Remote Monitoring and Virtual Collaborative Care For Hypertension Control to Prevent Cognitive Decline Phase II

This is a randomized, controlled, pragmatic trial designed as a "type I hybrid effectiveness-implementation trial" that tests a hypertension program integrating a virtual Collaborative Care Clinic (vCCC), home blood pressure monitoring, and telehealth for lowering blood pressure (BP) in two health systems.

Inclusion Criteria: * Age 65 and older * Active patient in participating primary care clinic * Access to compatible "smartphone" or device (i.e., Android, Kindle or Apple with internet connectivity or mobile network) * Elevated BP as defined by * SBP \>140 at current visit AND documented history of hypertension OR SBP \> 140 at current visit and at another visit in last 18 months OR SBP \>160 at current visit * Sufficiently fluent in English to participate in study procedures * Adequate hearing to complete study procedures * Able to give their own signed consent * Health insurance coverage by Medicare Exclusion Criteria: * Clinically significant illness that may affect safety or completion per their treating PCP or study physician * Needing interpreter for clinic visits (through Electronic Health Record) * Currently in hospice care * Currently receiving chemotherapy * Unable to take accurate BP measurement, either due to inability to follow protocol to check BP or due to medical conditions such as lymphedema or dialysis access on both arms. * Currently participating in another intervention trial * End stage kidney disease on dialysis * Diagnosis of dementia (i.e., dementia, Alzheimer's disease, vascular dementia, dementia with Lewy bodies, frontotemporal dementia) * Chronic active disease with expected life expectancy \< 2 years as determined by the study team