Pharmacist-guided, Patient-driven Management of High Blood Pressure in CKD: A Novel Approach

Description

The proposed research will evaluate if patients managing their blood pressure medications under the guidance of a clinical pharmacist works better to lower blood pressure than patients monitoring their blood pressure at home and the standard care. 60 Veterans with chronic kidney disease (CKD) will be included in the study. The study will further evaluate factors that may influence the Veteran to accept the self-management approach and what factors in the VHA healthcare system affect the implementation of the self-management approach.Chronic kidney disease (CKD) associates with high morbidity and mortality due to CKD progression and cardiovascular disease (CVD). Blood pressure (BP) lowering reduces the risk of CVD and CKD progression. In spite of the large number of BP medications available, a significant proportion of Veterans with CKD have BP above the goal. The current practice involves licensed providers performing medication titrations to achieve BP goals and is associated with lim

Trial Eligibility

Inclusion Criteria: * Age \>= 18 years, * CKD stage 3 or 4 (estimated GFR: 15-59 mL/min/1.73m2) or * Stage 2 CKD (estimated GFR 60-89 mL/min/1.73m2) with urinary albumin/creatinine ratio (ACR 300 mg/g if no DM and 30 mg/g if with DM), and * Uncontrolled hypertension defined as the avg of 2 readings \> 140 systolic. Exclusion Criteria: * Severely uncontrolled hypertension defined as systolic BP \>180, * Patients with resistant hypertension and taking 4 BP medications, * Orthostatic hypotension defined as reduced systolic BP by 20 mmHg or diastolic BP by 10 mmHg after 3 minutes of standing, * Severe CKD defined as estimated GFR \< 20 mL/min/1.73m2, * Life expectancy \<1 year, * Severe liver disease, * Severe congestive heart failure, * Severe cognitive decline due to dementia, * Pregnant, breastfeeding, or unwilling to use adequate birth control

Study Info

Interventions

Locations Recruiting

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