BackgroundSodium‐glucose cotransporter 2 (SGLT2) inhibitors are a novel class of antihyperglycemic agents that improve glycemic control by increasing glycosuria. Additional benefits beyond glucose lowering include significant improvements in seated clinic blood pressure (BP), partly attributed to their diuretic‐like actions. Less known are the effects of this class on 24‐hour ambulatory BP, which is a better predictor of cardiovascular risk than seated clinic BP.Methods and ResultsWe performed a meta‐analysis of randomized, double‐blind, placebo‐controlled trials to investigate the effects of SGLT2 inhibitors on 24‐hour ambulatory BP. We searched all studies published before August 17, 2016, which reported 24‐hour ambulatory BP data. Mean differences in 24‐hour BP, daytime BP, and nighttime BP were calculated by a random‐effects model. SGLT2 inhibitors significantly reduce 24‐hour ambulatory systolic and diastolic BP by −3.76 mm Hg (95% CI, −4.23 to −2.34; I2=0.99) and −1.83 mm Hg (95% CI, −2.35 to −1.31; I2=0.76), respectively. Significant reductions in daytime and nighttime systolic and diastolic BP were also found. No association between baseline BP or change in body weight were observed.ConclusionsThis meta‐analysis shows that the reduction in 24‐hour ambulatory BP observed with SGLT2 inhibitors is a class effect. The diurnal effect of SGLT2 inhibitors on 24‐hour ambulatory BP may contribute to their favorable effects on cardiovascular outcomes.

Proprotein convertase subtilisin/kexin type 9 (PCSK9) plays an integral role in the degradation of low-density lipoprotein receptors (LDL-R), making it an intriguing target for emerging pharmacotherapy. Two PCSK9 inhibitors, alirocumab and evolocumab, have been approved and are available in the United States and European Union. However, much of the PCSK9 story remains to be told. The pipeline for additional pharmacotherapy options is rich with several compounds under development, using alternative strategies for inhibiting PCSK9. Perhaps, more intriguing is the interaction between PCSK9 and non-LDL-R targets, including mediators of inflammation and immunological processes, which remain under intense investigation. This review will discuss the currently available PCSK9 inhibitors, the development of novel approaches to PCSK9 modulation, and the potential non-LDL-R-mediated effects of PCSK9 inhibition.

Pharmacist-physician collaborative practice models (PPCPMs) improve blood pressure (BP) control, but their effect on time to goal BP is unknown. This retrospective cohort study evaluated the impact of a PPCPM on time to goal BP compared with usual care using data from existing medical records in uninsured patients with hypertension. The primary outcome was time from the initial visit to the first follow-up visit with a BP <140/90 mm Hg. The study included 377 patients (259 = PPCPM; 118 = usual care).Median time to BP goal was 36 days vs 259 days in the PPCPM and usual care cohorts, respectively (P < .001). At 12 months, BP control was 81% and 44% in the PPCPM and usual care cohorts, respectively (P < .001) and therapeutic inertia was lower in the PPCPM cohort (27.6%) compared with usual care (43.7%) (P < .0001).Collaborative models involving pharmacists should be considered to improve BP control in high-risk populations. | BACKGROUND Hypertension affects approximately 80 million adults in the UnitedStates and is a major risk factor for coronary artery disease, stroke, heart failure, and kidney disease.

Introduction Although pharmacist‐physician collaborative care models (PPCCM) improve mean blood pressure (BP) and goal attainment rates, the impact of these models on time‐in‐therapeutic blood pressure range (TTBPR) is unknown. Objectives The primary objective of this study was to determine the effect of a PPCCM on TTBPR compared with a usual care group. Methods This post‐hoc analysis compared data obtained from two retrospective groups of patients with uncontrolled hypertension managed either by a PPCCM or usual care. The primary end point was TTBPR, defined as the proportion of clinic visits with a systolic BP between 120 and 140 mmHg over a 12‐month follow‐up period. Several secondary end points were also evaluated. Means were compared using a t‐test, while counts and comparisons were compared using chi‐square or Fisher exact test. Results The study included 56 patients and 56 controls matched by gender, baseline systolic BP, and history of cardiovascular disease. Mean age was 58 years, 37.5% were female, and 73% were black. The mean TTBPR was 46.2% ± 24.3% in the PPCCM group and 24.8% ± 27.4% in the usual care group (P < 0.0001). Therapeutic inertia was 20.1% in the PPCCM compared with 48.1% in the usual care group (P < 0.0001). Greater reductions in BP were observed in the PPCCM group compared with usual care (systolic BP: −27.8 vs −11.4 mmHg, respectively; P < 0.0001; diastolic BP: −19.2 vs −4.2 mmHg, respectively; P < 0.0001). The BP control rates at 12 months were 89% in the PPCCM compared with 50% in the usual care group (P < 0.0001). Conclusion Patients exposed to a PPCCM had higher TTBPR compared with those who received usual care. The PPCCM group also had a lower rate of therapeutic inertia, greater reductions in BP, and achieved a higher percentage of patients at goal BP in an urban, underserved population.

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