Hypertension (HT), uncontrolled blood pressure (>140/90 mmHg), is the leading preventable cause of premature death globally and a major risk factor for coronary heart disease, stroke, and other conditions. European and African regions have the highest prevalence rates at about 40% of adults. The U.S. has comparable rates and disturbing disparities in non-White minority groups. Native Hawaiians (NH), an indigenous U.S. population, are 70% more likely to have HT; 4 times more likely to have coronary heart disease or stroke than Whites. Hula, the cultural dance of NH, offers promise of a culturally responsive strategy for HT control. We conducted a randomized clinical trial with a waitlist control to test the impact of a hula-based cultural dance intervention (CDI) on systolic blood pressure (SBP) in 263 NH with HT. All participants received HT education (e.g. diet, exercise, medication) during 3 1-hr sessions over 2 weeks, then randomly assigned to CDI (n = 131) or waitlist control (WC; n = 132). The CDI received 6 months of hula (2 1-hr sessions/week x 3 months, then 1 lesson/mth x 3 months with self-directed practice), with group activities to reinforce HT education. WC only received the initial HT education, then offered hula after the study. Assessments were done at 0-, 3- and 6-month, with 12-month for CDI only. Baseline characteristics were balanced between groups, except for weight. Adjusting for weight and baseline SBP in intent-to-treat analysis, CDI achieved significant reductions (p < .05) in SBP (-15.3 mmHg; SE = 1.6) compared to WC (-11.8 mmHg, SE = 1.7). From 6 to 12 months, CDI maintained their SBP (mean change: 1.47 mmHg, SE = 1.26; p = .16) improvements at 12 months. CDI were more likely to achieve SBP reduction ≥ 10 mmHg than WC, 60% vs 48% (p = .03), respectively. A CDI based on the NH cultural dance significantly improved HTN management in NH with uncontrolled SBP. Improvements were comparable to the best proven non-medication treatment of HT. Key messages Improving elevated blood pressure control with at-risk populations can be effectively and innovatively achieved by utilizing culturally responsive strategies, such as cultural dance interventions. Leveraging and aligning community strengths and health objectives leads to innovation and empowerment.

HTN (HTN) is an important and modifiable risk factor for cardiovascular disease, the leading cause of death. Native Hawaiians, the indigenous people of Hawai‘i, experience a prevalence of HTN (i.e., systolic blood pressure (SBP) of ≥140mmHg or diastolic blood pressure of ≥90mmHg) of over 50%. Factors that contribute to HTN control are multilevel and include neighborhood or community level determinants such as walkability, availability of healthy foods, safety, and social cohesion. However, these factors and their potential relationship to HTN have yet to be examined in Native Hawaiian communities. Identifying important neighborhood factors in Native Hawaiian communities can inform HTN control interventions. The purpose of this study is to describe the perceptions of neighborhood level stressors among Native Hawaiians participating in a randomized controlled trial testing a culturally-grounded, hula-based HTN intervention. This study was comprised of a subset of participants (N=124) from an NIH-funded, randomized controlled trial testing the effectiveness of a hula-based intervention at improving SBP in Native Hawaiians with uncontrolled HTN compared to an education only group. Neighborhood Level Stressors Scale was used to assess seven neighborhood dimensions: walkability, availability of healthy foods, safety, social cohesion, aesthetic quality, violence, and activities with neighbors. Scores ranged from 1 to 5 with lower scores indicating more positive perceptions their neighborhoods (e.g., greater safety). Demographic variables included age, gender, marital status, education. Descriptive and summary statistics are presented. Two-sample t-test was done to compare neighborhood level stressor by intervention group. Mean scores for the seven dimensions were as follows: aesthetic quality 2.54 (SD=0.61) walkability 2.48 (SD=0.72), availability of healthy foods 2.59 (SD=1.10), safety 2.63 (SD=0.97), violence 3.44 (SD=0.54), social cohesion 2.17 (SD=0.76), and activities with neighbors 2.09 (SD=0.75). The hula-based intervention group had a significantly lower (i.e., better) mean neighborhood aesthetic quality score compared to the education only group (p=0.02). The intervention group also had marginally better perceived activities with neighbors (p=0.09). This study describes perceived neighborhood dimensions in a Native Hawaiian population engaged in a HTN control intervention trial. Mean scores on walkability, availability of healthy foods, safety, social cohesion, aesthetic quality, violence, and activities with neighbors were similar to those reported in larger, multiethnic cohort studies. Perceptions of greater walkability, availability of healthy foods, safety, and social cohesion have been associate with HTN in other populations. Analysis to examine the potential associations between neighborhood level stressors and SBP is planned.

Minority populations are at high risk for hypertension (HTN) and its sequellae. Native Hawaiians (NH) are 70% more likely to have HTN; 4 times more likely to have coronary heart disease (CHD) or stroke than Whites. Hula, the traditional dance of NH, offers the promise of a culturally responsive strategy to improve HTN control. We conducted a randomized clinical trial (RCT) with a waitlist control to test the impact of a hula-based intervention on systolic blood pressure (SBP) in 263 NH with uncontrolled HTN (SBP ≥ 140 mmHg or ≥ 130 mmHg if diabetes) but no prior CHD or stroke. All participants received HTN education (e.g., diet, exercise, medication) during 3 1-hr sessions over 2 weeks, and were then randomly assigned to hula-based intervention (HI; n = 131) or waitlist control ( n = 132). The HI received 6 months of hula (2 1hr sessions/week x 3 months, then 1 lesson/month x 3 months with self-directed practice), with group activities to reinforce HTN education and healthy behaviors. Waitlist control received the initial HTN education and then offered hula after the study. Assessments were done at 0-, 3- and 6-month, with 12-month for HI only. We used standard approaches to assess clinical and other measures. Baseline characteristics were balanced between the groups, except for weight. Adjusting for weight and baseline SBP in intent-to-treat analysis, HI achieved significant reductions ( p < .05) in SBP (-15.3 mmHg; SE = 1.6) and DBP (-6.4 mmHg; SE = 1.0) compared to controls (-11.8 mmHg, SE = 1.7; -2.6 mmHg, SE = 1.0, respectively). From 6 to 12 months, HI maintained their SBP (mean change: 1.47 mmHg, SE = 1.26; p = .16) and DBP (mean change: 0.82 mmHg, SE = 0.81; p = .63) improvements at 12 months. HI were more likely to achieve SBP reduction ≥ 10 mmHg than control, 60% vs 48% ( p = .03), respectively. Retention was similar for both groups at 6 (83%; 218 of 263) and 12 (77%; 101 of 131) month follow-up. A hula-based intervention improved HTN control in NH with elevated SBP. Notably, our study demonstrates the feasibility of recruiting and retaining a high-risk minority population for a RCT. With strong implications for other indigenous populations, to our knowledge, these findings represent one of the few rigorously performed examinations of an indigenous practice leveraged for health promotion.

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More than 25 million people have diabetes in the United States and its complications make it a leading cause of death. Pacific Islanders, specifically Micronesians, experience even higher rates of diabetes, and pharmacist care for these individuals may improve health outcomes. Objective: To better address health disparities in this population, a health center serving Hawaii Island added clinical pharmacy services into their shared medical appointment program for diabetes management. Methods: Standard care (n= 21) consisted of weekly education sessions for patients provided by a multi-disciplinary team, after which patients had one-on-one appointments with a primary care provider if they met threshold clinical criteria. The intervention group (n=36) received the same services, plus a medication management service provided by a pharmacist during the one-on-one appointments. Results: There was no statistically significant difference between the pharmacist care and standard care groups on clinical measures including glycosylated hemoglobin, low density lipoprotein and blood pressure at the end of the eighteenmonth intervention period. Conclusion: Pacific Islanders face unique health care challenges including low socioeconomic status, language barriers and differences in cultural perceptions of health care. The value of clinical pharmacy has been well-documented in the literature but further study of the role and impact of these services is warranted for high-risk populations.