Emergency Department Instruction May Help Hypertension Management

The TOUCHED trial, a recent randomized, clinical trial, has indicated that Education and mHealth Empowerment (E2) intervention, delivered to patients in the emergency department (ED), may be effective in improving hypertension management and raised blood pressure (BP) as opposed to standard care.1

“Further studies will explore the long-term effects of ED-based interventions and identify attributes linked to improved BP management,” wrote Heather Prendergast, MD, MPH, MS, department of emergency medicine, University of Illinois Chicago, and colleagues. “Insights from this study could refine ED interventions for broader application in multicenter trials.”1

Elevated blood pressure is one of the most pervasive conditions among patients visiting EDs. However, prior studies have indicated that BP reduction within the ED is not recommended in patients without new or worsening end-organ injury due to elevated BP. Prior research has noted a pressing need to improve care for patients with elevated or undiagnosed hypertension.2

The study enrolled a total of 574 participants, who were randomly split between a control and an intervention arm. Mean (standard deviation SD) age was 51.1 (12.5) years, and 323 participants were female. Of the total sample, 285 were assigned to control group and 289 to the intervention. Inclusion criteria included an age of 18-75 years and at least 2 recorded BP readings between ≥140/90 mm Hg and ≤180/110 mm Hg during their ED visit.1

Investigators also noted the primary complaints for participants’ visits. 139 complaints were muscoskeletal (24.2%), 110 cardiovascular (19.2%), 70 neurologic (12.2%), 59 gastrointestinal (10.3%), 41 genitourinary/gynecological (7.2%), 39 otolaryngology related (6.8%), 33 pulmonary (5.8%), 24 dermatologic (4.2%), 9 ocular related (1.6%), 8 endocrine (1.4%), and 44 involving multiple systems or weren’t system related (8.0%, e.g. medication refill, clearances, etc.)1

Prendergast and colleagues gave the control arm standard discharge instructions on hypertension along with a primary care referral. The intervention arm received these along with an E2 intervention made up of two components: a brief Post-Acute Care Hypertension consultation (PACHT-c) with a clinical pharmacist or advanced practice nurse (APN) before leaving the ED and a patient-centered mHealth intervention that combined a Bluetooth-enabled BP monitor and an app promoting medication adherence and self-monitoring BP.1

Investigators indicated that the intervention arm exhibited a statistically significant reduction in systolic blood pressure (SBP) from baseline to 6 months (interaction [SE], 4.9 [2.1] mm Hg: t572 = 2.34; P = .02). Notably, although both arms experienced an SBP decrease from baseline to 6 months, out of the 413 patients with BP data at that point, the intervention arm exhibited a larger decrease (-14.3 mm Hg; 210 participants) than in control (-9.4 mm Hg; 203 participants) with a mean difference of 4.9 (95% CI, .8-9.0) mm Hg.1

The probability of controlled BP ≤140/90 mm Hg was higher in the intervention arm (51% [80 of 157]) than control (38.4% [58 of 151]) at 3 months (odds ratio [OR], 1.67; 95% CI, 1.06-2.62, P = .03). However, at 6 months the probability of controlled BP ≤140/90 mm Hg was not significant in intervention or control. Similarly, the effects on the SBP change at 3 months and the diastolic blood pressure (DBP) at 6 months were not significant.1

Prendergast and colleagues suggest that, given the multicomponent intervention’s higher effectiveness than typical care, initiating or adjusting antihypertensive medications after an ED visit could optimize BP control in follow-up, thereby allowing for ongoing care.1

“Such interventions not only address immediate health needs but may also contribute to broader public health objectives with the potential to improve hypertension management,” wrote Prendergast and colleagues. “Future research should include multicenter evaluation of this intervention, examine the long-term health outcomes, and explore the patient’s perspective.”1

References

1. Prendergast H, Kitsiou S, Petzel Gimbar R, et al. Emergency department–based education and mhealth empowerment intervention for hypertension. JAMA Cardiology. Published online April 23, 2025. doi:10.1001/jamacardio.2025.0675

2. Miller J, McNaughton C, Joyce K, Binz S, Levy P. Hypertension Management in Emergency Departments. Am J Hypertens. 2020;33(10):927-934. doi:10.1093/ajh/hpaa068