# Development of an implementation-ready antihypertensive self-titration intervention to improve US blood pressure control

> **NIH NIH K23** · BRIGHAM AND WOMEN'S HOSPITAL · 2022 · $172,848

## Abstract

Nearly 1 in 2 US adults has hypertension, and it is a leading cause of myocardial infarction,
stroke, and death. Despite the importance of hypertension and the widespread availability of
medication treatment, only 44% of patients had controlled blood pressures in 2018. This is in
part due to the way in which we deliver care, and new strategies are needed to achieve better
blood pressure control. Team-based care with medication titration by a non-physician is a
promising approach, but the cost and infrastructure required make this option less feasible. An
alternative strategy is to have patients self-manage their own hypertension by checking blood
pressures and following an algorithm, pre-planned between the patient and primary care doctor,
to intensify their medications at home. Despite evidence for the effectiveness and cost-
effectiveness of this approach, it has not yet been incorporated into routine care.
In this project, we propose to develop an implementation-ready antihypertensive self-titration
intervention informed by qualitative interviews and real-world assessments of antihypertensive
adherence. The proposed aims are to: (1) explore barriers and facilitators to the implementation
of antihypertensive self-titration in routine US primary care; (2) assess adherence to
antihypertensive treatments; and (3) develop an implementation-ready antihypertensive self-
titration protocol, perform usability testing, and prepare a proposal for a pragmatic, randomized
trial to test the intervention’s effectiveness. The overarching goal of the project is to develop an
innovative alternative model of hypertension care that has the potential to improve blood
pressure control, patient self-efficacy, and disease understanding
Dr. Haff is a practicing primary care physician committed to a career in research to improve the
prevention and treatment of cardiometabolic disease, and this proposal includes a training plan
that will accelerate her career development in the areas of implementation science, qualitative
methods, health services research methods, and scientific writing. The mentorship team, led by
Niteesh Choudhry, an expert in health services research and implementation science related to
cardiometabolic disease, includes well-known experts in preventive cardiology (Paul Ridker, co-
mentor), biostatistics (Robert Glynn, co-mentor), and implementation science and qualitative
methods (Karen Emmons, co-mentor), and will ensure successful completion of the proposed
project and training. By the conclusion of this program, Dr. Haff will be able to independently
design, target, and evaluate interventions for cardiometabolic disease. The results of the
proposed K23 will be invaluable pilot work for a planned R01-level application.

## Key facts

- **NIH application ID:** 10524825
- **Project number:** 1K23HL161480-01A1
- **Recipient organization:** BRIGHAM AND WOMEN'S HOSPITAL
- **Principal Investigator:** Nancy Haff
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $172,848
- **Award type:** 1
- **Project period:** 2022-08-04 → 2027-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10524825

## Citation

> US National Institutes of Health, RePORTER application 10524825, Development of an implementation-ready antihypertensive self-titration intervention to improve US blood pressure control (1K23HL161480-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10524825. Licensed CC0.

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