Every adult with hypertension should have a clear, detailed, and current evidence-based plan of care that ensures the achievement of treatment and self-management goals, encourages effective management of comorbid conditions, prompts timely follow- up with the healthcare team, and adheres to CVD GDMT (Table 22). Recommendations for Financial Incentives (Continued) COR LOE Recommendations Synopsis A specific plan of care for hypertension is essential and should reflect understanding of the modifiable and nonmodifiable determinants of health behaviors, including the social deter- minants of risk and outcomes. A clinician s sequential flow chart for management of hypertension is presented in Table 21. Detailed evidence-based elements of the plan of care are listed in Table 22. The determinants will vary among demographic subgroups (see Section 10 for additional information). Recommendation-Specific Supportive Text 1. Studies demonstrate that implementation of a plan of care for hypertension can lead to sustained reduction of BP and attainment of BP targets over several years.S13-1 S13-6 Meta-analysis of RCTs shows reductions in BP of pa- tients with hypertension and achievement of BP goals at 6 months and 1 year when compared with usual care. 13.1. Health Literacy Communicating alternative behaviors that support self- management of healthy BP in addition to medication adher- ence is important. This should be done both verbally and in writing. Today, mobile phones have a recording option. For patients with mobile phones, the phone can be used to inform patients and family members of medical instructions after the doctor s visit as an additional level of communication. Inclusion of a family member or friend that can help interpret and encourage self-management treatment goals is suggested when appropriate. 