Comparing Remote Blood Pressure Monitoring and Team-Based Treatment to Improve Hypertension Control in Safety-Net Clinics

What this Trial Is About

High blood pressure, also known as hypertension, affects over 100 million people in the US and increases risks like stroke, heart attack, and kidney disease. This research aims to compare different interventions to improve blood pressure control in diverse urban safety-net primary care settings where disparities in hypertension outcomes exist. The study also focuses on patient engagement and overcoming barriers to effective hypertension management through a team approach involving patients, clinicians, and health systems. The trial evaluates two interventions remote blood pressure monitoring RBPM with standardized measurement and treatment protocols, and a multilevel intensification intervention MII involving team-based strategies like clinician support, medication adherence monitoring, and formulary changes. The study uses a cluster randomized stepped-wedge design across multiple sites, sequentially rolling out each intervention to compare their effects and implementation. Both interventions are offered to each site to ensure equitable access. Participants will have their blood pressure and patient-reported outcomes tracked over time, with assessments at baseline and every 3 to 6 months for up to 54 months. Researchers will monitor systolic blood pressure improvements, intervention reach, patient activation, medication adherence, and trust in care providers. Data on treatment intensification and blood pressure control are collected regularly to understand how well each approach works and is implemented in real-world settings.

Improving Hypertension Control in Safety-Net Settings: The Boston Hypertension Equity Alliance in Treatment