Please select the eligibility criteria that correspond to the clinical trial below.
Title: Alberta Clinical Trial in Optimizing Hypertension: The RxAction Study
Brief Summary: The purpose of this study is to evaluate the effect of enhanced pharmacist care (patient identification, assessment, education, prescribing/titration of antihypertensive medications and close follow-up) on systolic blood pressure (BP) reduction in patients with poorly controlled hypertension in the community setting.


Options:
A: Inclusion Criteria:

* Adults (≥18 years of age) at high risk for cardiovascular events, including:

  * Patients with diabetes
  * Patients with chronic kidney disease \[eGFR \<60 ml/min/1.73m2 and/or (ACR \>= 30 mg/mmol or two consecutive ACR tests which are \>= 3 mg/mmol)\]
  * Patients with established atherosclerotic vascular disease including cerebrovascular disease (prior stroke or transient ischemic attack), cardiovascular disease (myocardial infarction, acute coronary syndrome, stable angina, or revascularization), or peripheral arterial disease (symptomatic and/or ankle brachial index \<0.9).
  * Primary prevention patients with multiple risk factors and Framingham risk score \>20%
  * In order to qualify for inclusion, all patients must have at least one uncontrolled risk factor (i.e., blood pressure, LDL-cholesterol, HbA1c, or current smoking)

Exclusion Criteria:

* Unwilling to participate/sign consent form
* Unwilling or unable to participate in regular follow-up visits
* Pregnancy
B: Inclusion Criteria:

* Diagnosis of hypertension in the prior two years and on hypertension medications
* Access to the Internet and an e-mail address
* Ability to use a computer using the English language
* Medical care coverage which permits them to refill prescriptions at Group Health Cooperative pharmacies and a willingness to do so.
* Blood pressure on each of two screening visits averaging \> 90 mmHg diastolic or \> 140 mmHg systolic and \< 110 mmHg diastolic or \< 200 mmHg systolic

Exclusion Criteria:

* Diagnosed or history of diabetes, cardiovascular disease (ischemic heart disease, valvular heart disease, heart failure, arrhythmias, strokes or transient ischemic attacks, and peripheral vascular disease)
* Current treatment for cancer, on immunosuppressant or antiretroviral treatment.
* Surgery or hospitalization in the prior 3 months
* Pregnancy (or plans to become pregnant in the next 12 months)
* Plans to move out of the area or leave the health plan in the next 12 months.
* Upper arm circumference size \> 18 inches.
* Arrhythmia detected at screening visits
C: Inclusion Criteria:

The following patients will be eligible for study participation:

* Patients with either type 1 or type 2 diabetes. Diabetes will be defined as those patients presently taking either oral hypoglycemic agents or insulin therapy (oral hypoglycemic agents to include all drugs in the drug classes of: alpha-glucosidase inhibitors, biguanides, meglitinides, sulfonylureas, thiazolidinediones and adjunctive therapy) taken for \>6 months to rule-out steroid-induced diabetes and gestational diabetes.

Exclusion Criteria:

Patients will be excluded from the study if they:

* Do not provide or are unable to provide written informed consent
* Refuse or are unlikely to attend follow-up visits for BP measurements
* Are institutionalized
* Are \<18 years of age
* Do not understand English
* Enrolled in other diabetes or hypertension trials

Subjects will be recruited whether or not they are receiving antihypertensive therapy.
D: Inclusion Criteria:

1. Overall average (after 2 visits) systolic ≥180 OR diastolic ≥110 mmHg in undiagnosed patients without macrovascular target organ damage, diabetes or chronic kidney disease
2. Overall average (after 2 visits) systolic ≥140 OR diastolic ≥90 for patients with undiagnosed hypertension with macrovascular target organ damage (coronary artery disease, cerebrovascular disease, DM)
3. In patients with diagnosed hypertension, systolic ≥140 (≥ 130 with DM or CKD) OR diastolic ≥90, (≥ 80 with DM or CKD)
4. Overall average (after 5 visits, for those without macrovascular target organ damage, DM, or CKD and without an existing hypertension diagnosis) systolic ≥140 OR diastolic ≥90 mmHg
5. Overall average (after 7 days of twice-daily home blood pressure monitoring , for those without macrovascular target organ damage, DM, or CKD and without an existing hypertension diagnosis) systolic ≥135 OR diastolic ≥85

Exclusion Criteria:

* Patients with hypertensive urgency or emergency:

  * Urgency: SBP ≥ 180 mm Hg or DBP ≥ 120 mm Hg with no acute signs of end-organ damage
* Unwilling to participate/sign consent form
* Pregnancy

Answer: D