OBJECTIVE: The objective of this study was to compare two hypertension disease management strategies. METHODS: Uncontrolled HTN patients were identified by ICD-9 codes from administrative data and confirmed by chart review. Patients were randomized to 1) an Alert group (primary care physician [PCP] and patient notification of blood pressure results) or 2) a disease management (DM) clinic (pharmacist-PCP co-management). In consultation PCPs, pharmacists provided DM care utilizing evidence-based guidelines developed by a multi-disciplinary team. RESULTS: At baseline, there were no statistically significant differences between groups, including systolic blood pressure (SBP) and diastolic blood pressure (DBP), demographics, comorbidities, and antihypertensive medication costs. By intention-to-treat analysis the DM group had significant reductions in SBP and DBP at 6 and 12 months (SBP/DBP: -22mmHg/-9mmHg, [n= 78] and -22mmHg/-4mmHg, [n=58], respectively, p<0.01), compared to baseline. At 18 months, the SBP reduction was statistically significant (-21mmHg, [n=31], p<0.01), but DBP reduction was not (-3mmHg). The Alert group had significant reductions in SBP and DBP at 6, 12, and 18 months (SBP/DBP: -10mmHg/-7mmHg [n=92], -11mmHg/-8mmHg [n=81], -11mmHg/-7mmHg [n=39], respectively, p<0.01) compared to baseline. The reductions in SBP were significantly greater in the DM group than in the Alert group at 6 and 12 months (-22mmHg vs. -10mmHg and –22mmHg vs. -11mmHg, p=0.01), but not at 18 months. Differences in DBP were not statistically significant. At 12 and 18 months, per-member per-month DM group visit costs were significantly lower than those of the Alert group ($12 vs $16, p=0.01; $11 vs $17, p=0.05, respectively). CONCLUSIONS: These results suggest that clinically important BP reductions may be achieved cost-effectively in a hypertension disease management program.