Hypertension (HTN) is the most common chronic health condition worldwide and impacts chronic kidney disease patients at increasing rates as kidney function falls. Uncontrolled blood pressure can have a significant impact on cardiovascular disease, kidney disease progression, and mortality. In this study, we implemented an interdisciplinary team to assess the impact a fully virtual management system, on top of usual nephrology care, could have on HTN control among Veterans Administration patients with difficult to manage HTN.
Patients with difficult to control HTN were referred to a collaborative nephrology telemedicine clinic for care by a nephrologist and a clinical pharmacist. Blood pressure was managed via telephone visits conducted by the pharmacist every four to 12 weeks. Patients were sent a home blood pressure monitor, provided education about its use, and were instructed to monitor home blood pressure regularly. Those with at least three phone visits who had objective home blood pressure measurements at each visit were included in the pragmatic analysis. Change in systolic blood pressure from baseline was the primary outcome variable.
Of the 55 patients meeting inclusion criteria, a mean reduction of 16±14 mm Hg in systolic blood pressure and 6±7 mm Hg in diastolic blood pressure was shown. In 12±7 months 44% of patients achieved goal blood pressure (<130/80) and 31% were discharged back to primary care management in an average of 8±5 months with apparent sustained effect.
An interdisciplinary team of a pharmacist and nephrologist using a virtual care model is an effective method for managing difficult to control HTN in this pragmatic assessment.