Implementing Evidence Based Treatment of Hypertension

You may be eligible if

• No active prescription for a thiazide diuretic (or a medication that combines a thiazide and another agent (e.g., hydrochlorothiazide and triamterene)
• Prior diagnosis of hypertension, as documented in VA outpatient administrative files
• Two or more visits to a primary care clinic in the prior 12 months;
• Blood pressure above treatment goal at the two most recent VA outpatient clinic visits Above goal is defined as a systolic pressure \>140 mmHg or diastolic pressure \>90 mmHg. For diabetics above goal is defined as systolic pressure \>130 mmHg or diastolic pressure \>80 mmHg
• Blood pressure at goal (as defined above) during one of the last two outpatient clinic visits, but the patient is receiving a prescription for a calcium channel blocker (CCB)
• Documented allergy to thiazides or to sulfa agents
• Previously documented intolerance or adverse drug reaction to thiazide diuretics
• Active prescription for a loop diuretic agent (e.g. furosemide)
• Renal insufficiency, defined by a glomerular filtration rate less than 30 ml/min
• No serum creatinine in the past year (to permit calculation of a creatinine clearance)
• Prior history of hypokalemia or serum potassium less than 3.5 meq/l in the prior year
• Diagnosis of gout or active prescription for allopurinol
• Congestive heart failure (CHF) due to systolic dysfunction with a documented left ventricular ejection fraction \< 35% by echocardiography, nuclear medicine study, or ventriculography
• Residence in a long-term care facility
• No telephone for follow-up calls
• Life-expectancy \< 6 months
• Inability to give informed consent or impaired cognitive function (defined as \> 4 errors on the 10-item Pfeiffer Portable Mental Status Questionnaire82, administered during study intake)