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

非裔美国人患阿尔茨海默病的发病率最高， 痴呆症（AD/ADRD）在美国的任何种族/民族群体。同样，非洲裔美国人也有 高血压发病率和患病率最高。我们小组最近的研究表明， 美国人较高的累积血压水平导致他们晚年认知能力下降的风险更大 与白人相比。一场革命正在这里--基于SPRINT-MIND试验的最新数据， 血压治疗降低了轻度认知障碍和痴呆症的发病率。第一次， 有一个有效的策略来预防AD/ADRD，然而，实现持续的血压控制是一个 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展到急诊科（艾德）。的 艾德错过了识别和治疗高血压的机会。目前，有1.36亿人次的艾德就诊 几乎所有的接触都至少测量和记录一次血压。非裔美国人 和社会经济上处于不利地位的患者在艾德患者人群中的比例过高， 艾德提供了一个接触这些弱势群体的想法。我们的母研究，Reach Out，是一个多成分的研究， 以健康理论为基础移动的健康行为干预对高血压患者降压效果的研究 在密歇根州弗林特的安全网艾德中评估的患者。它的设计早于SPRINT的结果- MIND出版了。血压与糖尿病之间的密切联系的程度和影响 痴呆症现在更清楚了。因此，我们有机会通过扩展Reach来延续这一势头 包括认知的测量。 在严格控制的功效研究和更务实的功效研究之间存在着内在的紧张关系。 我们的小组认为，鉴于高血压的流行，需要采取大规模的公共卫生措施。 为了大规模地推动科学发展，我们需要更好的方法来跟踪认知和血压。一 方法是通过移动的健康。在这种情况下，我们将扩大Reach Out的数据收集范围， 临床试验，探索创新的移动的健康方法，测量认知和血压， 我们的主要工作年龄的非裔美国人参与者。我们还将估计痴呆症的患病率 在高血压艾德患者中进行调查，以更好地了解艾德患者的需求。理解可接受性， 移动的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，以减少痴呆症的发病率和减轻痴呆症的差距。

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.