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.