Abstract Body: Background: Hypertension is a significant, but modifiable, cause of morbidity. Many people are unaware that they have hypertension, and of those with a diagnosis, many do not have controlled blood pressure (BP). Undertreatment may be especially problematic in medically unserved rural areas with reduced access to medical care. The goal of this study was to evaluate whether a remote pharmacist-based intervention improves BP management for patients in rural areas.

Methods: We recruited English- and Spanish-speaking rural adults from University of Iowa Health Care with at least 2 previous clinically measured BP values > 145 mmHg systolic or > 95 mmHg diastolic, for a 12-month study. Patients submitted up to 14 home BP measurements via text messaging pre-randomization. They had one conversation with the research pharmacist, and then they were randomized to the intervention or control group. The control group received only usual care for the rest of the study period. The intervention group received calls as often as once a month from a remote pharmacist who reviewed their home BP, gave medication recommendations to patients’ providers through the electronic medical record, and provided lifestyle recommendations. Research BPs and antihypertensive medication use were measured at baseline, 6 months, and 12 months. At the end of the study, patients were asked about their experiences with the remote pharmacist and the study in general.

Results: There were 211 patients in the control group, and 209 in the intervention group. Average age was 58 years. Four percent of participants were Black, and 23% were Hispanic. Average BMI was 33, and 29% had diabetes. The decrease in systolic BP in the intervention group was 9.5 mmHg lower than the control group at 6 months (p<0.001), and 4.8 mmHg lower than the control group at 12 months (p=0.019). There were no changes in the probability of being treated, but the intervention group had 75% more medication changes in the first 6 months compared to the control group (p<0.001). Many patients commented about the ease of participation and were interested in continuing communications with the pharmacists and reporting home BP readings after the study finished.

Conclusions: Our bi-directional texting and remote pharmacist intervention successfully lowered BP levels. Future work will expand this study to other populations and examine this study’s cost effectiveness.