Disparities In Hypertension Control Research Articles

Design and Rationale of the Cardiometabolic Health Program Linked with Community Health Workers and Mobile Health Telemonitoring to Reduce Health DisparitieS (LINKED-HEARTS) Program.

Hypertension and diabetes are major risk factors for cardiovascular diseases, stroke, and chronic kidney disease (CKD). Disparities in hypertension control persist among Black and Hispanic adults and persons living in poverty in the United States. The "LINKED-HEARTS Program" (a Cardiometabolic Health Program LINKED with Community Health WorkErs and Mobile HeAlth TelemonitoRing To reduce Health DisparitieS"), is a multi-level intervention that includes home blood pressure (BP) monitoring (HBPM), blood glucose telemonitoring, and team-based care. This study aims to examine the effect of the LINKED-HEARTS Program intervention in improving BP control compared to enhanced usual care (EUC) and to evaluate the reach, adoption, sustainability, and cost-effectiveness of the program. Using a hybrid type I effectiveness-implementation design, 428 adults with uncontrolled hypertension (systolic BP ≥ 140 mm Hg) and diabetes or CKD will be recruited from 18 primary care practices, including community health centers, in Maryland. Using a cluster-randomized trial design, practices are randomly assigned to the LINKED-HEARTS intervention arm or EUC arm. Participants in the LINKED-HEARTS intervention arm receive training on HBPM, BP and glucose telemonitoring, and community health worker and pharmacist telehealth visits on lifestyle modification and medication management over 12 months. The primary outcome is the proportion of participants with controlled BP (<140/90 mm Hg) at 12 months. The study tests a multi-level intervention to control multiple chronic diseases. Findings from the study may be leveraged to reduce disparities in the management and control of chronic diseases and make primary care more responsive to the needs of underserved populations.

The interplay of socio-demographic characteristics and lifestyle choices in hypertension management among women in Bangladesh

Background: Hypertension is a significant public health challenge globally, particularly in low- and middle-income countries like Bangladesh. It contributes extensively to the morbidity and mortality associated with cardiovascular diseases (CVDs). The management of hypertension is influenced by a complex interplay of socio-demographic and lifestyle factors. Methods: This cross-sectional observational study assessed the prevalence of uncontrolled hypertension and its associated factors among women undergoing treatment in a tertiary medical college and hospital in Dhaka, Bangladesh. The study, spanning six months, involved 371 participants diagnosed with hypertension. Data was collected through semi-structured questionnaires, blood pressure measurements, and physical assessments. Statistical analyses included descriptive statistics, Chi-square tests, T-tests, and multivariable logistic regression. Results: Most respondents (52.84%) were over 60 years old, with a higher rate of controlled hypertension observed in this age group. Socio-demographic factors such as education and income levels significantly influenced hypertension control, with higher socioeconomic status correlating with better hypertension management. Lifestyle factors, including BMI, smoking status, and physical activity, played a crucial role in hypertension control. The study also highlighted the significant impact of comorbid conditions such as dyslipidemia and diabetes mellitus on hypertension management. Notably, there were marked disparities in hypertension control between urban and rural residents. Conclusion: The findings of this study underscore the need for targeted public health interventions to address the socio-demographic and lifestyle determinants influencing hypertension management among adult women in Bangladesh. Tailored strategies that consider these factors are essential for improving hypertension control, reducing the burden of CVDs, and enhancing the health and well-being of this vulnerable population. Collaborative efforts from healthcare providers, policymakers, and public health professionals are crucial to developing and implementing effective hypertension management programs.

Investigation of the role of perceived access to primary care in mediating and moderating racial and ethnic disparities in chronic disease control in the veterans health administration.

To examine the role of patient-perceived access to primary care in mediating and moderating racial and ethnic disparities in hypertension control and diabetes control among Veterans Health Administration (VA) users. We performed a secondary analysis of national VA user administrative data for fiscal years 2016-2019. Our primary exposure was race or ethnicity and primary outcomes were binary indicators of hypertension control (<140/90 mmHg) and diabetes control (HgbA1c < 9%) among patients with known disease. We used the inverse odds-weighting method to test for mediation and logistic regression with race and ethnicity-by-perceived access interaction product terms to test moderation. All models were adjusted for age, sex, socioeconomic status, rurality, education, self-rated physical and mental health, and comorbidities. We included VA users with hypertension and diabetes control data from the External Peer Review Program who had contemporaneously completed the Survey of Healthcare Experience of Patients-Patient-Centered Medical Home. Hypertension (34,233 patients) and diabetes (23,039 patients) samples were analyzed separately. After adjustment, Black patients had significantly lower rates of hypertension control than White patients (75.5% vs. 78.8%, p < 0.01); both Black (81.8%) and Hispanic (80.4%) patients had significantly lower rates of diabetes control than White patients (85.9%, p < 0.01 for both differences). Perceived access was lower among Black, Multi-Race and Native Hawaiian and Other Pacific Islanders compared to White patients in both samples. There was no evidence that perceived access mediated or moderated associations between Black race, Hispanic ethnicity, and hypertension or diabetes control. We observed disparities in hypertension and diabetes control among minoritized patients. There was no evidence that patients' perception of access to primary care mediated or moderated these disparities. Reducing racial and ethnic disparities within VA in hypertension and diabetes control may require interventions beyond those focused on improving patient access.

The Importance of Equity Value Judgments and Estimator-Estimand Alignment in Measuring Disparity and Identifying Targets to Reduce Disparity.

The choice of which covariates to adjust for (so-called allowability designation (AD)) in health disparity measurements reflects value judgments about inequitable versus equitable sources of health differences, which is paramount for making inferences about disparity. Yet, many off-the-shelf estimators used in health disparity research are not designed with equity considerations in mind, and they imply different ADs. We demonstrated the practical importance of incorporating equity concerns in disparity measurements through simulations, motivated by the example of reducing racial disparities in hypertension control via interventions on disparities in treatment intensification. Seven causal decomposition estimators, each with a particular AD (with respect to disparities in hypertension control and treatment intensification), were considered to estimate the observed outcome disparity and the reduced/residual disparity under the intervention. We explored the implications for bias of the mismatch between equity concerns and the AD in the estimator under various causal structures (through altering racial differences in covariates or the confounding mechanism). The estimator that correctly reflects equity concerns performed well under all scenarios considered, whereas the other estimators were shown to have the risk of yielding large biases in certain scenarios, depending on the interaction between their ADs and the specific causal structure.

PS-P03-2: RACIAL AND ETHNIC DISPARITIES IN HYPERTENSION CONTROL IN AN INTEGRATED HEALTHCARE SYSTEM IN THE UNITED STATES, 2008–2019

Objective: To determine whether racial/ethnic disparities in control of hypertension changed from 2008 through 2019 within a large and diverse integrated healthcare system that implemented a series of health care delivery changes in 2011 to address disparities in hypertension control. Design and method: We evaluated hypertension control, defined as systolic BP &lt; 140 mmHg and diastolic BP &lt; 90 mmHg, among adults age 18 years and older with diagnosed hypertension identified from a clinical hypertension registry, stratified by race/ethnicity (self-reported as non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic, or Asian or Pacific Islander (API)) from 2008–2019. Results: Between 2008 and 2019, the population with hypertension increased from 624,094 to 855,257. Mean age was 61.8 years in 2008 and increased to 64.5 years in 2019; ∼52% of the population in each year was female. The proportion of NHW and NHB adults decreased during this period from 45.4% to 38.8% and 14.3% to 12.5%, respectively, while the proportion of API and Hispanic adults increased from 9.8% to 12.6% and 25.2% to 33.0%, respectively. The overall age-adjusted estimated proportion with controlled hypertension increased from 2008 to 2013 from 74.3% (95% CI, 74.1%-74.6%) to 83.0% (95% CI, 82.8%-83.2%) and then decreased from 2014 to 2019 from 81.1% (95% CI, 80.9%-81.3%) to 79.3% (95% CI, 79.1%-79.4%). This trend was present in men and women across all races/ethnicities (Figure). In each year, API adults had the highest and NHB adults had the lowest age-adjusted estimated proportion with controlled hypertension. The disparity in controlled hypertension between NHW and NHB women was 5.7% (p &lt; .001) in 2008 and decreased to 1.6% (p &lt; .001) in 2015 and increased to 2.7% (p &lt; .001) by 2019. In 2008, the disparity in controlled hypertension between NHW and NHB men was 7.1% (p &lt; .001) and decreased to 2.8% (p &lt; .001) in 2016 and increased to 3.7% (p &lt; .001) by 2019. In 2019, NHB adults were more likely to have uncontrolled hypertension compared with NHW adults (multivariable-adjusted prevalence ratio, 1.13 [95% CI, 1.12–1.14]). Conclusions: While disparities in hypertension control have narrowed between NHB and NHW adults in this integrated healthcare system, differences persist. Understanding these differences can help identify continued unmet needs and guide more equitable health care to reduce the burden of hypertension-related cardiovascular disease.

Adverse Childhood Experiences, Depression, Patient Activation, and Medication Adherence Among Patients With Uncontrolled Hypertension.

Identifying potential pathways through which adverse childhood experiences (ACEs) impact health and health behavior remains important, given ACE survivors' increased risk for cardiovascular disease and poor cardiovascular health behaviors. This study examines whether modifiable variables-depression and patient activation-explain the relationship between ACEs and medication adherence. Using baseline data from a pragmatic trial designed to decrease disparities in hypertension control, we conducted regression analyses to examine whether depression and patient activation mediated the association between ACEs and medication adherence. Data were collected between August 2017 and October 2019 (n = 1,818). Participants were predominantly female (59.4%) and Black or African American (57%) with uncontrolled blood pressure (mean-152.3/85.5 mm Hg). Most participants reported experiencing at least 1 ACE (71%) and approximately 50% reported being adherent to their blood pressure medication. A significant indirect effect between ACEs and medication adherence was found for depression symptoms (Sobel's test z = -5.46, P < 0.001). Patient activation was not a mediator in these relationships. Experiencing more depression symptoms significantly accounted for the association between ACEs and medication adherence in a diverse sample of adults with uncontrolled blood pressure. Addressing depression symptoms, which may result from experiences with ACEs and other current stressors, could translate to better medication adherence and, potentially, better blood pressure control among this high-risk group. Given the serious lifetime health implications of ACEs, continued efforts are needed for primary prevention of childhood adversities.

Health Professionals' Perceptions of Disparities in Hypertension Control: A Mixed Methods Study.

Health professionals' commitment is needed to address disparities in hypertension control by ancestry, but their perceptions regarding these disparities are understudied. Cross-sectional mixed methods study in a universal healthcare setting in the Netherlands. Snowball sampling was used to include professionals practicing in a large multicity conglomerate including the capital city. Online surveys were collected, and survey participants were randomly selected for in-depth interviews. We used quantitative and qualitative methods to analyze health professionals' awareness, beliefs, and possible interventions regarding these disparities. We analyzed questionnaire data of 77 health professionals (medical doctors n = 70, nurses = 7), whereas 13 were interviewed. Most professionals were women (59%), general practitioners (81%); and White-European (77%), with 79% caring for patients of diverse ancestry. Disparities in hypertension control by ancestry were perceived to exist nationally (83% [95% CI, 75;91]), but less so in health professionals' own clinics (62% [52;73]), or among their own patients (56% [45;67]). Survey respondents emphasized patient rather than provider-level factors as mediators of poor hypertension control by ancestry. The collection of data on patients' ancestry, updating guidelines, and professional training were considered helpful to reduce disparities. Interviewees further emphasized patient-level factors, but also the need to better educate health professionals and increase their awareness. This explorative study finds that health professionals predominantly attribute disparities in hypertension control to patient-level factors. Awareness of disparities was lower for more proximate healthcare settings. These data emphasize the need to consider health professionals' perceptions when addressing disparities in hypertension control.

Abstract EP69: Age, Sex And Race Disparities In Hypertension Control: The Multi-Ethnic Study Of Atherosclerosis (MESA)

Introduction: Hypertension control is lower among women than men after age 65 years, but it is unknown whether age and sex disparities in hypertension control differ by race and ethnicity. We used data from the Multi-Ethnic Study of Atherosclerosis (MESA), to assess the association of age, sex, and race with hypertension control. Methods: At baseline, MESA enrolled 6814 adults aged 45 to 84 years without clinical CVD during years 2000-2002 followed by 5 follow-up exams. Due to loss of follow-up after exam 5, analysis was limited to participants with use of BP lowering medications at any of the first 5 MESA exams (n=2017). Hypertension control was defined as BP &lt; 140/90 mmHg based on average of second and third BP readings at each exam. Among 873 men and 1144 women with treated hypertension, mean baseline age was 64.1 (9.1 [SD]) years and race/ethnicity was non-Hispanic white in 34.1%, 10.1% Chinese, 35.1% Non-Hispanic Black and 20.7% Hispanic. Results: Figure 1 shows the fully adjusted proportion of participants with hypertension control at any of the first five MESA exams by age group, sex and by race and ethnicity. In all racial and ethnic groups, hypertension control declined with age among women and was lowest at age 75+ years. However, this decline in hypertension control with advancing age was most pronounced among Hispanic women, a group with the lowest adjusted proportion with hypertension control at age 75+ years (45.2%; 95% CI 35.3, 55.1). Hypertension control increased with advancing age among non-Hispanic Black men and stayed stable among Chinese men. Among white and Hispanic men, the adjusted proportion with hypertension control decreased from 81.1% (95% CI 76.7, 85.5) and 70.9% (95% CI 64.1, 77.8), respectively, at age 45-64 years, to 75.4% (95% CI 69.6, 81.3) and 61.5% (95% CI 55.3, 70,8), respectively, at age 75+ years. Conclusion: Age and sex differences in hypertension control are present in these four race and ethnic groups but declines in hypertension control with advancing age appear more prominent among Hispanic women.

Examining Neighborhood Socioeconomic Status as a Mediator of Racial/Ethnic Disparities in Hypertension Control Across Two San Francisco Health Systems.

A contextual understanding of hypertension control can inform population health management strategies to mitigate cardiovascular disease events. This retrospective cohort study links neighborhood-level data with patients' health records to describe racial/ethnic differences in uncontrolled hypertension and determine if and to what extent these differences are mediated by neighborhood socioeconomic status (nSES). We conducted a mediation analysis using a sample of patients with hypertension from 2 health care delivery systems in San Francisco over 2 years (n=47 031). We used generalized structural equation modeling, adjusted for age, sex, and health care system, to estimate the contribution of nSES to disparities in uncontrolled hypertension between White patients and Black, Hispanic/Latino, and Asian patients, respectively. Sensitivity analysis removed adjustment for health care system. Over half the cohort (62%) experienced uncontrolled hypertension during the study period. Racial/ethnic groups showed substantial differences in prevalence of uncontrolled hypertension and distribution of nSES quintiles. Compared with White patients, Black, and Hispanic/Latino patients had higher adjusted odds of uncontrolled hypertension: odds ratio, 1.79 [95% CI, 1.67-1.91] and odds ratio, 1.38 [95% CI, 1.29-1.47], respectively and nSES accounted for 7% of the disparity in both comparisons. Asian patients had slightly lower adjusted odds of uncontrolled hypertension when compared with White patients: odds ratio, 0.95 [95% CI, 0.89-0.99] and the mediating effect of nSES did not change the direction of the relationship. Sensitivity analysis increased the proportion mediated by nSES to 11% between Black and White patients and 13% between Hispanic/Latino and White patients, but did not influence differences between Asian and White patients. Among patients with hypertension in this study, nSES mediated a small proportion of racial/ethnic disparities in uncontrolled hypertension. Population health management strategies may be most effective by focusing on additional structural and interpersonal pathways such as racism and discrimination in health care settings.

Clinical Decision Support to Address Racial Disparities in Hypertension Control in an Integrated Delivery System: Evaluation of a Natural Experiment.

Effective, equity-promoting interventions implemented by health care systems are needed to address health care disparities and population-level health disparities. We evaluated the impact of a clinical decision support tool to improve evidence-based thiazide diuretic prescribing among Black patients to address racial disparities in hypertension control. We employed an interrupted time series design and qualitative interviews to evaluate the implementation of the tool. Our primary outcome measure was the monthly rate of thiazide use among eligible patients before and after implementation of the tool (January 2013-December 2016). We modeled month-to-month changes in thiazide use for Black and White patients, overall, and by sex and medical center racial composition. We conducted key informant interviews to identify modifiable facilitators and barriers to implementation of the tool across medical centers. Of the 318,720 patients, 15.5% were Black. We observed no change in thiazide use or blood pressure control following the implementation of the tool in either racial subgroup. There was a slight but statistically significant reduction (2.32 percentage points, p < 0.01) in thiazide use among Black patients following the removal the tool that was not observed among White patients. Factors affecting the tool's implementation included physician and pharmacist resistance to thiazide use and a lack of ongoing promotion of the tool. The clinical decision support tool was insufficient to change prescribing practices and improve blood pressure control among Black patients. Future interventions should consider physician attitudes about thiazide prescribing and the importance of multilevel approaches to address hypertension disparities.

Treatment Intensification and Missed Visits as Important Targets for Reducing Racial and Ethnic Disparities in Hypertension Control

Treatment Intensification and Missed Visits as Important Targets for Reducing Racial and Ethnic Disparities in Hypertension Control

Abstract 13406: Psychosocial Stress, Life Satisfaction, And Hypertension: A Mediation Analysis

Background: Disparities in hypertension control remain an important issue in public health. Evidence indicates that psychosocial factors are associated with onset and trajectory of hypertension. However, mediators of the association between psychosocial factors and hypertension are understudied. The objective of this study is to explore the mediating effect of life satisfaction on the link between psychosocial stress and hypertension. Method: This is a secondary analysis of data from the Panel Study of Income Dynamics (PSID) with the 2019 wave of 26,084 adults. Hypertension was assessed with the question: “Has a doctor or other health professional ever told you that you had high blood pressure or hypertension?” Psychosocial stress was assessed by using the K-6 Non-Specific Psychological Distress Scale developed by Dr. Ronald Kessler with 6 items. Participants were asked to rate their life satisfaction with a Likert-type question. Multiple logistic regression and mediation analysis were performed. Results: The mean age of this sample was 45 years and 27.5% were female. Results showed that participants with a higher level of psychosocial stress had a lower proportion of life satisfaction (26.3% vs. 70.7%, p&lt;0.01) and a higher proportion of hypertension (42.5% vs. 28.6%, p&lt;0.01) compared to those with a lower level of psychosocial stress. Participants who rated their life satisfied had a lower proportion of hypertension (27.4% vs. 32.9%, p&lt;0.01) compared to those who rated their life not satisfied. After controlling for covariates, regression results showed that psychosocial stress and life satisfaction were associated with hypertension independently. The indirect effect of psychosocial stress on hypertension through life satisfaction was significant (p&lt;0.01). Conclusions: Psychosocial stress was significantly associated with hypertension and this effect was partially mediated by life satisfaction. Interventions to decrease psychosocial stress that also emphasize improvements in life satisfaction may be needed to reduce the impact on hypertension.

The Relationship Between Racial/Ethnic Concordance and Hypertension Control.

Given the increasing impact of the healthcare cost of hypertension on the economy, understanding the control of high blood pressure is warranted, particularly as it pertains to racial/ethnic disparities in hypertension control. To understand the relationship between hypertension control and racial/ethnic concordance, we investigated whether the racial/ethnic concordance between a patient's race/ethnicity and that of the individual's provider is a predictor of high blood pressure control. Data was collected for 612,524 patients from Kaiser Permanente Southern California who were at least 18 year old and received a diagnosis of hypertension between January 1, 2016 and December 31, 2019. A multiple regression analysis was carried out to assess the correlation between hypertension control and patient-provider concordance. The independent variables proxying for patient-provider relationship are positive and statistically significant at the 5% level. Out of the 3 types of concordance, language has the highest standardized estimate, followed by gender and race. We found correlations between racial/ethnic patient-provider concordance and hypertension control. Consistent with previous studies, we found that Asian patients experience more time in hypertension control. By contrast, Black and Hispanic patients have less time in hypertension control. Having the same primary care provider for a longer span of time is also positively correlated with length of hypertension control. Correlation between racial/ethnic concordance, length of time under the primary provider's care, and length of time spent in hypertension control suggests that the patient-provider relationship remains a critical component of health outcomes.

Age and sex disparities in hypertension control: The multi-ethnic study of atherosclerosis (MESA)

ObjectiveDetermine sex differences in hypertension control by age group in a diverse cohort of adults age 45–84 years at baseline followed for an average of 12 years. MethodsThe Multi-Ethnic Study of Atherosclerosis enrolled 3213 men and 3601 women from six communities in the U.S. during years 2000–2002 with follow-up exams completed approximately every two years. At each exam, resting blood pressure (BP) was measured in triplicate, and the last two values were averaged. Hypertension was defined as a BP ≥ 140/90 mmHg and/or use of antihypertensive medications. Hypertension control was defined as a BP < 140/90 mmHg and in separate analyses as < 130/90 mmHg. Generalized linear mixed effects models with a binomial function were used to calculate the odds of hypertension control by age group (45–64,75–74, 75+) at a given exam and by sex, while accounting for the intra-individual correlation, and adjustment for demographics, co-morbidities, smoking, alcohol use, education and site among participants with hypertension at any of the first five exams. ResultsAt baseline, mean age was 64.1 (9.1 [SD]) years, 48.0% were men, and race/ethnicity was Non-Hispanic white in 34.1%, 10.1% Chinese, 35.1% Non-Hispanic Black and 20.7% Hispanic. Average SBP was lower while average DBP was higher among men vs. women at each exam. Adjusted odds ratios of hypertension control defined as BP < 140/90 mmHg among men vs. women was 0.89 (95% CI 0.67, 1.19) for age 45–64 years, 1.37 (95% CI 1.04, 1.81) for age 65–74 years and 2.08 (95% CI 1.43, 3.02) for age 75+ years. When defined as < 130/80 mmHg, adjusted odds of hypertension control among men vs. women was 0.60 (OR 0.60; 95% CI 0.46, 0.79) at age 45–64 years, 1.01 (OR 1.01; 95% CI 0.77, 1.31) at age 65–74 years and 1.71 (95% CI 1.19, 2.45) at age 75+ years. ConclusionSex disparities in hypertension control increase with advancing age and are greatest among adults age 75+ years.

Efficacy of Hypertension Self-Management Classes Among Patients at a Federally Qualified Health Center.

Structural racism has contributed to persistent racial disparities in hypertension control, with Black men suffering the highest prevalence of uncontrolled hypertension. Lincoln Community Health Center, our urban Federally Qualified Health Center (FQHC), aimed to use hypertension self-management classes to improve hypertension control among our clinic patients, particularly Black men. Patients attending classes learned about hypertension, were given blood pressure cuffs to use at home, and had the opportunity to speak to physicians in a group setting. We used a nonexperimental quality improvement intervention design to identify baseline differences between participants who attended multiple classes and those who attended only 1 class. Participants who attended multiple classes, most of whom were Black men, achieved an average blood pressure reduction of 19.1/14.8 mm Hg. Although the classes were effective, current policies around health insurance reimbursement and federal quality reporting standards hamper the ability of health care providers to implement such patient education initiatives.

Hypertension Control in the United States 2009 to 2018: Factors Underlying Falling Control Rates During 2015 to 2018 Across Age- and Race-Ethnicity Groups.

[Figure: see text].

Social Determinants of Health as Potential Influencers of a Collaborative Care Intervention for Patients with Hypertension.

The use of collaborative care teams, comprising nurse care managers and community health workers, has emerged as a promising strategy to tackle hypertension disparities by addressing patients' social determinants of health. We sought to identify which social determinants of health are associated with a patient's likelihood of engaging with collaborative care team members and with the nurse care manager's likelihood of enlisting community health workers (CHW) to provide additional support to patients. We conducted a within-group longitudinal analysis of patients assigned to receive a collaborative care intervention in a pragmatic, cluster randomized trial that aims to reduce disparities in hypertension control (N=888). Generalized estimating equations were used to identify which social determinants of health, reported on the study's baseline survey, were associated with the odds of patients engaging with the collaborative care intervention, and of nurses deploying community health workers. Patients who were unable to work and those with higher health literacy were less likely to engage with the collaborative care team than those who were employed full time or had lower health literacy, respectively. Patients had a greater likelihood of being referred to a community health worker by their care manager if they reported higher health literacy, perceived stress, or food insecurity, while those reporting higher numeracy had lower odds of receiving a CHW referral. A patient's social determinants of health influence the extent of engagement in a collaborative care intervention and nurse care manager appraisals of the need for supplementary support provided by community health workers.

Targeting of uncontrolled hypertension in the emergency department (TOUCHED): Design of a randomized controlled trial

BackgroundUncontrolled or undiagnosed hypertension (HTN) is estimated to be as high as 46% in emergency departments (EDs). Uncontrolled HTN contributes significantly to cardiovascular morbidity and disproportionately affects communities of color. EDs serve high risk populations with uncontrolled conditions that are often missed by other clinical settings and effective interventions for uncontrolled HTN in the ED are critically needed. The ED is well situated to decrease the disparities in HTN control by providing a streamlined intervention to high risk populations that may use the ED as their primary care. MethodsTargeting of UnControlled Hypertension in the Emergency Department (TOUCHED), is a two-arm single site randomized controlled trial of 770 adults aged 18–75 presenting to the ED with uncontrolled HTN comparing (1) usual care, versus (2) an Educational and Empowerment (E2) intervention that integrates a Post-Acute Care Hypertension Consultation (PACHT-c) with a mobile health BP self-monitoring kit. The primary outcome is differences in mean systolic blood pressure (SBP) at 6-months post enrollment. Secondary outcomes include differences in mean SBP and mean diastolic BP (DBP) at 3-months and mean DBP at 6-months. Additionally, improvement in cardiovascular risk score, medication adherence, primary care engagement, and HTN knowledge will also be assessed as part of this study. ConclusionsThe TOUCHED trial will be instrumental in determining the effectiveness of a brief ED-based intervention that is portable to other urban EDs with high-risk populations. Trial registrationclinicaltrials.gov Identifier: NCT03749499.

The Target Trial: A Powerful Device Beyond Well-defined Interventions.

The Target Trial: A Powerful Device Beyond Well-defined Interventions.

Abstract 12688: Age and Sex Disparities in Hypertension Control: The Multi-ethnic Study of Atherosclerosis (mesa)

Introduction: Blood pressure (BP) control may decline with age and degree of decline may differ by sex. Methods: The Multi-Ethnic Study of Atherosclerosis (MESA) recruited 6814 men and women, age 45 to 84 years, from six communities in the U.S. during 2000-2002 and follow-up exams occurred every two years for a total of 6 exams from 2000-2016. We assessed the association of age and sex with hypertension control using MESA data among participants receiving treatment for hypertension at any of the first five exams At each exam, resting BP was measured in triplicate at 1-minute intervals using an automated oscillometric device; we used the mean of last two measurements. Hypertension control was defined as BP &lt; 140/90 mmHg among adults with treated hypertension. Mixed-effects models were used to examine the association of sex with BP control by age group (45-64, 65-84, 85+ yrs) while accounting for the clustering within sites and intra-individual correlation and adjusting for demographics, co-morbidities, smoking, alcohol use, and education. Results: Among the 2,017 adults receiving treatment for hypertension (63.1% controlled), the mean age at exam 1 was 64.0 (9.1) yrs, 43.3% male; race/ethnicity was 33.5% White, 9.2% Chinese, 37.2% Black and 20.1% Hispanic. There was a significant interaction of sex*age group (P &lt; 0.001) in mixed-effects models after adjustment for all covariates. The adjusted probability of BP control was then calculated for each sex and age group. Among women, the probability of BP control declined from 74.6% (95% CI 70.8%, 78.5%) for age 45-64 yrs to 55.9% (50.0%, 61.8%) for age 85+ yrs. Among men, probability of BP control declined from 74.0% (70.0%, 78.0%) for age 45-64 yrs to 70.6% (65.7%, 75.5%) for age 85+ yrs. The figure shows the probability of hypertension control by sex and age at a given exam. Conclusion: Hypertension control differs by sex. Interventions are needed to address age-related sex disparities in hypertension control.