Comparing Pharmacist-Led Telehealth Care and Clinic-Based Care for Uncontrolled High Blood Pressure: The Hyperlink 3 Pragmatic Cluster-Randomized Trial

Abstract

Background: A team approach is one of the most effective ways to lower blood pressure (BP) in uncontrolled hypertension, but different models for organizing team-based care have not been compared directly.

Methods: A pragmatic, cluster-randomized trial compared 2 interventions in adult patients with moderately severe hypertension (BP≥150/95 mm Hg): (1) clinic-based care using best practices and face-to-face visits with physicians and medical assistants; and (2) telehealth care using best practices and adding home BP telemonitoring with home-based care coordinated by a clinical pharmacist or nurse practitioner. The primary outcome was change in systolic BP over 12 months. Secondary outcomes were change in patient-reported outcomes over 6 months.

Results: Participants (N=3071 in 21 primary care clinics) were on average 60 years old, 47% male, and 19% Black. Protocol-specified follow-up within 6 weeks was 32% in clinic-based care and 27% in telehealth care. BP decreased significantly during 12 months of follow-up in both groups, from 157/92 to 139/82 mm Hg in clinic-based care patients (adjusted mean difference -18/-10 mm Hg) and 157/91 to 139/81 mm Hg in telehealth care patients (adjusted mean difference -19/-10 mm Hg), with no significant difference in systolic BP change between groups (-0.8 mm Hg [95% CI, -2.84 to 1.32]). Telehealth care patients were significantly more likely than clinic-based care patients to report frequent home BP measurement, rate their BP care highly, and report that BP care visits were convenient.

Conclusions: Telehealth care that includes extended team care is an effective and safe alternative to clinic-based care for improving patient-centered care for hypertension.

Registration: URL: https://www.

Clinicaltrials: gov; Unique identifier: NCT02996565.

Keywords: blood pressure; hypertension; nurse practitioners; patient-reported outcomes; pharmacists; physicians; telemedicine.

Figure 1.

Hyperlink 3 participant flow diagram Abbreviations: BP – blood pressure; CKD – chronic kidney disease; ITT – intention to treat; MA – medical assistant; MTM – Medication Therapy Management; PCP – primary care professional; PRO – patient-reported outcome; SBP – systolic blood pressure

Figure 2:

Observed systolic blood pressure (SBP) by treatment group from index visit to 365 days post-index

Figure 3:

Observed diastolic blood pressure (DBP) by treatment group from index visit to 365 days post-index