Telemonitoring Hypertension and Breast Cancer

Eligibility Criteria

• * Eligibility and exclusion criteria are intended to capture a population broadly representative of breast cancer patient's stages I-IV with hypertension, while excluding patients with hypertension complicated by major co-morbidities as determined by chart review who would not be appropriate for algorithmic management.
• * Clinical/study eligibility will be confirmed by the patient's Breast Oncologist and/or Primary Care Providers who will refer identified patients or provide permission for outreach to eligible patients for recruitment into the pilot study.
• * Patients eligible for the intervention must meet all eligibility criteria intended to identify breast cancer patients with hypertension and positive screening for food insecurity according to the 2017 ACC/AHA Guidelines, healthcare provider hypertension diagnosis and Hunger Vital Signs Tool United States Departments of Agriculture:
• * Women ages 18 years and older UMMC breast cancer patients in stages I-IV as primary diagnosis within the last three years and who were diagnosed with hypertension exceeding 2017 ACC/AHA guidelines of ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg will be identified from UMMC electronic health records (EHR).
• * Women ages 18 years and older UMMC breast cancer patients in stages I-IV as a primary diagnosis within the last three years with physician-coded hypertension, who have their most recently documented blood pressures exceeding 2017 ACC/AHA guidelines of ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg in at least three consecutive instances in the EHR, three consecutive high BP measurements within 12 months, consistent with SNOMED coded phenotypes for hypertension identify from UMMC EHR records (A diagnosis of hypertension).
• * Positive screening for food insecurity via the Hunger Vital Signs tool, a validated two-question screening tool based on the United States Department of Agriculture.
• * Ability to speak English.
• * Reliable access to internet, video and telephone services.
• * Stage 4 or 5 kidney disease (eGFR \<30 ml/min/1.73m2 on the most recent measurement)
• * Acute coronary syndrome, coronary revascularization, stroke, or other major cardiovascular event within the past 3 months
• * Known secondary causes of hypertension including coarctation of the aorta, pheochromocytoma, and adrenal cortical hypertension
• * Prescribed 3 or more antihypertensive medications
• * Class III or IV New York Heart Association heart failure or left ventricular ejection fraction \<50%
• * Institutionalized (i.e., nursing home) or limited life expectancy as determined by chart review including advanced stage cancer, severe frailty, or other major comorbidity
• * Further exclusion criteria include unwillingness to be followed for the duration of the study, participation in another clinical trial or research study, difficulty with communication in English without an interpreter over the telephone, substance abuse, dementia, disability or mental illness that would prohibit ability to provide informed consent or perform home BP monitoring. Additionally, patients are ineligible if they report a major health event requiring hospitalization since the last documented UMMC clinic visit.