Reach Out: Randomized Clinical Trial of Emergency Department-Initiated Hypertension Behavioral Intervention Connecting Multiple Health Systems

伸出援手：急诊室发起的连接多个卫生系统的高血压行为干预的随机临床试验

• 批准号: 10121491
• 负责人: William Joseph Meurer
• 金额: $ 39万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-14 至 2024-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10121491
• 关键词: Accident and Emergency department; African American; Age; Alzheimer' s Disease; Alzheimer' s disease related dementia; Behavior Therapy; Blood Pressure; Blood Pressure Monitors; Bluetooth; Cellular Phone; Clinical Trials; Cognition; Cognitive; Data; Data Collection; Dementia; Elderly; Emergency Care; Emergency Department patient; Emergency department visit; Ethnic group; Focus Groups; Goals; Health; Health Surveys; Health system; Hypertension; Impaired cognition; Incidence; Instruction; Intervention Trial; Measurement; Measures; Michigan; Neurology; Online Systems; Parents; Participant; Patients; Physicians; Population; Prevalence; Public Health; Publishing; Randomized Clinical Trials; Research; Risk; Science; Scientist; Self Administration; Self Blood Pressure Monitoring; Self Management; Surveys; Telephone; Testing; Text; Time; United States; Vulnerable Populations; Wireless Technology; Work; base; behavioral health intervention; blood pressure intervention; blood pressure reduction; blood pressure regulation; cognitive testing; design; disparity reduction; efficacy study; frontier; hypertension control; innovation; mHealth; mild cognitive impairment; mobile application; novel; novel strategies; patient population; prevent; racial and ethnic; recruit; safety net; satisfaction; socioeconomic disadvantage; theories

African Americans have the highest incidence of Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD) of any racial/ethnic group in the United States. Similarly, African Americans also have the highest incidence and prevalence of hypertension. Recent research by our group suggests that African Americans’ higher cumulative blood pressure levels contribute to their greater risk of later-life cognitive decline compared to whites. A revolution is here—based on the recent data from the SPRINT-MIND trial, aggressive blood pressure treatment reduces the incidence of mild cognitive impairment and dementia. For the first time, there is an effective strategy to prevent AD/ADRD, however, achieving sustained blood pressure control is a challenge. Innovative approaches to cognitive and blood pressure monitoring are needed. One such approach may be expanding hypertension management to the Emergency Department (ED). The ED represents a missed opportunity to identify and treat hypertension. Currently, there are 136 million ED visits per year; nearly all encounters have at least one blood pressure measured and recorded. African Americans and socioeconomically disadvantaged patients are over-represented in the ED patient population making the ED an idea setting to reach these vulnerable populations. Our parent study, Reach Out, is a multicomponent, health theory based, mobile health behavioral intervention trial to reduce blood pressure among hypertensive patients evaluated in a safety net ED in Flint, Michigan. It was designed well before the results of SPRINT- MIND were published. The magnitude and impact of the strong connection between blood pressure and dementia is clearer now. Therefore, we have the opportunity to continue the momentum by extending Reach Out to include measures of cognition. There is an inherent tension between tightly controlled efficacy studies and more pragmatic efficacy studies. Our group believes that given the prevalence of hypertension, broad scale public health initiatives are needed. In order to move the science forward at scale, we need better ways to track cognition and blood pressure. One approach is via mobile health. In this context, we will extend the data collection of Reach Out, our ongoing clinical trial to explore innovative mobile health approaches of measuring cognition and blood pressure among our predominately work-age African American participants. We will also estimate the prevalence of dementia among hypertensive ED patients to better understand ED patients’ needs. Understanding the acceptability, feasibility, and satisfaction of mobile health cognitive and blood pressure assessments will open a new frontier in clinical trials and self-management to reduce dementia incidence and alleviate dementia disparities.

非裔美国人阿尔茨海默病发病率最高以及与阿尔茨海默病相关 美国任何种族/民族的痴呆症(AD/ADRD)。同样，非裔美国人也有 高血压患病率和患病率最高。我们小组最近的研究表明，非洲人 美国人的累积血压水平较高，导致他们晚年认知能力下降的风险更大 与白人相比。一场革命在这里--基于Sprint-Mind试验的最新数据，咄咄逼人 降压治疗可降低轻度认知障碍和痴呆症的发生率。这是第一次， 有一种有效的策略来预防AD/ADRD，然而，实现持续的血压控制是一种 挑战。认知和血压监测的创新方法是必要的。 其中一种方法可能是将高血压管理扩大到急诊科(ED)。这个 ED代表着错失了识别和治疗高血压的机会。目前，急症室就诊人次达1.36亿人次 每年；几乎所有的接触都至少测量和记录一次血压。非洲裔美国人 而社会经济上处于不利地位的患者在急诊患者中的比例过高，这使得 为帮助这些弱势群体建立了一个创意环境。我们的母公司研究项目REACH OUT是一个多组分的项目， 以健康理论为基础的流动健康行为干预试验降低高血压患者血压 患者在密歇根州弗林特的安全网ED中进行评估。它的设计远远早于Sprint的结果- 《心智》出版了。血压和血压之间的强联系的程度和影响 痴呆症现在更明显了。因此，我们有机会通过扩大覆盖范围来延续这一势头 将认知测量包括在内。 严格控制的效能感研究与更务实的效能感研究之间存在内在的张力。 我们小组认为，鉴于高血压的流行，需要广泛的公共卫生倡议。 为了推动科学在规模上向前发展，我们需要更好的方法来跟踪认知和血压。一 方法是通过移动医疗。在这种情况下，我们将扩大REACH OUT的数据收集，我们正在进行的 探索创新的移动健康方法测量认知和血压的临床试验 我们以工作年龄的非裔美国人为主的参与者。我们还将估计痴呆症的患病率 以更好地了解高血压ED患者的需求。了解可接受性， 移动健康认知和血压评估的可行性和满意度将开辟一个新的前沿 在临床试验和自我管理方面，以减少痴呆症的发病率和缓解痴呆症的差异。