Interdisciplinary Telehealth Team Positively Impacts Difficult-to-Control Hypertension in CKD

KEY POINTS: A collaborative nephrologist–pharmacist telehealth clinic significantly improved difficult-to-control hypertension in patients with CKD. Reduction in systolic BP was achieved without significant and widespread worsening of renal function or change in electrolytes. BACKGROUND: Hypertension (HTN) is the most common chronic health condition worldwide and affects patients with CKD at increasing rates as kidney function falls. Uncontrolled BP can have a significant effect on cardiovascular disease, kidney disease progression, and mortality. 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. METHODS: Patients with difficult-to-control HTN were referred to a collaborative nephrology telemedicine clinic for care by a nephrologist and a clinical pharmacist. BP was managed through telephone visits conducted by the pharmacist every four to 12 weeks. Patients were sent a home BP monitor, provided education about its use, and were instructed to monitor home BP regularly. Those with at least three phone visits who had objective home BP measurements at each visit were included in the pragmatic analysis. Change in systolic BP from baseline was the primary outcome variable. RESULTS: Of the 55 patients meeting inclusion criteria, a mean reduction of 16±14 mm Hg in systolic BP and 6±7 mm Hg in diastolic BP was shown. In 12±7 months, 44% of patients achieved goal BP (<130/80) and 31% were discharged back to primary care management in an average of 8±5 months with apparent sustained effect. CONCLUSIONS: 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.