Stream-lined tactics for improving antihypertensive medication adherence and BP control

Prescribing related tactics (high-level clinician control)Patient management (moderate clinician control)Healthcare system, policy, and payment-related (limited clinician control)
SPCs for initial and long-term therapyRigorous measurement of office BP including AOBP with validated devicesAvailable and affordable SPC
Longer days of supply, especially for maintenance therapy (90 vs. 30 days)SMBP training with relay of BP data to care team with patient advice and supportInfrastructure and payment for efficient SMBP with relay and advice/support
Rx intensification, especially adding BP med within an SPC or concurrent dose increase of 2–3 meds in SPC at encounters with uncontrolled BPMonthly encounters until BP controlledPatient-centered, team-based care with payment for quality
Refill consolidation, especially when multiple chronic conditionsTeach back, pill organizers, apps tailored to patient needsAvailable and affordable objective measures of adherence

BP: blood pressure; SPCs: single-pill combinations; SMBP: self-measured BP; AOBP: automated office BP