWs and students into care teams and bridge clinical and community settings.

  “It’s possible to get intervention like this off the ground and it really can make a real big difference in patients lives. And...connecting back that primary care...is a really important component.” — Anna Therakin (12:17)

Notable Quotes & Memorable Moments

• “Wouldn't we all benefit from having a personal cheerleader, especially when fighting...a condition like hypertension, which is so seemingly innocuous because it's just a number on a machine.”
  — Dr. Dirienzo (08:05)

• “Our real achievement...is...bringing the power to the patient to set their goals and really be able to be aware and to be responsible for changes and improvements in their health…”
  — Prof. Granger (09:21)

Closing Thoughts

• The episode showcases how academic health systems, community clinics, CHWs, and students can partner to address health disparities through locally tailored innovation and patient empowerment.
• Emphasis is placed on measurable improvement, relationship-building, and system change for sustainable health gains.

“Thanks for your support and for the dissemination of efforts like this and the impact it has on our community.” — Prof. Granger (12:56)

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