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

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.