p.56 抽出テキスト
CLINICAL STATEMENTS AND GUIDELINES Circulation. 2025;152:e114–e218. DOI: 10.1161/CIR.0000000000001356 September 16, 2025 e169 expressed that lower BP targets may compromise blood flow to an extremity with impaired perfusion caused by PAD and worsen symptoms.3 However, to date, mul tiple studies have shown no deterioration in symptoms of claudication and functional status caused by antihy pertensive treatments in adults with PAD.4–6 Although no single antihypertensive medication appears to be more effective at treating hypertension in adults with PAD, car diovascular benefits are shown with the use of ACEi or ARB, and these agents should be first line for adults with PAD and hypertension.7,8 For additional information on the management of hypertension in adults with PAD, see Section 5.3 in the “2024 ACC/AHA/AACVPR/APMA/ ABC/SCAI/SVM/AVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease.”9 5.4 Plan of Care for Hypertension Recommendations for Plan of Care for Hypertension Referenced studies that support the recommendations are summarized in the Evidence Table. COR LOE Recommendations Team-Based Care 1 A 1 For adults with uncontrolled hypertension, a team-based care approach is recommended to achieve and maintain BP control.1–4 1 C-LD 2 For adults with uncontrolled hypertension, an evidence-based care plan utilizing HBPM, and team-based care that is responsive to addressing adverse SDOH, is recommended to achieve and maintain BP control.5,6 Framework in Clinical Practice to Improve Hypertension Control 1 B-NR 3 For adults with uncontrolled hypertension, an integrated treatment model that includes accu rate BP measurement, prompt treatment, patient engagement, and ongoing review of HBPM is recommended to improve BP control.7–10 Follow-Up After Initial BP Evaluation and Initiation of Antihypertensive Therapy 1 B-R 4 Adults with uncontrolled hypertension placed on new or intensified medical therapy should have follow-up evaluations for medication adherence and response to treatment at monthly intervals until control is achieved.11–13 Health Information Technology 1 B-R 5. For adults with uncontrolled hypertension, health information technology (HIT) by synchronous (eg, phone, video call) or asynchronous (eg, text, e-mail) communication is beneficial in improving BP control, access to care, and adherence to standards of care and should be incorporated in the management of hypertension, including the titration of BP medications.14–17 1 B-NR 6 In adults with undiagnosed or uncontrolled hypertension, use of the electronic health record (EHR) and patient registries is beneficial for screening and identification of hypertension to focus on those who need additional care.15 2a B-R 7 In adults with uncontrolled hypertension, telehealth interventions can be useful to reduce BP18–26 and improve office BP control.19,21,23–26 Synopsis Team-based care is a health systems level organizational intervention that incorporates a trained multidisciplinary team and is frequently implemented as part of a multifac eted approach to improve hypertension outcomes using strategies outlined in Table 19.1–3,27–36 Multidisciplinary teams can be effective in assessing and addressing in dividual social determinants of health, such as access to medications and other structural barriers to optimize patient-centered cardiovascular care for all patients with hypertension and reduce the disparities in hypertension control.36 Delineation of individual team member roles based on knowledge, skill set, availability, and patient needs allows the primary care clinician more time to man age complex and critical issues.27,31,37 Team-based care often requires organizational change and reallocation of resources.27,38 Although cost-effective,39 current payment models do not support reimbursement for hypertension care that is provided by health care team members other than physicians. A comprehensive care plan for hyperten sion should incorporate current best practices, including standardized treatment protocols, team-based care, and HBPM with clinical support, while considering the lo cal environment, associated risk factors, and SDOH.5,6,40 This personalized approach should integrate strategies to enhance medication adherence (SPC therapy),5,41 utilize technology for self-management, and implement case management through a multidisciplinary team to ef fectively address the complexities of hypertension man agement.1–3,5,6,27–35,37,38,40–45 Integration of HIT, including computerized clinical decision support systems like EHR and patient registries, facilitates large-scale queries to support population health by effective identification and management of patients with hypertension. Telehealth interventions (Section 3.1.3, “Out-of-Office BP Monitoring”) allow the exchange of medical infor mation between patients and their health care team for chronic disease management at a distance by synchro nous (eg, phone, video call) or asynchronous (eg, text, email) communication using Wi-Fi, Bluetooth, cellular, and/or mobile communication technologies (“mHealth”; mobile apps).20,42,46,47 Effective telehealth interventions include proactive outreach by health care profession als to integrate remote BP data exchange with lifestyle education and medication management.20,24,42,46–48 The frequency of follow-up depends on the stage of hyper tension, target organ damage, medication use, and BP control.49–52 Uncontrolled hypertension is the average BP above the patient’s goal BP. Please refer to Table 4 and Section 3 (“Evaluation and Diagnosis”) for nuances on accurate BP measurement. Recommendation-Specific Supportive Text 1 The hypertension care team may include primary care clinicians, specialists, nurses, pharmacists, dieticians, Downloaded from http://ahajournals.org by on October 7, 2026