Design, rationale, and baseline findings from a patient-centered randomized trial of technology-enabled team care: the heart-2-heart BP control partners study

BACKGROUND: Evidence demonstrates that home blood pressure (BP) monitoring improves control; however, the impact of supplementing home BP monitoring with team care is less well described. PURPOSE: To assess the impact of combining cellular-enabled home BP monitoring with pharmacist-led team care relative to usual care for patients with uncontrolled hypertension. METHODS: Guided by patients and caregivers, researchers worked with 19 primary care practices in North Carolina (NC) to enroll diverse adult patients with uncontrolled hypertension and randomize them to technology-enabled team care (TTC) or enhanced usual care (EUC). Both groups were asked to check their home BP using a cellular-enabled monitor. TTC arm patients received regular telephonic BP management from a clinical pharmacist who reviewed home BP readings and worked with the patient's physician/provider to adjust anti-hypertensive medicines, provide brief nutrition and physical activity counseling, and make referrals for unmet social needs. RESULTS: We randomized 719 patients (EUC n = 362; TTC n = 357); mean age 62.3 ± 13.5 years, 45.6% men, 38.4% Black, average systolic blood pressure (SBP) 156.7 (±14.4) mmHg with no statistically significant differences between treatment arms. Mean BMI was 32.5 ± 7.4; mean Patient Activation Measure (PAM) Score was 70.45; mean Social Vulnerability Index score was 0.52; 66% were on 2 or more anti-hypertensives at baseline; and 16% reported less than perfect medication adherence. CONCLUSION: Combining cellular-enabled home BP monitoring and pharmacist-led team care for diverse patients with uncontrolled hypertension in primary care may have great potential to improve BP control. This trial is registered at ClinicalTrials.gov; registration number = NCT05809713.