What TensiónCare is built on

Every reading is classified in src/lib/htn-rules.ts against the ACC/AHA 2017 bands and drives what the patient sees, whether an alert is created, and whether a 5-minute recheck is required.

Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Hypertension. 2018;71(6):e13-e115.

The med engine in src/lib/titration.ts mirrors the Kaiser SoCal HTN protocol — one of the most-cited real-world programs, credited with 90%+ control rates. We prioritize ACEi/ARB + thiazide because a single BMP covers both drug classes' safety monitoring, keeping lab overhead low for uninsured patients.

1. Step 1 — Lisinopril 10 mg (or Losartan 50 mg if ACEi-intolerant)
2. Step 2 — Add HCTZ 12.5 mg (or Chlorthalidone 12.5–25 mg)
3. Step 3 — Increase ACEi/ARB to max dose + HCTZ 25 mg
4. Step 4 — Add amlodipine 5–10 mg; refer if still uncontrolled

A 14-day gate prevents same-visit re-titration, and the engine blocks advancement when K+ > 5.0, Cr rises > 30%, or eGFR drops below step-specific thresholds.

Jaffe MG, Lee GA, Young JD, Sidney S, Go AS. Improved Blood Pressure Control Associated With a Large-Scale Hypertension Program. JAMA. 2013;310(7):699-705.

Titration decisions are cross-referenced against KDIGO's eGFR × albuminuria matrix. Patients in the "orange" or "red" cells (e.g., eGFR 30–59 with UACR > 300) are held from thiazide advancement in favor of a loop diuretic pathway and get earlier lab follow-up.

Kidney Disease: Improving Global Outcomes (KDIGO). 2024 Clinical Practice Guideline for the Evaluation and Management of CKD. Kidney Int. 2024;105(4S):S117-S314.

When a reading is Stage 1 or Stage 2, the patient's log flow surfaces the full MI guide — importance/confidence rulers, change-talk elicitation, barriers, and a concrete commitment. Follow-up readings in the same cycle switch to a lighter MI check-in so patients aren't asked the same questions repeatedly.

Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. 3rd ed. Guilford Press; 2013.

Because the program is not staffed 24/7 and targets uninsured patients, the triage logic is intentionally conservative on severe readings:

1. ≥ 180/110 → ask the patient to rest 5 min and re-check.
2. If the recheck is still ≥ 180/110, ask the six red-flag questions.
3. Any positive symptom → 911 / ED.
4. Confirmed severe but asymptomatic → urgent care (not "call your clinic").

The program manages chronic hypertension. Hypertensive urgencies and emergencies are explicitly routed out of the platform to the correct level of care.

TensiónCare targets uninsured and under-insured patients on a low monthly subscription. Sustainability requires that infrastructure + device cost per patient stay below the subscription price. Device tiers meet patients where their tech comfort is:

See the public device tier one-pager for the full cost comparison.

This site is a prototype using only synthetic data. Production readiness is being pursued through a de-identified architecture with the EMR (or a non-profit-hosted vault) as the crosswalk, keeping PHI out of the application layer. See docs/HIPAA-READINESS.md for the full pre-production checklist.