Targeting of Uncontrolled Hypertension in the Emergency Department (TOUCHED)

Project Description
Targeting of Uncontrolled Hypertension in the Emergency Department (TOUCHED) is a two-arm randomized, controlled clinical trial targeting a high-risk emergency department population with persisting evidence of moderately elevated blood pressure (≥140/90 mmHg) at the time of discharge from the emergency department. It has been funded by the National Institutes of Health and will run for 5 years with an enrollment goal of 770 participants.

Rates of uncontrolled hypertension (HTN) in the Chicago area are significantly higher than the US national averages and reflect a significant health disparity especially among minority populations. The prevalence of uncontrolled hypertension (≥140 mmHg systolic or 90 mmHg diastolic) within the University of Illinois Hospital and Health System (UI Health) primary service area is about two-fold that of the USA national rates (69% among Non-Hispanic Blacks and 68.9% among Hispanics). Uncontrolled HTN is a significant contributor to cardiovascular morbidity and mortality and is frequently encountered among patients presenting to the emergency department (ED). EDs serve as the point of entry into the health care system for many high-risk patient populations, particularly minority and low-income individuals. EDs are well situated at the interface between inpatient and outpatient care and can serve as a portal for identifying high-risk individuals and initiating validated screening methods. The TOUCHED study is highly responsive to the call for more research in minority populations particularly African Americans and Hispanics to improve HTN treatment and control.

Who is involved?
Principal Investigator: Heather Prendergast, MD, MPH, MS
Co-Investigator: Martha Daviglus, MD, PhD (Participant retention)
Co-Investigator: Marina Del Rios, MD, MS (Echocardiogram)
Co-Investigator: Renee Petzel Gimbar, PharmD (Pharmacy consultation)
Co-Investigator: Spyros Kitsiou, PhD (Remote Blood Pressure Monitoring)
Consultant: Ramon Durazo-Arvizu, PhD (Statistical Analysis)
Consultant: Barry Carter, PharmD (Pharmacy Consultation)
Director of Research: Sara Heinert, PhD (Research Assistant Recruitment)
Project Manager: Brenda Lara, MA
Project Coordinator: Maya Jackson, MA

Main Objectives:
The primary objective is to determine the effectiveness of an emergency department-initiated Educational and Empowerment (E2) intervention targeting moderately elevated BPs (≥140/90 mmHg) in a predominately minority population with high rates of uncontrolled hypertension by examining mean BP differences between the two trial arms. Secondary objectives include testing whether this ED education and empowerment intervention improves overall rates of BP control (defined as BP < 140/90 mmHg), improvement in cardiovascular risk score, medication adherence (as measured by the Modified Morisky Scale), primary care engagement (measured by compliance with outpatient follow-up appointments), and HTN knowledge improvement (as measured by a validated HTN knowledge survey).

Study Design
Emergency Department patients who have completed their ED evaluation and have been identified for discharge yet still have elevated BPs, will be recruited and randomized into one of two arms: 1) usual care (preprinted discharge instructions and 48-72 hour outpatient referral for primary care follow-up); 2) ED-based E2 intervention with a Post-Acute Care Hypertension Transition–consultation (PACHT-c) by ED clinical pharmacist or APN followed by 48-72 hour referral for primary care follow-up. The Educational and Empowerment (E2) intervention consists of an educational video on HTN, visual clips of age/gender-matched echocardiograms, and blood pressure monitoring kit.
This is novel because it is initiated in the emergency department, is an innovative change to the current care delivery model, utilizes mobile health home BP monitoring, and can decrease the health disparity gaps associated with uncontrolled HTN. Our E2 intervention will educate patients about the secondary cardiovascular complications associated with uncontrolled hypertension and potential of early target organ damage to increase their motivation for behavior change as well as their knowledge of how to improve BP control. The addition of the PACHT-c pharmacist/APN consultation intervention will integrate improved access and effective approaches to intensify BP medications. TOUCHED evaluates an innovative, integrated approach to improving BP’s in an underrepresented population with uncontrolled/undiagnosed HTN identified in the ED.