Patient-driven Management of BP in CKD

The proposed research will evaluate if patients managing their blood pressure medications under the guidance of a clinical pharmacist works better to lower blood pressure than patients monitoring their blood pressure at home and the standard care. 60 Veterans with chronic kidney disease (CKD) will be included in the study. The study will further evaluate factors that may influence the Veteran to accept the self-management approach and what factors in the VHA healthcare system affect the implementation of the self-management approach.

Inclusion Criteria: * Chronic kidney disease stage 3 or 4 (estimated glomerular filtration rate: 15-59 milliliters per minute /1.73 square meters) or * Stage 2 chronic kidney disease (estimated GFR 60-89 milliliters per minute/1.73 square meters) with urinary albumin/creatinine ratio (ACR 300 milligrams per gram if no diabetes mellitus and 30 milligrams per gram if with diabetes mellitus), and * Uncontrolled hypertension defined as the avg of 2 readings \> 140 systolic Exclusion Criteria: * Severely uncontrolled hypertension defined as systolic blood pressure (BP)\>180 * Patients with resistant hypertension and taking 4 blood pressure medications * Orthostatic hypotension defined as reduced systolic blood pressure by 20 millimeters of mercury or diastolic blood pressure by 10 millimeters of mercury after 3 minutes of standing * Severe chronic kidney disease defined as estimated glomerular filtration rate \< 20 milliliters per minute /1.73 square meters * Life expectancy \