# Pharmacist-guided, patient-driven management of high blood pressure in CKD: A Novel Approach

> **NIH VA I01** · IOWA CITY VA MEDICAL CENTER · 2022 · —

## Abstract

Background. Chronic kidney disease (CKD) associates with high morbidity and mortality due to CKD
progression and cardiovascular disease (CVD). Blood pressure (BP) lowering reduces the risk of CVD and
CKD progression. In spite of the large number of BP medications available, a significant proportion of Veterans
with CKD have BP above the goal. The current practice involves licensed providers performing medication
titrations to achieve BP goals and is associated with limited patient engagement. Our preliminary data indicate
that the implementation of pharmacist-guided patient-driven titration of BP medications is effective and feasible
in CKD. In this model, Veterans self-manage their BP medications under the guidance of the clinical
pharmacist based on a pre-determined medication titration plan.
Significance. The prevalence of CKD is extremely high among Veterans, with some studies reporting a
prevalence of 47% (vs 11% in the general population). Here, we propose a novel interdisciplinary care model
that engages the Veterans as an active participant in their care with the goal of improving BP control to
improve long term outcomes. The application addresses a key HSR&D priority (management of complex
chronic disease).
Innovation and Impact. First, the proposed care model is one that has not been tested and includes the
clinical pharmacist working with the provider and the Veterans so that Veterans with CKD can self-manage
their hypertension. While self-management is exercised in CKD once patients are on dialysis (via home
dialysis modalities), the self-management approach is not utilized in the earlier stages of CKD. Second, in the
approach, we will utilize a transdisciplinary approach to evaluate the implementation of pharmacist-guided self-
management of BP medications and we will apply constructs of an implementation science framework,
Consolidated Framework for Implementation Research (CFIR), to understand Veteran and system factors that
may either facilitate or impede the implementation and sustainment of the pharmacist-guided self-management
approach.
Specific aims. Specific aim 1 will evaluate if pharmacist-guided self-management of BP medications is more
effective than self-monitoring of home BP + the standard care amongst Veterans with CKD. Specific aim 2 will
identify and understand Veteran factors that may influence the acceptability of and the adherence to the self-
management approach whereas specific aim 3 will focus on understanding system factors that may facilitate or
impede the implementation of the self-management approach.
Methods. One hundred and sixty Veterans with uncontrolled hypertension and either stage 2 CKD with
albuminuria or stage 3 and 4 CKD will be randomized to either pharmacist-guided self-management or to self-
monitoring + the standard practice for 12 months. Aim 1 will evaluate change in [standardized] office systolic
BP at 12 months as the primary outcome. Aim 2 will utilize a mixed methods approach including s...

## Key facts

- **NIH application ID:** 10535326
- **Project number:** 1I01HX003533-01A1
- **Recipient organization:** IOWA CITY VA MEDICAL CENTER
- **Principal Investigator:** Diana I Jalal
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2022-10-01 → 2026-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10535326

## Citation

> US National Institutes of Health, RePORTER application 10535326, Pharmacist-guided, patient-driven management of high blood pressure in CKD: A Novel Approach (1I01HX003533-01A1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10535326. Licensed CC0.

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