Introduction: Hypertension (HTN) is the most important modifiable stroke risk factor. The Emergency Department (ED) represents an opportunity to identify and treat HTN in difficult-to-reach populations. Electronic health records (EHR) can alert clinicians and researchers when parameters, such as elevated blood pressure (BP) are met. Our primary objective was to determine what proportion of ED patients would utilize prompted BP self-monitoring and respond to texts with home readings consistent with persistent HTN.
Methods: This was a randomized, controlled trial of patients recruited from a university ED with a volume of about 70,000 adult patient visits per year. Real-time EHR alerts identified patients with systolic BP ≥160 or a diastolic BP ≥100 (stage II HTN) who were likely to be discharged from the ED. At enrollment, all subjects were provided a home BP cuff and were sent weekly text messages to check their BP and text back the values to the study team. Subjects responding to texts and indicating persistent HTN during the 3-week run-in period were randomized to control or a 12-week intervention consisting of healthy behavior text messages and reminders to check BP and text the result back to investigators. We conducted secondary analyses evaluating change in BP over 12 weeks based on the self-reported assessments.
Results: Over 9,300 patients with elevated BP were identified through the EHR alerts over 7 months; data were abstracted on 1,908 patients. Of these, 169 were approached and 104 patients enrolled (64%). Of those enrolled, 73 (70%) texted back at least 1 BP reading during the run-in period of which 55 (53% of the 104) subjects had persistent HTN; this was higher than pre-specified goal of 25.5%. In those randomized (n=55), SBP decreased 8.9 mm Hg in the intervention group compared to an increase of 8.3 mm Hg in controls (p=0.039, see table).
Conclusion: Real-time, ED EHR based patient selection combined with mobile health monitoring of BP is feasible and promising.