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

非裔美国人阿尔茨海默病和阿尔茨海默病相关疾病的发病率最高

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.