Gupta A, Chouhdry H, Ellis SD, Young K, Mahnken J, Comfort B, Shanks D, McGreevy S, Rudy C, Zufer T, Mabry S, Woodward J, Wilson A, Anderson H, Loucks J, Chandaka S, Abu-El-Rub N, Mazzotti DR, Song X, Schmitz N, Conroy M, Supiano MA, Waitman LR, and Burns JM
Hypertension control remains poor. Multiple barriers at the level of patients, providers, and health systems interfere with implementation of hypertension guidelines and effective lowering of BP. Some strategies such as self-measured blood pressure (SMBP) and remote management by pharmacists are safe and effectively lower BP but have not been effectively implemented. In this study, we combine such evidence-based strategies to build a remote hypertension program and test its effectiveness and implementation in large health systems. This randomized, controlled, pragmatic type I hybrid implementation effectiveness trial will examine the virtual collaborative care clinic (vCCC), a hypertension program that integrates automated patient identification, SMBP, remote BP monitoring by trained health system pharmacists, and frequent patient-provider communication. We will randomize 1000 patients with uncontrolled hypertension from two large health systems in a 1:1 ratio to either vCCC or control (usual care with education) groups for a 2-year intervention. Outcome measures including BP measurements, cognitive function, and a symptom checklist will be completed during study visits. Other outcome measures of cardiovascular events, mortality, and health care utilization will be assessed using Medicare data. For the primary outcome of proportion achieving BP control (defined as systolic BP < 130 mmHg) in the two groups, we will use a generalized linear mixed model analysis. Implementation outcomes include acceptability and feasibility of the program. This study will guide implementation of a hypertension program within large health systems to effectively lower BP., Competing Interests: Declaration of competing interest None of the authors have financial or other conflict of interest with the study., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)