Emergency Department-Initiated, Team-based care to reduce Severely elevated Blood Pressure (EDIT-SBP)
Funded Grant
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Hypertension disproportionately affects racial and ethnic minority populations, with disparities driven by factors such as access to care, medication nonadherence, health literacy, and fragmented care coordination. These challenges are particularly evident among patients discharged from emergency departments (EDs) after encounters for severe hypertension, defined as systolic blood pressure at or above 180 mm Hg and/or diastolic blood pressure at or above 110 mm Hg. The ED represents a critical yet underutilized opportunity to initiate evidence-based hypertension management; however, current clinical practices fail to address long-term patient needs. As a result, many patients remain uncontrolled, experience recurrent ED visits, and face an increased risk of adverse cardiovascular events. This project seeks to transform hypertension care through a team-based care (TBC) model that integrates clinical pharmacists and virtual primary care. The intervention leverages a collaborative practice agreement that allows pharmacists to initiate and adjust antihypertensive therapy, with support from home blood pressure monitoring. Treatment optimization begins in the ED, where patients receive initial therapy and a structured warm handoff to our TBC approach, ensuring ongoing management and adherence. To evaluate this model, we will conduct a single-blind, randomized controlled trial enrolling 530 patients with severe hypertension across three EDs serving diverse communities in metro Detroit, Michigan. The study will assess the impact of the TBC program on blood pressure control following an ED encounter for severe hypertension. Additionally, it will evaluate whether the intervention reduces reliance on the ED and decreases the incidence of adverse clinical events. The cost-effectiveness of this model compared to usual care will also be examined. The primary outcome will be the mean systolic blood pressure at six months, while secondary outcomes will include major adverse cardiovascular events, recurrent ED visits, and the economic impact of the intervention. With a focus on long-term scalability and sustainability, the intervention integrates billable pharmacist services and virtual care to create a more connected, evidence-based approach to chronic disease management. By addressing a common but understudied challenge in emergency medicine on how to effectively manage severe hypertension when patients do not meet criteria for hypertensive emergency, this study has the potential to improve outcomes, reduce healthcare disparities, and inform future clinical policies for hypertension management in the ED setting.
