Antihypertensive self-titration to improve US blood pressure control - Nearly 1 in 2 US adults has hypertension, and it is a leading cause of myocardial infarction, stroke, and death. Despite the importance of hypertension and the widespread availability of medication treatment, less than half of patients have blood pressures that are controlled. This is in part due to the way in which we deliver care, and new strategies are needed to achieve better blood pressure control. Team-based care with medication titration by a non-physician is a promising approach, but the cost and infrastructure required make this option less feasible. An alternative strategy is to have patients self-manage their own hypertension by checking blood pressures and following an algorithm, pre-planned between the patient and primary care doctor, to intensify their medications at home. Despite evidence for the safety, effectiveness and cost- effectiveness of this approach, it has not yet been incorporated into routine care. Prior to a large-scale trial of this intervention in the US, several key factors need to be tested. First, the sociodemographic characteristics of patients with hypertension in the US, patient preferences, practice patterns, perspectives of US providers and regulatory environment are different from the original trials. Our preliminary work has demonstrated that US patients and providers are enthusiastic about antihypertensive self- titration, and that adaptation of the intervention to the US context will require specific prioritization of diverse patient participation. Moreover, usual care has evolved, and an adapted intervention will need to optimally utilize the electronic health record and consider use of connected home blood pressure cuffs. Thus, in this project we will complete key preparatory steps to ensure the intervention is adapted to and implementable in the US primary care context. In Aim 1 we will refine our process to identify patients with uncontrolled hypertension to incorporate home blood pressure measurements. In Aim 2 we will develop and refine recruitment and intervention materials and processes based on feedback from a diverse group of healthcare team members and patients. We will then pilot test all aspects of the intervention in clinical care for 30 patients to determine reach, adoption, feasibility and fidelity (Aim 3). Upon completion of this work all materials and procedures will be proven ready for the successful conduct of a randomized trial testing antihypertensive self-titration in the US primary care context.
