Pharmacist-Led Medication Titration for Cardiometabolic Disease: Evidence, Equity, and Scale.

PURPOSE OF REVIEW: To review community-based pharmacist-led medication titration across cardiometabolic conditions and the infrastructure needed to deliver this model at scale. RECENT FINDINGS: This review reframes cardiometabolic medication optimization as a continuum from passive gap identification to active longitudinal medication management. Registries, dashboards, audit and feedback, electronic health record alerts, and inpatient initiation can identify undertreatment or prompt prescribing, but they do not provide infrastructure for dose adjustment, monitoring, adherence support, and medication-access navigation. Pharmacist-led, team-based models occupy the active end of this continuum. The strongest evidence is in hypertension, with meaningful blood pressure reductions; in heart failure, interdisciplinary titration programs more directly address target-dose achievement than alerts or decision-support tools. Emerging data extend this framework to diabetes, lipidology, and obesity. Value-based care provides a reimbursement framework to support these services. Pharmacist-led titration can close gaps between therapies and delivery, but scaling requires equity-focused implementation, flexible staffing, population health infrastructure that connects artificial intelligence-enabled patient identification to action, and sustainable reimbursement.