Objective To illustrate the impact of a pharmacist-led hypertension medication management program on skilled nursing facility residents. Design Sixteen-week retrospective, observational study. Setting Long-term care, local skilled nursing facility. Patients, Participants Subjects with a diagnosis of hypertension and treated with at least one antihypertensive medication were identified using electronic health records. The subjects also needed to be enrolled in the Hypertension Medication Management Program, and were excluded if receiving hospice or psychiatric treatment or had active infection with COVID-19. Initially, 120 residents were eligible with 54 in an intervention and 66 in a control group. At 16-weeks, a total of 67 residents remained after some were lost to follow-up. Interventions Under a collaborative practice agreement, a pharmacist optimized medications, ordered monitoring of vital signs, and relevant labs in conjunction with standard physician care (intervention): these subjects were compared to those who received standard physician care alone (control). Results There was a significant difference in the proportion of subjects who attained treatment goals for diastolic BP, but not for systolic BP or mean arterial pressure. The proportion of subjects in the intervention group who had falls, hospitalization or death was not significantly different between groups. diastolic pressure (90.9% and 38.0%; P < 0.0001; 86.7% and 32.4%; P < 0.0001) but not for systolic and mean arterial pressure at 8 and 16 weeks. For secondary endpoints, there was clinical significance in de-prescribing incidence (P < 0.0001) but not for fall events, hospitalizations, and death. However, control group had 11% more falls and 1.2% more hospitalizations. Conclusion A pharmacist-led hypertension program appeared to impact skilled nursing facility residents by allowing attainment of maintaining diastolic blood pressure, goals de-prescribing events, and reducing fall incidence and hospitalization. The intervention has the potential to promote de-prescribing but does not appear to have increased the prevalence of serious adverse outcomes relative to standard practice.