Abstract Body: Introduction: Hypertension is a prevalent condition that is often asymptomatic. Emergency Department (ED) patients commonly present with underlying and undiagnosed hypertension. As EDs serve as critical access points for healthcare, they present a unique opportunity for hypertension screening and intervention, and ED-based interventions could target patients who are often missed in other healthcare settings.
Hypothesis: We hypothesize that an Education and mHealth Empowerment intervention would be effective when compared to standard discharge instructions in reducing systolic blood pressure by 6-month follow-up among patients with asymptomatic elevated blood pressure discharged from the ED.
Methods: A randomized clinical trial was designed to enroll patients with asymptomatic elevated blood pressure (> 140/90 mm Hg and ≤ 180/110 mm Hg) discharged from an urban academic ED that predominantly serves patients from minoritized racial and ethnic groups. Patients were randomized to either usual care (standard discharge with outpatient follow-up referral) or the intervention arm (education and mHealth Empowerment intervention at discharge – the intervention included a consultation with a clinical pharmacist or an advanced practice nurse, and use of mHealth to educate on and facilitate self-monitoring and behavior change along with a primary care referral, and follow-up visits at 3 and 6 months).
Results: Of the 574 enrolled, 289 were randomized to the intervention group. The mean age of the sample was 51.1 (+12.5) years, and 57% were female, 72% were Black, and 20% Hispanic. There were no statistically significant differences between the two arms by demographics or mean blood pressure at baseline. At 6 months follow up, the intervention arm showed a greater reduction in systolic blood pressure compared to the usual care group, and the difference was statistically significant (mean difference: 4.9 mm Hg, 95% CI [0.8, 9.0], p=0.02).
Conclusions: The Education and mHealth Empowerment intervention was more effective than standard discharge instructions in reducing systolic blood pressure in a predominantly Black and Latino patient population with elevated blood pressure discharged from the ED. This intervention, and other similar ED-based interventions could be a viable and scalable strategy for blood pressure control in asymptomatic patients for preventing secondary cardiovascular complications due to uncontrolled hypertension.