REACH OUT: to Reduce High Blood Pressure in the Emergency Department

Study Overview
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Brief Summary
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One of the most powerful predictors of stroke is hypertension, with estimates of approximately 33% of adults in the United States experiencing this condition. Hypertension is very prevalent in the emergency department (ED), but significantly undertreated. The overall goal of this project is to develop a text messaging intervention to improve hypertension care in the ED. This will first be done by testing the feasibility of identifying hypertensive patients in the ED, and the response rate to text messages.

Conditions
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Hypertension, Stroke

Intervention / Treatment
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* Behavioral: Text messaging


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult (≥18 y/o) At least one BP of systolic blood pressure (SBP) ≥160 or a diastolic blood pressure (DBP) ≥100 or only BP performed prior to enrollment is SBP ≥160 or a DBP ≥100 (If the patient has repeated measurements after achieving Criteria 1, but prior to being enrolled, at least one of the repeat BP remains SBP ≥140 or a DBP ≥90) Must have mobile phones with text-messaging capability Likely to be discharged from the ED Exclusion Criteria: Adult who is in an urgent condition Unable to read Non-English speaking Incarcerated/ institutionalized resident Pregnant, or has a pre-existing condition that makes follow-up for 4 months unlikely.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control, Not hypertensive<br>Participants who after 3 weeks do not have high blood pressure or are not responsive to text messages. | |
| Experimental: Text messages, hypertensive<br>Participants who after 3 weeks have high blood pressure and are responsive to text messages, who are then randomized to receive text messages. | Behavioral: Text messaging<br>* persistently hypertensive participants will be randomized to receive these tailored, motivational text messages<br>|
| No Intervention: No text messages, hypertensive<br>Participants who after 3 weeks have high blood pressure and are responsive to text messages, who are then randomized to not receive text messages. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of people who respond to text messages and are persistently hypertensive |  | 3 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in systolic and diastolic blood pressure |  | 4 months | 
| Feasibility of a screening algorithm | Proportion of subjects recruited compared to proportion of subjects approached. Subject eligibility identified by screening algorithm. | 4 months | 
| Feasibility of subject follow-up mechanism | Proportion of subjects responding to follow-up text messages | 4 months | 
| Mean group differences and standard deviations for systolic blood pressure |  | 4 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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hypertension treatment, stroke prevention