Vascular Age as a Key for a Team-based Approach to Manage Blood Pressure bridging Community Pharmacists and Primary Health Care Physicians – the TOGETHER trial

Enrique Rodilla^1,2*Monika Aichberger³Florian Ardelt⁴Vicente Javier Baixauli Fernández⁵Sergio Cinza-Sanjurjo⁶Kathrin Danninger⁷María Soledad Fernández⁸Luis Garcia-Ortiz⁹Viktoria Gastens¹⁰Ana-Karen Guzmán-Aguayo⁸Bernhard Hametner¹¹Antonela Jiménez⁵Valeria Kopytina⁶Cristina Lugones-Sanchez⁹Christopher Clemens Mayer¹¹Zuri Montal¹Telmo Pereira¹²Valérie Santschi¹⁰Wolfgang Schimetta¹³Thomas Weber⁷

• ¹Fundacio per al Foment de la Investigacio Sanitaria i Biomedica de la Comunitat Valenciana, Valencia, Spain
• ²Universidad CEU Cardenal Herrera, Moncada, Spain
• ³Austrian Chamber of Pharmacists, Upper Austria (APO), Linz, Austria
• ⁴Upper Austrian Society for General and Family Medicine (OBGAM), Linz, Austria
• ⁵Sociedad Espanola de Farmacia Clinica Familiar y Comunitaria, Madrid, Spain
• ⁶Sociedad Espanola de Medicos de Atencion Primaria, Madrid, Spain
• ⁷Klinikum Wels-Grieskirchen GmbH, Wels, Austria
• ⁸Universidad Complutense de Madrid, Madrid, Spain
• ⁹Instituto de Investigacion Biomedica de Salamanca, Salamanca, Spain
• ¹⁰Haute Ecole Specialisee de Suisse Occidentale Institut et Haute Ecole de la Sante La Source, Lausanne, Switzerland
• ¹¹AIT Austrian Institute of Technology, Center for Health $ Bioresources, Vienna, Austria
• ¹²Instituto Politecnico de Coimbra Escola Superior de Tecnologia da Saude de Coimbra, Coimbra, Portugal
• ¹³Johannes Kepler Universitat Linz, Linz, Austria

Background: Highlighting arterial stiffness in Community Pharmacies (CPh) has been met with considerable interest in Portugal, Austria and Spain. TOGETHER aims to evaluate whether empowering hypertensive subjects by determining blood pressure (BP) and vascular aging in CPh increases hypertension (HTN) control, establishing paths of lasting cooperation between General Practitioners (GP) and CPh. Methods: TOGETHER is a cluster-randomized, prospective study in Portugal, Austria and Spain. All consecutive subjects entering CPh will be offered BP measurement and ambulatory BP monitoring (ABPM) for those with BP ≥ 140/90 mmHg. CPh will be randomly assigned to a usual care arm (including health education for HTN). In the experimental care group, vascular aging (VA) will be additionally assessed via estimating aortic pulse wave velocity from brachial oscillometry. In this group, health education will include VA, which will also be communicated to GPs. In both groups, HTN will be treated by GPs according to usual clinical practice. A second evaluation with ABPM will be performed after 6 months and the percentage of patients with controlled hypertension will be compared between both arms. The degree of CPh/GP interaction and patients´ adherence will be assessed through validated surveys. Discussion: Five fundamental unmet needs will be addressed by TOGETHER: 1) lack of HTN screening programs; 2) Implementation of the simpler and more informative VA concept (“Your arteries are 10 years older than you”); 3) understanding CV risk on an individual basis (individual VA) should improve patient adherence and reduce physician inertia; 4) Implementation of health educational programs, combined with the concept of VA; 5) Higher collaboration and development of a team-based approach to HTN care between CPh and GP. The complementary organizational settings and strengths of CPh and GP will allow TOGETHER to creating new strategies for early identification and intervention in uncontrolled HTN, ranging from lifestyle to medical treatment, taking social, economic, and behavioral aspects into account. Trial Registration: The study has been registered at ClinicalTrials.gov (FP-1533-ROD-SAL-2024-01).