부산대학교 도서관

Introduction: Uncontrolled hypertension (HTN) is more frequently encountered among ethnic minority patients presenting to the emergency department (ED). ED engagement and early risk assessment is a feasible innovation to help close health disparity gaps in HTN. Objective: To determine whether an ED education and empowerment intervention can help improve BPs in a high- risk population. The primary outcomes were mean differences in systolic and diastolic BP from baseline to 9-month follow-up. Methods: AHEAD2 (A Hypertension Emergency Department Intervention Aimed at Decreasing Disparities) is a three-arm single site RCT conducted in an urban academic ED. Patients with severely elevated BP (≥160/100 mmHg) were enrolled to the study and randomized to one of three study arms: (1) Enhanced Usual Care (EUC) where patients received a BP monitoring kit and referral for primary care follow up; (2) ED-initiated Screening, Brief Intervention, and Referral for Treatment (ED-SBIRT) intervention; and (3) ED- SBIRT coupled with a 48-72 hours Post-Acute Care Hypertension Transition Clinic (ED-SBIRT + PACHT-c) consultation with an ED clinical pharmacist. BP measurements were obtained during two separate follow-up visits and study assessments were repeated at the final follow-up visit. Results: Of the 150 participants (mean age, 48 years (SD, 9.1); 58% women), 112 (75%) completed the trial. The mean baseline systolic BPs were similar across the 3 arms. Systolic BP reduction from baseline to month 9 was -26.8 mmHg (SD, 20.6 mmHg) for the ED-SBIRT group, -23.4 mmHg (SD, 21.8 mmHg) for the ED-SBIRT+PACHT-c group, and -18.9 mmHg (SD, 22.6 mmHg) for the EUC group. Diastolic BP decreased by -12.5 mmHg (SD, 13.2 mmHg) for the ED-SBIRT group, -11.4 mmHg (SD, 12.3 mmHg) for the ED-SBIRT+PACHT-c group, and -8.4 mmHg (SD, 12.1 mmHg) for the EUC group. Conclusions: Participants in the intervention arms experienced greater improvements in systolic and diastolic pressures over a 9-month period as compared to the enhanced usual care. This pilot highlights the roles that EDs can play in secondary cardiovascular prevention through education and empowerment, and demonstrates the range of interventions potentially available to EDs managing similar high-risk minority populations. [ABSTRACT FROM AUTHOR]