Uncontrolled Hypertension Management (TEAM-HTN)

Current guideline directed medical therapies (GDMT) for hypertension (HTN) endorse a trial
and error approach based on drug class. This pilot study will evaluate the efficacy of a
Clinical Decision Support (CDS) program to assist providers with delivering a more
personalized approach using individual renin-aldosterone levels and the mechanism of action
of medications included in GDMT recommendations. Current research suggests underlying
mechanisms of HTN can be categorized by renin and aldosterone levels into approximately 50
categories and sub-categories. Timely identification of a patients' category is challenging
for clinicians and possibly a contributing factor to the low rates of HTN control reported in
the 2014 National Health and Nutrition Examination Survey (NHANES) of 53%. The overarching
goal of this study is to achieve HTN control rates above the 2014 NANES rate in a timely,
cost-effective manner by individualizing medication management, thereby reducing the patient
risk of stroke, heart and renal disease, and other devastating HTN-related outcomes. Specific
aims are: 1) evaluate the efficacy of the CDS software program to assist providers in
identifying and matching the underlying mechanisms of HTN with the mechanism of action of
antihypertensive medications to achieve better HTN control rates than the 53% reported in the
2014 NHANES data, 2) assess the efficacy of the CDS program across prescribing provider
levels (MD/DO, residents, and APRN/PA), and 3) Determine the impact of the CDS program on: a)
medication costs, b) provider management time, c), provider and patient satisfaction with and
perception of usability and efficacy of the CDS program to manage their blood pressure. This
2-phase, prospective, within-subjects, repeated measures pilot study will enroll up to 20
multi-level providers with prescriptive authority and 160 military beneficiaries with
uncontrolled HTN in the Northwest to evaluate the efficacy, feasibility, and usability of a
CDS program to improve blood pressure control over a six-month period.

Inclusion Criteria:

1. Providers with prescriptive authority practicing in outpatient clinics at a military
treatment facility in the Northwest.

2. Patients 18 years or older with uncontrolled hypertension receiving care in an
outpatient setting that can give a valid consent (over age 18 years, the ability to
read and understand English, and cognitively intact). Active duty service members who
will not be deployed or due to change duty station for the duration of the study.

Exclusion Criteria:

1. Credentialed providers without prescribing privileges in good standing. 2. Age less than
18 years, night shift workers, anyone who cannot give a valid informed consent, pregnant or
breast feeding women, prisoners, patients on renal dialysis, transplant recipients, life
expectancy less than 1 year, and those disqualified during screening procedures.