Vascular age as a key for a team-based approach to manage blood pressure bridging community pharmacists and primary healthcare physicians—The TOGETHER trial

Background: Highlighting arterial stiffness in Community Pharmacies (CPh) has been met with considerable interest in Portugal, Austria, and Spain. TOGETHER aims to evaluate whether empowering hypertensive subjects by determining blood pressure (BP) and vascular aging in CPh increases hypertension (HTN) control, while establishing paths of lasting cooperation between General Practitioners (GP) and CPh. Methods: TOGETHER is a cluster-randomized, prospective study in Portugal, Austria, and Spain. All consecutive subjects entering CPh will be offered BP measurement and ambulatory BP monitoring (ABPM) for those with BP ≥ 140/90 mmHg. CPh will be randomly assigned to a usual care arm (including health education for HTN). In the experimental care group, vascular aging (VA) will be additionally assessed by estimating aortic pulse wave velocity using brachial oscillometry. In this group, health education will include VA, which will also be communicated to GPs. In both groups, HTN will be treated by GPs according to usual clinical practice. A second evaluation with ABPM will be performed after 6 months, and the percentage of patients with controlled hypertension will be compared between both arms. The degree of CPh/GP interaction and patients´ adherence will be assessed through validated surveys. Discussion: Five fundamental unmet needs will be addressed by TOGETHER: 1) the lack of HTN screening programs; 2) implementation of the simpler and more informative VA concept ("Your arteries are 10 years older than you"); 3) understanding CV risk on an individual basis (individual VA) should improve patient adherence and reduce physician inertia; 4) implementation of health educational programs, combined with the concept of VA; 5) higher collaboration and development of a team-based approach to HTN care between CPh and GP. The complementary organizational settings and strengths of CPh and GP will allow TOGETHER to create new strategies for the early identification and intervention in uncontrolled HTN, encompassing both lifestyle and medical treatment, while considering social, economic, and behavioral aspects. Clinical trial registration: https://clinicaltrials.gov/, identifier FP-1533-ROD-SAL-2024-01.