Home Blood Pressure Monitoring to Improve Hypertension

The goal of this single group pre-post-study is to test the possibility of self-monitoring with shared medical appointments program for lifestyle education in improving blood pressure (BP) of patients with uncontrolled hypertension. The main questions it aims to address is: To assess if patients with uncontrolled hypertension and their physicians will be interested in trying a program that includes self-monitoring with 6-week support for lifestyle changes and coping skills to improve BP and hypertension control. To assess if patients with uncontrolled hypertension can safely participate in a program that includes self-monitoring with 6-week support for lifestyle changes and coping skills to improve their BP and ability to self-manage hypertension Participants will: Send self-reports of their home BPs, diet, physical activity and emotions Attend 6-week education program of lifestyle changes and coping skills delivered by physicians, holistic psychotherapists and yoga therapists.

Participants will be taught the proper use of Home BP machines using a teach-back technique. Patients will be loaned valid home BP machines. Participants will be taught how to send self-reports of their home BP, diet, physical activity and emotions using an app on their phone. Participants will be signed up for a 6-week educational program of lifestyle changes and coping skills delivered by physicians, holistic psychotherapists and yoga therapists. Participants will receive summary reports of their Home BP, lifestyle and emotions. Researchers will monitor home BP levels and any adverse effects. Primary care physicians of the patients with persisting high BP levels will be notified of their average home BPs. Patients will complete surveys that assess their ability to self-manage their hypertension, emotions, and social connections. Change in average home BP from before, during, and after 6-week educational program participation will be evaluated. Final average home BP and clinic BP notifications will be sent to the primary care physicians of all patients.

Participants will send self-reports of their home BPs, diet, physical activity and emotions while attending a 6-week education program of lifestyle changes and coping skills. Participants will get summary reports of their home BP and lifestyle monitoring. Participants primary care physicians will be notified of persisting high BPs and final average home BP levels. Researchers will monitor home BP levels and change in hypertension control state

Home BP monitoring with self-monitoring of emotions, diet, physical activity, with shared medical appointment program for lifestyle changes and coping skills

Percentage of patients with uncontrolled hypertension referred or self-referred for self-monitoring and lifestyle education program by physicians or patient self-referrals

Investigators will measure the percentage of patients with uncontrolled hypertension that were referred or self-referred to and enrolled per month in the program for self-monitoring and lifestyle changes.

Change in average home BP in mm Hg from before, during, and after the 6-week educational program participation will be evaluated.

Percentage of study participants that change from uncontrolled hypertension state to controlled hypertension state.

Change in the percentage of study participants with uncontrolled hypertension from before, during, and after the 6-week educational program participation will be evaluated.

Investigators will measure percentage of enrolled patients with uncontrolled hypertension that: participated in at least 4 of the 6 weeks of education program Preferred weekly educational materials instead of attending weekly shared medical appointments. Sent self-reports of home BP at least 3days/week in 4 out of 6weeks

Percentage of study participants that did not benefit from self-monitoring and lifestyle education program as measured by persisting high BP of more than 160/100 and need for additional medications

Investigators will measure percentage of enrolled patients with uncontrolled hypertension that: had persisting average home BP>160/100 needed additional medications

The PROMIS Self-Efficacy for Managing Chronic Conditions item banks are well-validated and comprise of five domains, Self-Efficacy for Managing: Daily Activities, Symptoms, Medications and Treatments, Emotions, and Social Interactions. We will measure before, after the 6-week educational program participation, and 6 months later will be evaluated.

Investigators will assess exploratory outcomes of changes in coping skills using Mindfulness Attention Awareness Scale; Insomnia severity Index scale; Change in number of vegetable and fruit serving intake; Change in the number of minutes of physical activity; Number of hypertension medications; Comparison of BP trends from 12 months before to 12 months after participating in the self-monitoring and education program

Investigators will assess exploratory outcomes of changes in sleep using Insomnia severity Index scale;

Investigators will assess exploratory outcomes of Change in number of vegetable and fruit serving intake;

Investigators will assess exploratory outcomes of Change in the number of minutes of physical activity;

Investigators will assess exploratory outcomes of change in Number of hypertension medications; Comparison of BP trends from 12 months before to 12 months after participating in the self-monitoring and education program

Investigators will assess exploratory outcomes of change in Comparison of BP trends from 12 months before to 12 months after participating in the self-monitoring and education program

Investigators will gain insights into what worked what did not work for patients and referring primary care physicians

Inclusion Criteria: Uncontrolled hypertension based on Clinic BP measurement of systolic BP>140 or diastolic BP >90 mm Hg (as the cutoff in the current common hypertension performance measures and ACO metrics) PCP recommends or patient desires a trial of self-monitoring and lifestyle modifications Patient owns a smart phone and be willing to complete self-reports of BP during study participation. Exclusion Criteria: On dialysis Pregnant Have a terminal illness, Clinic BP > systolic>180, diastolic>110 Arm circumference that exceeds the limit for the largest home BP monitor cuff Severe cognitive impairment Major cardiovascular or cerebrovascular event in the past 6 months (Coronary artery disease, heart valve problems, arrhythmias, heart failure, stroke) Any physical or mental impairment that would affect patients' ability to participate(Ability to participate will be assessed by demonstrated ability to use available home BP machine and complete self-report during recruitment).

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