American journal of hypertension · 2026
Optimizing multidisciplinary and interprofessional collaboration in the management of patients with difficult-to-control and resistant hypertension.
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Giacona John M, Vongpatanasin Wanpen
Аннотация
BACKGROUND: Hypertension remains one of the leading causes of cardiovascular morbidity and mortality worldwide, yet blood pressure (BP) control rates remain suboptimal despite available therapeutic options. Patients with difficult-to-control or resistant hypertension face elevated cardiovascular risk and require intensive, coordinated management that addresses measurement accuracy, medication adherence, and treatment intensification. Multidisciplinary collaboration has emerged as a highly effective approach, with systematic reviews demonstrating significant BP reductions and increases in control rate vs usual care.
METHODS: This review discusses evidence supporting collaborative care models, including advanced practice provider-physician partnerships, physician-pharmacist collaborative management, nurse-led interventions, and community health worker programs. Key implementation strategies include standardized treatment protocols, home BP monitoring with clinical support, and health information technology integration.
RESULTS: Despite demonstrated cost-effectiveness, significant barriers to collaborative care persist, including inadequate reimbursement, organizational inertia, and workforce limitations. The advanced practice provider-physician model shows promise, with advanced practice providers managing routine and complex hypertension, allowing physicians to focus on more challenging cases. Specialized centers, including American Heart Association Certified Comprehensive Hypertension Centers, provide multidisciplinary expertise for difficult-to-control hypertension.
CONCLUSIONS: Future directions include sustainable payment models and leveraging technology to enhance team communication and patient engagement. Optimizing interprofessional collaboration represents an evidence-based strategy to close the gap between evidence-based management and real-world BP control.
METHODS: This review discusses evidence supporting collaborative care models, including advanced practice provider-physician partnerships, physician-pharmacist collaborative management, nurse-led interventions, and community health worker programs. Key implementation strategies include standardized treatment protocols, home BP monitoring with clinical support, and health information technology integration.
RESULTS: Despite demonstrated cost-effectiveness, significant barriers to collaborative care persist, including inadequate reimbursement, organizational inertia, and workforce limitations. The advanced practice provider-physician model shows promise, with advanced practice providers managing routine and complex hypertension, allowing physicians to focus on more challenging cases. Specialized centers, including American Heart Association Certified Comprehensive Hypertension Centers, provide multidisciplinary expertise for difficult-to-control hypertension.
CONCLUSIONS: Future directions include sustainable payment models and leveraging technology to enhance team communication and patient engagement. Optimizing interprofessional collaboration represents an evidence-based strategy to close the gap between evidence-based management and real-world BP control.