Dr. Candace McNaughton, MD, MPH, is a board certified emergency medicine physician and Assistant Professor in the Department of Emergency Medicine at Vanderbilt University. Her long-term goal is to reduce the burden of cardiovascular (CV) disease due to hypertension among patients who seek emergency care, through impactful scientific inquiry. Her short-term goals, with support from this K23, are to gain 1) advanced skills in development and implementation of behavioral health interventions tailored to the unique sociodemographics of patients who seek emergency department (ED) care for CV disease; and 2) practical experience in behavioral and clinical research, including responsible conduct of research. Nearly 37 million Americans have uncontrolled hypertension, the most important modifiable risk factor for CV and kidney failure, with associated annual costs of more than $93.5 billion. Only 50% of patients have controlled blood pressure, and nearly 5 million patients visit the ED annually for uncontrolled hypertension. Medication adherence, or taking medications as prescribed, plays an important role in blood pressure control, particularly among patients who seek care in the ED for hypertension-related complaints. This proposal addresses the critical need to improve blood pressure control by focusing on patients in the ED for hypertension-related complaints; these patients are likely to gain significant benefit and are at high risk for poor clinical outcomes. Dr. McNaughton's primary mentor, Dr. Russell Rothman MD MPP, is a federally funded expert in cross-cultural health behavior interventions and health services research; her co-mentor, Dr. Alan Storrow MD is an expert in emergency cardiovascular research. During an institutional K12, Dr. McNaughton gained expertise in determinants of adherence, validated a mass spectrometry assay to directly measure medication adherence, and over nine months enrolled 300 ED patients with hypertension in a cohort study, of whom 95% have completed one-year follow-up. Drawing on her prior and ongoing research, Dr. McNaughton will accomplish the following research aims among ED patients with hypertension-related complaints: 1) develop an ED-based antihypertensive adherence intervention from successful clinic-based interventions using patient and provider feedback, and 2) in a randomized trial of 350 patients, test this intervention's impact on 1- and 3-month systolic blood pressure and antihypertensive adherence, compared to usual ED care plus education. This proposal responds directly to NHLBI's goals of developing and evaluating culturally appropriate interventions to improve patient behavior in order to enhance quality of care. In summary, this proposal is a crucial first step to better understand and address antihypertensive adherence among patients who are likely to gain significant benefit from ED visits as teachable moments. Dr. McNaughton will also gain expert mentorship, study design and execution skills, and experience vital for a successful independent career in cardiovascular research.

Public Health Relevance

Uncontrolled blood pressure is an important health problem that affects 37 million Americans, with increased risk for stroke, heart attack, heart failure, and kidney failure, $93.5 billion in costs in 2010, and nearly 5 million emergency department visits per year. Medication adherence, or taking blood pressure medications as prescribed, is an important cause of many of these emergency department visits; this proposal uses blood test to measure adherence and leverages emergency department visits as a teachable moment, an opportunity for improving medication adherence. The goals of this proposal are to 1) develop and test an ED-based behavioral intervention to improve medication adherence one month after the ED visit, and 2) provide the expert mentorship and experience necessary to allow Dr. McNaughton to transition to an independent, effective clinical researcher focused on high blood pressure and cardiovascular disease among patients in the emergency department.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Mentored Patient-Oriented Research Career Development Award (K23)
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NHLBI Mentored Patient-Oriented Research Review Committee (MPOR)
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Einhorn, Paula T
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Vanderbilt University Medical Center
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McNaughton, Candace D; Brown, Nancy J; Rothman, Russell L et al. (2017) Systolic Blood Pressure and Biochemical Assessment of Adherence: A Cross-Sectional Analysis in the Emergency Department. Hypertension 70:307-314
Upchurch, Cameron P; Grijalva, Carlos G; Russ, Stephan et al. (2017) Comparison of Etomidate and Ketamine for Induction During Rapid Sequence Intubation of Adult Trauma Patients. Ann Emerg Med 69:24-33.e2
McWade, Conor M; McWade, Melanie A; Quistberg, D Alex et al. (2017) Epidemiology and mapping of serious and fatal road traffic injuries in Guyana: results from a cross-sectional study. Inj Prev 23:303-308
Brody, Aaron; Twiner, Michael; Kumar, Arun et al. (2017) Survey of Emergency Physician Approaches to Management of Asymptomatic Hypertension. J Clin Hypertens (Greenwich) 19:265-269
Griffey, Richard T; McNaughton, Candace D; McCarthy, Danielle M et al. (2016) Shared Decision Making in the Emergency Department Among Patients With Limited Health Literacy: Beyond Slower and Louder. Acad Emerg Med 23:1403-1409
McNaughton, Candace D; Brody, Aaron; Levy, Phillip D (2016) Appropriate Management of Asymptomatic Hypertension. JAMA Intern Med 176:1723-1724
McNaughton, Candace D; Levy, Phillip (2016) Asymptomatic Elevated BP and the Hypertensive Insurgency. Curr Hypertens Rep 18:88
Janke, Alexander T; McNaughton, Candace D; Brody, Aaron M et al. (2016) Trends in the Incidence of Hypertensive Emergencies in US Emergency Departments From 2006 to 2013. J Am Heart Assoc 5:
Rupp, Jordan D; Ferre, Robinson M; Boyd, Jeremy S et al. (2016) Extravasation Risk Using Ultrasound-guided Peripheral Intravenous Catheters for Computed Tomography Contrast Administration. Acad Emerg Med 23:918-21
Goldberg, Elizabeth M; Levy, Phillip D; McNaughton, Candace D (2016) When More Isn't Better: Visits for Hypertension: September 2016 Annals of Emergency Medicine Journal Club. Ann Emerg Med 68:385-6

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