REMAP-BP: REmote Blood Pressure Monitoring and Pharmacist-Led Telehealth Program in an Emergency Department Transitional Care Clinic (ED-TCC) - SUMMARY/ABSTRACT Hypertension (HTN), defined as blood pressure (BP) ≥130/80 mmHg or use of antihypertensive medications, affects nearly half of U.S. adults and remains the leading modifiable risk factor for cardiovascular disease (CVD). Despite extensive public health and clinical efforts, BP control is suboptimal, with only 51% of adults with HTN controlled in 2021-2023, down from 54% in 2013-2014. Prevalence and poor control are disproportionately higher among uninsured adults and those without regular interactions with primary care. The Emergency Department (ED) is often the primary healthcare contact for these groups, and up to 45% of ED patients present with elevated BP. Yet most are discharged without a definitive follow-up strategy, leaving a critical gap in continuity of HTN care. Remote BP monitoring (RBPM), pharmacist-led medication management via telehealth, and automated text reminders are each evidence-based approaches that improve HTN outcomes, but they have rarely been integrated into a bundled strategy for patients discharged from the ED. In 2022, the University of Alabama at Birmingham (UAB) established an ED-Transition Care Clinic (ED-TCC) to provide structured follow-up within 3 to 7 days of ED discharge. From July 2024 to April 2025, we conducted a pilot randomized controlled trial (RCT) of this bundled strategy at the UAB ED-TCC with 24 patients. The intervention demonstrated high feasibility (92% enrollment, 80% visit completion), strong adherence to BP monitoring (85% measured BP ≥2 times/day), and preliminary benefit (78% achieving BP <130/80 mmHg vs 50% in usual care). Building on these data, we propose a fully powered, hybrid type 1 implementation- effectiveness RCT across two Southern U.S. health systems: the UAB ED-TCC and the Tampa General Hospital ED-TCC. We will randomize 400 patients with elevated BP to intervention or usual care. The bundled intervention includes RBPM, pharmacist-led telehealth visits with guideline-based medication titration and automated text reminders. Effectiveness will be assessed through BP control and patient-reported outcomes at 12 and 24 weeks. Implementation will be evaluated through fidelity and acceptability metrics using validated measures, supplemented with qualitative interviews. Sustainability will be assessed through semi-structured interviews with providers, payers, and health system leaders guided by the Exploration, Preparation, Implementation, and Sustainment framework. We hypothesize that the bundled intervention will improve BP control by ≥10% compared with usual care, enhance patient-reported outcomes, be delivered with high fidelity and acceptability, and yield potential strategies for long-term sustainment. This pragmatic trial targets a population with a high burden of uncontrolled HTN in an understudied transitional care setting and a population with limited access to routine care. Findings will generate essential evidence on the effectiveness, implementation, and scalability of an ED-TCC based HTN management model, directly informing strategies to strengthen post-ED transitional care and advancing NHLBI's mission to prevent and treat CVD.
