A hypertension emergency department intervention aimed at decreasing disparities: Design of a randomized clinical trial

• Published in: Contemporary clinical trials 2018-01, Vol.64, p.1-7
• Main Authors: Prendergast, Heather M., Del Rios, Marina, Petzel-Gimbar, Renee, Garside, Daniel, Heinert, Sara, Escobar-Schulz, Sandra, Kotini-Shah, Pavitra, Brown, Michael, Chen, Jinsong, Colla, Joseph, Fitzgibbon, Marian, Durazo-Arvizu, Ramon A., Daviglus, Martha
• Format: Article
• Language: English
• Subjects: Adult; Antihypertensive Agents - therapeutic use; Blood Pressure; Emergency department; Emergency Service, Hospital - organization & administration; Female; Health disparities; Health Knowledge, Attitudes, Practice; Health Status Disparities; Humans; Hypertension - diagnosis; Hypertension - drug therapy; Hypertension - ethnology; Male; Medication Adherence; Middle Aged; Minorities; Minority Groups; Primary Health Care; Randomized control trial; Referral and Consultation; Risk Assessment; Risk Factors; Uncontrolled hypertension
• ISSN: 1551-7144; 1559-2030
• DOI: 10.1016/j.cct.2017.11.009

Effective interventions to identify and treat uncontrolled hypertension (HTN), particularly in underrepresented populations that use the emergency department (ED) for primary care, are critically needed. Uncontrolled HTN contributes significantly to cardiovascular morbidity and mortality and is more frequently encountered among patients presenting to the ED as compared to the primary care setting. EDs serve as the point of entry into the health care system for high-risk patient populations, including minority and low-income patients. Previous studies have demonstrated that the prevalence of uncontrolled/undiagnosed HTN in patients presenting to the ED is alarmingly high. Thus ED engagement and early risk assessment/stratification is a feasible innovation to help close health disparity gaps in HTN. A Hypertension Emergency Department Intervention Aimed at Decreasing Disparities (AHEAD2) trial, funded by the National Heart, Lung, and Blood Institute (NHLBI) is a three-arm single site randomized clinical pilot trial of adults presenting to the ED with Stage 2 hypertension (blood pressure [BP]>160/100) comparing (1) an ED-initiated Screening, Brief Intervention, and Referral for Treatment (SBIRT) focused on HTN, (2) the same ED-initiated SBIRT coupled with a Post-Acute Care Hypertension Transition Consultation by ED Clinical Pharmacists, and (3) usual care. The primary outcome is mean BP differences between study arms. Secondary outcomes are proportion of participants with BP control (BP