# Reach Out 2: Randomized Clinical Trial of Emergency Department-Initiated Hypertension Mobile Health Intervention Connecting Multiple HealthSystems

> **NIH NIH R01** · NORTHWESTERN UNIVERSITY · 2023 · $599,307

## Abstract

Hypertension is the most important modifiable risk factor for cardiovascular disease. Black Americans have the
highest prevalence of hypertension and the lowest rates of blood pressure (BP) control of any racial or ethnic
group in the U.S., contributing to cardiovascular disease disparities. Low-income Americans are also
disproportionally burdened by hypertension. To achieve health equity, new approaches to hypertension
management leveraging safety-net healthcare systems to reach underserved populations are needed.
One approach to addressing the hypertension epidemic is to identify and treat people undiagnosed, untreated,
or with undertreated hypertension - people who have fallen through the cracks in the healthcare system. We
did this in Reach Out 1 (R01MD011516), a mobile health (mHealth) 8-arm factorial trial of hypertensive
patients recruited from a safety-net ED. Among the ~500 majority Black, mid-life participants, 43% were
unemployed; 21% did not carry a diagnosis of hypertension; 51% were not taking antihypertensive
medications, and 22% did not have a primary care provider. Overall, systolic BP declined by 9.2 mmHg (95%
CI -12.2 to - 6.3) after 6 months, without differences across treatment arms. Reach Out 1 successfully enrolled
a hypertensive, medically underserved population into a mHealth intervention. Despite a very large reduction in
BP overall, the efficacy of the Reach Out mHealth intervention is uncertain, given the lack of a control group.
Reach Out 2 proposes to test the most promising components of Reach Out 1 in a randomized open, blinded-
endpoint (PROBE) controlled trial. Reach Out 2, continues our work with the same safety-net ED and Federally
Qualified Health Centers. In Reach Out 2, we will compare usual care, to 6-months of prompted self-monitored
blood pressure (SMBP) monitoring with tailored feedback and facilitated primary care appointment and
transportation. The usual care group will receive instructions to follow up with a primary care provider after ED
discharge. After 6 months, the intervention participants will enter an extended treatment period of long-term
SMBP monitoring. To contextualize our findings, we will use our chronic disease agent-based simulation model
to estimate the reduction in myocardial infarction, stroke, and dementia if Reach Out 2 were to be implemented
in safety-net EDs across the US. The overarching goal of our proposal is to determine whether a low-tech
mHealth intervention will reduce BP more than usual care among patients recruited from a safety-net ED and
to understand the potential national impact of such an intervention. Because safety-net EDs are anchor
institutions that care for large populations of medically underserved hypertensive people, mHealth strategies
initiated here have tremendous potential to reduce cardiovascular inequities. To reach this potential, evidence-
based interventions to reduce BP must be identified (aim 1), long-term engagement evaluated (aim 2), and
their i...

## Key facts

- **NIH application ID:** 10791418
- **Project number:** 1R01MD019124-01
- **Recipient organization:** NORTHWESTERN UNIVERSITY
- **Principal Investigator:** William Joseph Meurer
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $599,307
- **Award type:** 1
- **Project period:** 2023-09-24 → 2028-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10791418

## Citation

> US National Institutes of Health, RePORTER application 10791418, Reach Out 2: Randomized Clinical Trial of Emergency Department-Initiated Hypertension Mobile Health Intervention Connecting Multiple HealthSystems (1R01MD019124-01). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10791418. Licensed CC0.

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