Emergency Department-Based Education and mHealth Empowerment Intervention for Hypertension: The TOUCHED Randomized Clinical Trial.

Emergency department (ED) visits serve as critical access points within health care and present a unique opportunity for hypertension screening and intervention.

急诊科（ED）的访问是医疗保健系统中的关键接入点，为高血压筛查和干预提供了独特的机会。

Background

To evaluate the effectiveness of an Education and mHealth Empowerment (E2) intervention compared with usual care in reducing systolic blood pressure (SBP) among patients with elevated BP discharged from the ED.

评估教育和移动健康赋权(E2)干预措施与常规护理相比在降低急诊出院的高血压患者收缩压(SBP)方面的有效性。

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial enrolled participants who presented to an urban academic medical center ED for any indication and had elevated blood pressure (≥140/90 mm Hg and ≤180/110 mm Hg).

设计、环境和参与者：这项随机临床试验招募了前往城市学术医疗中心急诊科就诊的参与者，他们因任何原因就诊且血压升高（≥140/90毫米汞柱且≤180/110毫米汞柱）。

Eligible participants who were discharged from the ED were enrolled between February 12, 2019, and March 31, 2023, and were randomized to receive either usual care or the intervention with follow-up visits at 3 and 6 months.

符合条件的参与者在2019年2月12日至2023年3月31日期间出院后被纳入研究，并被随机分配接受常规护理或干预，干预组在3个月和6个月时进行随访访问。

Methods

Usual care involved standard hypertension discharge instructions with a referral for outpatient follow-up.

常规护理包括标准高血压出院指导和门诊随访的转诊。

The E2 intervention involved a 3-prong approach, which included a brief Post-Acute Care Hypertension consultation (PACHT-c) with a clinical pharmacist or an advanced practice nurse, a smartphone-enabled BP monitoring kit (Withings device and mobile app) for daily self-monitoring along with behavior change text messages, and primary care referral.

E2干预措施包括三管齐下的方法，其中包括与临床药师或高级执业护士进行简短的急性期后高血压咨询（PACHT-c），一个智能手机启用的血压监测套件（Withings设备和移动应用程序）用于日常自我监测以及行为改变短信，以及初级保健转诊。

main_outcomes_and_measures

The primary outcome was the mean change in SBP (mm Hg) from baseline to 6 months.

主要结果是基线至6个月期间收缩压（mm Hg）的平均变化。

Results

Of the 574 participants enrolled, mean (SD) age was 51.1 (12.5) years, and 323 (56%) were female; 413 were Black (72%), 115 were Hispanic or Latino (20%), 27 were White (5%), and 19 were other race and ethnicity (3%), which included Asian, American Indian, and other racial or ethnic groups.

在纳入的574名参与者中，平均（标准差）年龄为51.1（12.5）岁，其中323名（56%）为女性；413名为黑人（72%），115名为西班牙裔或拉丁裔（20%），27名为白人（5%），19名为其他种族和民族（3%），包括亚洲人、美洲印第安人和其他种族或民族群体。

Of the 413 patients with BP data at 6 months, the E2 intervention group (n = 210) showed a greater mean reduction in SBP (mean difference, 4.9 mm Hg; 95% CI, 0.8-9.0 mm Hg; P = .02) compared with the usual-care group (n = 203).

在有6个月血压数据的413名患者中，E2干预组（n = 210）显示出收缩压（SBP）的平均降低幅度更大（平均差异，4.9毫米汞柱；95%置信区间，0.8-9.0毫米汞柱；P = .02），与常规护理组（n = 203）相比。

A similar proportion of patients achieved BP less than or equal to 140/90 mm Hg at 6 months in the intervention arm (42.9% [90 of 210]) and the control arm (36.9% [75 of 203]; P = .22).

在这项单中心随机临床试验中，针对急诊科血压升高的患者实施的多组分干预措施与6个月时收缩压（SBP）的更大降低相关。

conclusions_and_relevance

In this single-center randomized clinical trial, a multicomponent intervention directed at patients in the ED who have elevated BP was associated with greater reduction in SBP at 6 months.

在这项单中心随机临床试验中，针对急诊科血压升高的患者实施的多组分干预措施与6个月时收缩压（SBP）更大程度的降低相关。

Identifying patients who present to the ED with hypertension may be a viable strategy to improve BP management.

识别出现高血压症状而前往急诊科的患者可能是一种改善血压管理的有效策略。

trial_registration

ClinicalTrials.gov Identifier: NCT03749499.

ClinicalTrials.gov 注册号：NCT03749499。