Pharmacist-led Home Blood Pressure (BP) Monitoring and Team Care for Uncontrolled Hypertension

Introduction: Uncontrolled hypertension is a major health concern and disparities persist. Prior research using technology-enabled team care (TTC) demonstrated significantly improved BP control but was completed in affluent white patients.

Research Question or Hypothesis: This RCT evaluates how pharmacist-led TTC with technology-enabled BP monitors impacts BP control relative to Enhanced Usual Care (EUC), and the heterogeneity of treatment effects based on pre-specified sub-groups in diverse patients across NC.

Study Design: The setting is fourteen primary care practices in NC with embedded Clinical Pharmacist Practitioners (CPP). The RCT is powered to detect a treatment difference of ≥ 4 mmHg, with a goal treatment difference of ≥ 7 mmHg in mean SBP reduction between study groups.

Methods: Adults with uncontrolled hypertension ( SBP >140 mmHg) are randomized to TTC or EUC. Goal patient enrollment is 780, (50% African American, 40% male). The intervention arm includes TTC with management by a CPP. CPPs receive a 2-week display of BPs of TTC arm participants and engage with patients in person or via telehealth to discuss BP readings, medications, lifestyle changes, and adherence every two weeks for 2 months, then monthly for months 3-12. EUC patients receive the BP monitor and are asked to document their BP. All participants receive informational materials aimed at supporting self-management of hypertension. All patient-facing materials are vetted and approved by the study’s Stakeholder Advisory Council. The primary outcome is mean change in SBP at six months. Secondary outcomes include mean change in SBP at 12 months and SBP in the pre-specified subgroups.

Results: To date, 308 patients have enrolled. Better BP control can be achieved through TTC and CPP intervention within one year.

Conclusion: This study will determine the impact of pharmacist-led TTC on hypertension outcomes.