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CLINICAL STATEMENTS AND GUIDELINES

September 16, 2025 Circulation. 2025;152:e114–e218. DOI: 10.1161/CIR.0000000000001356 e170

community health workers, or social workers (Table 19). RCTs and meta-analyses of RCTs of team-based hypertension care involving nurse or pharmacist inter­ vention demonstrated reductions in SBP and DBP and/or greater achievement of BP goals when com­ pared with usual care.1–4,31,34,53–56 Systematic reviews of team-based care, including a review of studies that included nurses, pharmacists, and community health workers, showed reductions in SBP and DBP and improvements in BP control, appointment keeping, and hypertension medication adherence compared with usual care.1,31,35,53,57 Team-based care interven­ tions that include medication titration by a nonphysi­ cian health care clinician or titration by a physician had the greatest reduction in SBP (−7.1 and −6.2 mm Hg) compared with other implementation strategies.56

2 Studies demonstrate that implementing an evidence-

based care plan for hypertension can lead to sustained reduction of BP and attainment of BP targets.43,45 The care plan should take into account the local environment,6 patient preferences, SDOH, and readiness for behavioral change,58,59 with resources matched to the needs of each patient to promote health equity. Several RCTs have evaluated the effectiveness of team-based care on changes in BP and hypertension control for up to 12 months with case management provided by nurses or phar­ macists.43,44 These studies demonstrate that case management utilizing strategies such as individual­ ized training and education,44,60–62 home BP moni­ toring,43 telenursing, and home visits63 can improve hypertension control. Given that hypertension is a chronic disease requiring ongoing long-term care to prevent or delay complications,43,61 consideration should be given to implementing longitudinal case management strategies to assist in health promo­ tion, support medication adherence, foster and sup­ port behavioral change, and address comorbidities that impact BP control.44,63 As HBPM is incorpo­ rated into the care plan, it is important to facilitate active collaboration40 and relay of BP data back to the care team so that appropriate and timely advice can be provided to the patient. 3.	 A clinical framework including accurate BP mea­

surement, timely initiation of pharmacotherapy, regular interval follow-up and therapeutic intensifi­ cation for uncontrolled BP, active engagement and support of adults with hypertension, and ongoing data monitoring and reporting enables rapid and sustained improvement in hypertension control.64 Using this approach, improvement in hypertension control has been observed in historically underresourced groups,7–10 including those receiving care in resource-limited care settings.8–10

4 The addition of new medications or intensified

dosing of current medications requires follow-up to monitor BP response and the potential for adverse effects. High-quality RCTs have successfully and safely developed strategies for follow-up, monitor­ ing, and reassessment for management of BP from which recommendations can be made (Figure 7). Components of the follow-up evaluation should include assessment in the office, and when pos­ sible, outside of the office (eg, telehealth), for BP control, including evaluation for OH, adverse drug effects, adherence to medication and lifestyle ther­ apy, need for additional therapeutic intensification of medication dosing, and indicated laboratory test­ ing (eg, electrolytes, renal function, target organ damage).

Table 19.  Responsibilities and Roles of the Hypertension Team Hypertension Team Responsibilities Communication, shared decision-making, and care coordination among vari­ ous clinical team members, the patient, and patient caregivers Effective use of evidence-based diagnosis and management guidelines Regular, structured follow-up mechanisms and reminder systems to monitor patient progress Medication adherence support and patient education about hypertension medication Medication initiation, addition, and titration using evidence-based treatment algorithms Use of evidence-based tools and resources designed to maximize selfmanagement (including health behavior change, lifestyle modification, etc) Individual Hypertension Team Members Roles (examples) Primary care physician/cardi­ ologist, physician assistant or associate/nurse practitioner/ advanced practice nurse Routine and complex hypertension care, managing primary care issues Cardiologist/physician as­ sistant or associate/nurse practitioner/advanced practice nurse Routine and complex hypertension care, especially for patients with cardiac disease or high risk for major cardiovascular events Nephrologist, endocrinolo­ gist, hypertension specialist Management of complex hypertension care, especially due to secondary causes, and/or resistant hypertension Nurse (including in-office, home care, internal and external population health personnel) Accurate assessment of BP, medication reconciliation, patient education, selfmanagement, lifestyle modification, and adherence Clinical Pharmacist Comprehensive medication management, identification of medication-related interac­ tions, and educating patients on their medi­ cation regimen Dietician Ongoing patient-centered counseling to as­ sess dietary habits and preferences and set and monitor goals for healthy lifestyle Social Worker Assess for psychosocial, cultural, and finan­ cial barriers and find solutions to overcome these barriers Community health worker Assess and address social determinants of health and identify and promote acceptable community-based resources to overcome these barriers

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