Please select the eligibility criteria that correspond to the clinical trial below.
Title: Home Blood Pressure Monitoring Program
Brief Summary: The goal of this project is to improve hypertension control at Kaiser Permanente Colorado (KPCO) by implementing a population-based multi-factorial intervention that uses home BP monitors that can download BP readings to KPCO's health records via internet, interactive voice response (IVR) technology, and multidisciplinary care team. Participants will be randomized to either the home blood pressure monitoring group receiving the multi-factorial intervention or the usual care group who will be receiving Kaiser standard of care. We will determine the proportion of patients in each group who achieve their target BP goals at 6 months, according to national clinical practice guidelines. The study hypothesis is that a higher proportion of patients with uncontrolled hypertension in the home blood pressure monitoring (HBPM) group will achieve their target blood pressure compared to those in the usual care (UC) group.


Options:
A: Inclusion Criteria:

1. English or Spanish speaking males or females, over 18 years of age with a diagnosis of hypertension,
2. have uncontrolled BP defined as \> 140 mm Hg SBP or \> 90 mm Hg DBP for patients with uncomplicated hypertension; or \> 130 mm Hg SBP or \> 80 mm Hg DBP for patients with diabetes or chronic kidney disease, and
3. receive care from one of the participating clinics.

Exclusion Criteria:

1. current signs of hypertensive emergency (acute angina, stroke, or renal failure;
2. severe HTN (systolic BP \>200 or diastolic BP \> 114 mm Hg);
3. history of MI, stroke, or unstable angina in the prior 6 months;
4. systolic dysfunction with a LV ejection fraction \< 35% documented by echocardiography, nuclear medicine study, or ventriculography;
5. renal insufficiency, defined by a glomerular filtration rate less than 20 ml/min or previously documented proteinuria \> 1 gram per day;
6. significant hepatic disease, including prior diagnoses of cirrhosis, Hepatitis B or C infection, or laboratory abnormalities (serum ALT or AST \> 2 times control or total bilirubin \> 1.5 mg/dl) in the prior 6 months;
7. pregnancy;
8. diagnoses of pulmonary hypertension or sleep apnea (unless treated by continuous positive pressure ventilation);
9. poor prognosis with a life expectancy estimated less than 2 years;
10. residence in a nursing home or diagnosis of dementia; and
11. inability to give informed consent or impaired cognitive function (defined as \> 3 errors on the 10-item Pfeiffer Portable Mental Status Questionnaire, administered during study intake).
B: Inclusion Criteria:

* Age 18 to 85 years At least 1 diagnosis for hypertension,

  * Receive primary care from one of the participating clinics,
  * The two most recent BPs documented within that last 24 months are elevated (SBP\>140 and/or DBP\>90)
  * Receiving \< 3 antihypertensive medications, and
  * Have access to a computer with a USB port.

Exclusion Criteria:

* Pregnant, or breast-feeding,
* Patients on dialysis or being followed by nephrology,
* Patients with coronary artery disease, given these patients are already followed by the Clinical Pharmacy Cardiac Risk Service (CPCRS),
* On KPCO "Do Not Call" or deceased list,
* PCP does not give permission to include patient in the study,
* BP is at or below target at the baseline study visit,
* Not English-speaking.
C: Inclusion Criteria:

* spoken language is French or English
* physician is a user of MOXXI (electronic health record system) and patient has consented to be captured by MOXXI
* receiving a high-risk incident prescription
* medication insurance through Regie de l'Assurances Maladie du Quebec (RAMQ) insurance program

Exclusion Criteria:

* patient not appropriate for inclusion (as determined by prescribing physician)
D: Inclusion Criteria:

All patients admitted with acute coronary syndrome (ACS) as the primary reason for hospital admission and use the VA for their usual source of care, defined as having 1 primary care visit within the 12 months prior to hospital admission will be screened for eligibility to participate. ACS is defined as acute myocardial infarction (both ST-elevation MI and non-ST elevation MI) or unstable angina. The presence of acute myocardial infarction will be defined using standard definitions from an international consensus statement, based on the following: a rise and/or fall of cardiac biomarkers (preferably troponin) with at least one value above the 99th percentile of the upper reference limit and at least one of the following:

* symptoms of ischemia;
* ECG change indicative of new ischemia (new ST-T changes or new left bundle branch block);
* development of pathological Q waves in the ECG; or
* imaging evidence of new loss of viable myocardium or new regional wall motion abnormality.42 Unstable angina will be defined by presence of ischemic symptoms and ECG changes indicative of new ischemia but without biomarker evidence of myonecrosis (i.e., biomarker elevation) and no evidence of new pathological Q waves, loss of viable myocardium or regional wall motion abnormality.

Exclusion Criteria:

* Patient admitted for primary non-cardiac diagnosis and develop ACS as a secondary condition (e.g. perioperative MI);
* planned discharge to nursing home or skilled nursing facility;
* irreversible, non-cardiac medical condition (e.g. metastatic cancer) likely to affect 6-month survival or ability to execute study protocol;
* lack of telephone/cell phone;
* VA is not primary source of care;
* regularly fill medications at non-VA pharmacy.

Answer: B