Effect of an emergency department education and empowerment intervention on uncontrolled hypertension in a predominately minority population: The AHEAD2 randomized clinical pilot trial

Abstract

Abstract OBJECTIVE To determine whether an emergency department (ED) education and empowerment intervention coupled with early risk assessment can help improve blood pressure (BP) in a high‐risk population. METHODS A hypertension emergency department intervention aimed at decreasing disparities (AHEAD2) is a 3‐arm, single‐site randomized pilot trial for feasibility in an urban academic ED. A total of 150 predominantly ethnic minorities with no primary care provider and severely elevated blood pressure (BP) (≥160/100 mm Hg) were enrolled over 10 months. Participants were randomized into 1 of 3 study arms: (1) enhanced usual care (EUC), (2) ED‐initiated screening, brief intervention, and referral for treatment (ED‐SBIRT), or (3) ED‐ SBIRT plus a 48–72 hours post‐acute care hypertension transition clinic (ED‐SBIRT+PACHT‐c). Primary outcomes were change in systolic and diastolic BP (SBP and DBP) from baseline to 9 months. Secondary outcomes were BP control (BP <140/90 mm Hg), changes in hypertension knowledge, medication adherence, and limited bedside echocardiogram (LBE) findings. RESULTS SBP reduction from baseline to month 9 was −26.8 (95% confidence interval [CI]: −32.8, −20.7) mm Hg for ED‐SBIRT, −23.4 (95% CI: −29.5, −17.3) mm Hg for ED‐SBIRT+PACHT‐c, and −18.9 (95% CI: −24.9, −12.9) mm Hg for EUC. DBP decreased by −12.5 (95% CI: −16.1, −9.0) mm Hg for ED‐SBIRT, −11.3 (95% CI: −14.8, −7.7) mm Hg for ED‐SBIRT+PACHT‐c, and −8.4 (95% CI: −11.9, −4.9) mm Hg for EUC. A multicomponent intervention compared with EUC resulted in SBP decrease of −7.9 mm Hg (95% CI: −16.4, 0.6). At 9 months, hypertension was controlled for 29.3% (95% CI: 20.3, 38.3) of intervention and 23.5% (95% CI: 11.9, 35.2) of EUC participants. All groups saw improvements in hypertension knowledge, medication adherence, and LBEs, with greater improvements in intervention groups. CONCLUSIONS The study findings suggest that a multicomponent intervention comprising of ED education and empowerment coupled with early risk assessment may help improve BP in a high‐risk population.

Keywords

• emergency department
• minority
• pilot study
• uncontrolled hypertension