Health disparities related to cardiovascular disease (e.g., heart disease, high blood pressure, diabetes, and stroke) have remained higher in the African-American community than in other populations. African Americans living in the stroke belt are at an even higher risk for these conditions. Recently, increasing numbers of health agencies and researchers have successfully partnered with the black church to respond to the troubling statistics regarding these health disparities. Because the black church has a long history of being in the forefront of addressing critical social, economic, political, and health issues of African Americans, it is clear they are the principal gatekeepers in reversing these negative health trends. Working with churches to reduce cardiovascular disease is not a new concept. Hypertension screening programs were established at churches approximately 30 years ago. This article shares findings of elements to improve relations between community agencies and pastors, explores the strengths and challenges of working with churches, examines the role of the pastors in establishing successful programs, and identifies model programs. This article will identify key factors that are essential to cardiovascular health programs that purport to reach high-risk populations for cardiovascular disease with life saving environmental policies and behavior change strategies. Suggestions are provided for working with pastors, churches, and church resources to maximize the desired outcomes of future health promotion interventions. Examples of strategies include serving healthier choices during church meals; the inclusion of relevant scriptural citations in promotional materials; the implementation of instruction, training, and exercise programs; and, the provision of tangible compensation to the churches and congregants facilitating the health initiatives.