Please select the eligibility criteria that correspond to the clinical trial below.
Title: Preventing Heart Disease in Underserved Patients
Brief Summary: The study will evaluate the impact of an internet based telemedicine system on cardiovascular risk profile of underserved patient populations. It is our hypothesis that a treatment plan and frequent communication via an internet based Telemedicine system will improve the cardiovascular risk profile of underserved patient populations at increased risk for cardiovascular disease. Our primary endpoint is a reduction over one year in the 10-year CVD risk score (ATP III risk model).


Options:
A: Inclusion Criteria:

* Diagnosis of uncontrolled hypertension,
* prescribed a medication to lower blood pressure,
* have a regular primary care physician at Durham VA Medical Center, and
* be a veteran. For Sustainability portion the patient must have participated in an intervention arm of primary study.

Exclusion Criteria:

* Hospitalized in past 3 months for stroke,
* heart attack,
* surgery for blocked arteries,
* diagnosed with metastatic cancer or treated with dialysis,
* have a diagnosis of dementia or a hearing impairment which prevents them from being able to hear/speak on the telephone, and
* creatinine serum lab which exceed 2.5.
B: Inclusion Criteria for Clinics:

* The clinic is affiliated with the Remediar+Redes program.
* The clinic is located in urban poor areas according to the 2010 census data.
* The clinic has ≥1000 outpatient visits each month, so that sufficient participants can be recruited.
* The minimum distance between the selected clinics will be 10 kilometers to minimize the risk for contamination of the intervention.
* Physician visits and essential medications are free of charge to patients under all circumstances.
* The clinic has a high number of prescriptions for antihypertensive medications.
* The clinic employs community health workers.
* The clinic has general practitioners and nurses.
* The clinic has a history of good performance in the Remediar+Redes program.
* The clinic performs blood draws on patients when appropriate.

Inclusion Criteria for Participants:

* Patients aged ≥21 years who received primary care from the participating clinics and have hypertension ( SBP ≥140 mmHg and/or DBP ≥90 mmHg on at least 2 separate visits) and their spouses (with or without hypertension) and/or any adult hypertensive family members (age ≥21 years) living in the same household will be included.
* Hypertension patients and their spouses and/or family members must be available for the first baseline nurse home visit.
* The index patient must have a cell phone that receives text messages.
* The family's homes must be located within 10 kilometers from the clinic.

Exclusion Criteria for Participants:

* Hypertension patients who do not have a spouse or another adult with hypertension in the household.
* Plans to move from the neighborhood in the next two years
* Pregnant women or women who are planning to become pregnant in the next two years
* Persons who are bed-bound
* Persons who cannot give informed consent
* Persons with an arm circumference \>50 cm
C: Inclusion Criteria:

* Framingham risk score equal to or greater than 10%
* literacy
* 22 -85 years of age
* access to phone

  * ability to use Internet and system following training

Exclusion Criteria:

* Class 3 and 4 heart failure
* ESRD
* stroke with residual disability or dementia
* unable to read or write
D: Inclusion Criteria:

* Age of 18 or greater
* At least one BP with Systolic Blood Pressure (SBP) ≥ 160 or a Diastolic Blood Pressure (DBP) ≥ 100 (criteria 1)
* If the patient has repeated measurements after achieving Criteria 1, at least one of the repeat BP remains SBP ≥ 140 or a DBP ≥ 90
* Must have cell phones with text-messaging capability and willingness to receive texts
* Likely to be discharged from the ED

Exclusion Criteria:

* Unable to read English (\<1% at study site)
* Prisoners
* Pregnant
* Pre-existing condition making one year follow-up unlikely

  * Terminal illness with death expected within 90 days
* Current use of 3 or more antihypertensive agents
* Patients with other serious medical conditions that prevent self-monitoring of BP
* Critical illness with placement in resuscitation bay
* Dementia/cognitive impairment

Answer: C