Prendergast Heather, Kitsiou Spyros, Petzel Gimbar Renee, Freels Sally, Sanders Anissa, Daviglus Martha, Kotini-Shah Pavitra, Carter Barry, Del Rios Marina, Heinert Sara, Khosla Shaveta
Department of Emergency Medicine, University of Illinois Chicago.
Department of Health Information Sciences, University of Illinois Chicago.
JAMA Cardiol. 2025 Apr 23. doi: 10.1001/jamacardio.2025.0675.
Hypertension is a leading risk factor for cardiovascular diseases and is often undiagnosed. Emergency department (ED) visits serve as critical access points within health care and present a unique opportunity for hypertension screening and intervention.
To evaluate the effectiveness of an Education and mHealth Empowerment (E2) intervention compared with usual care in reducing systolic blood pressure (SBP) among patients with elevated BP discharged from the ED.
DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial enrolled participants who presented to an urban academic medical center ED for any indication and had elevated blood pressure (≥140/90 mm Hg and ≤180/110 mm Hg). Eligible participants who were discharged from the ED were enrolled between February 12, 2019, and March 31, 2023, and were randomized to receive either usual care or the intervention with follow-up visits at 3 and 6 months.
Usual care involved standard hypertension discharge instructions with a referral for outpatient follow-up. The E2 intervention involved a 3-prong approach, which included a brief Post-Acute Care Hypertension consultation (PACHT-c) with a clinical pharmacist or an advanced practice nurse, a smartphone-enabled BP monitoring kit (Withings device and mobile app) for daily self-monitoring along with behavior change text messages, and primary care referral.
The primary outcome was the mean change in SBP (mm Hg) from baseline to 6 months.
Of the 574 participants enrolled, mean (SD) age was 51.1 (12.5) years, and 323 (56%) were female; 413 were Black (72%), 115 were Hispanic or Latino (20%), 27 were White (5%), and 19 were other race and ethnicity (3%), which included Asian, American Indian, and other racial or ethnic groups. Of the 413 patients with BP data at 6 months, the E2 intervention group (n = 210) showed a greater mean reduction in SBP (mean difference, 4.9 mm Hg; 95% CI, 0.8-9.0 mm Hg; P = .02) compared with the usual-care group (n = 203). A similar proportion of patients achieved BP less than or equal to 140/90 mm Hg at 6 months in the intervention arm (42.9% [90 of 210]) and the control arm (36.9% [75 of 203]; P = .22).
In this single-center randomized clinical trial, a multicomponent intervention directed at patients in the ED who have elevated BP was associated with greater reduction in SBP at 6 months. Identifying patients who present to the ED with hypertension may be a viable strategy to improve BP management.
ClinicalTrials.gov Identifier: NCT03749499.
高血压是心血管疾病的主要危险因素，且常常未被诊断出来。急诊科就诊是医疗保健中的关键接入点，为高血压筛查和干预提供了独特机会。
评估教育与移动健康赋能（E2）干预措施与常规护理相比，在降低急诊科出院的血压升高患者收缩压（SBP）方面的效果。
设计、地点和参与者：这项随机临床试验纳入了因任何指征到城市学术医疗中心急诊科就诊且血压升高（≥140/90 mmHg且≤180/110 mmHg）的参与者。2019年2月12日至2023年3月31日期间，从急诊科出院的符合条件的参与者被随机分组，分别接受常规护理或干预措施，并在3个月和6个月时进行随访。
常规护理包括标准的高血压出院指导及转介至门诊进行随访。E2干预措施采用三管齐下的方法，包括与临床药剂师或高级执业护士进行简短的急性后护理高血压咨询（PACHT-c）、用于日常自我监测的配备智能手机的血压监测套件（Withings设备和移动应用程序）以及行为改变短信，还有初级保健转介。
主要结局是从基线到6个月时SBP的平均变化（mmHg）。
在纳入的574名参与者中，平均（标准差）年龄为51.1（12.5）岁，323名（56%）为女性；413名是黑人（72%），115名是西班牙裔或拉丁裔（20%），27名是白人（5%），19名是其他种族和族裔（3%），包括亚洲人、美洲印第安人及其他种族或族裔群体。在6个月时有血压数据的413名患者中，与常规护理组（n = 203）相比，E2干预组（n = 210）的SBP平均降低幅度更大（平均差值为4.9 mmHg；95%置信区间为0.8 - 9.0 mmHg；P = 0.02）。干预组在6个月时血压小于或等于140/90 mmHg的患者比例（42.9% [210名中的90名]）与对照组（36.9% [203名中的75名]；P = 0.22）相似。
在这项单中心随机临床试验中，针对急诊科血压升高患者的多组分干预措施与6个月时SBP的更大幅度降低相关。识别到急诊科就诊的高血压患者可能是改善血压管理的可行策略。
ClinicalTrials.gov标识符：NCT03749499。
