Pharmacist Intervention for Blood Pressure Control in Patients with Diabetes and/or Chronic Kidney Disease

Abstract

This study demonstrated that a physician-pharmacist collaborative intervention was effective in reducing mean systolic BP and improving BP control in patients with uncontrolled hypertension with DM and/or CKD, regardless of which BP guidelines were used.

Clinical pharmacy practice in the care of Chronic Kidney Disease patients: a systematic review

“…The customized care plan was designed and delivered to the patients on monthly basis based on the condition and need of the patient by the WHO-FIP Pharmaceutical care model. (2) The QoL was assessed using validated KDQoL-36 instrumentUsual care (n = 75)The HRQoL scores were significantly improved over time in the domains noticed with regard to the “physical functioning, general health, emotional well-being, social functioning, symptom/problem list, and effects of kidney disease” in all the three centres of PC group compared to UC group with p < 0.05The baseline HRQoL score of KDQoL-36 domains such as ESRD-targeted areas were not significantly different in the UC group versus PC group in all the three HD centresThe pharmaceutical care provided by a trained pharmacist had positive impact in HRQoL of HD patientsAnderegg et al (2018)USA [54]Cluster randomised trial32 medical offices from 15 statesTo determine if hypertensive patients with comorbid DM and CKD receiving a pharmacist intervention had improved BP control and greater reduction in mean BP at 9 months compared with those receiving usual care227 patientsIntervention group 61.7 (11.6), control 63.1 (12.2)Pharmacist interviewed patients to review medications, assessed knowledge and then educated the patients on HTN. Individualised care plans were prepared and presented to the physician108 patientsIntervention group had significantly greater mean systolic blood pressure reduction compared with usual care at 9 months (8.64 mm Hg; 95%, CI − 12.8 to − 4.49, p < 0.001).…”

“…Many studies reported pharmacists’ interventions in: modifying drug doses and recommending new pharmacotherapy; [ 16 , 19 , 21 – 23 , 25 – 27 , 29 , 30 , 32 – 40 , 52 , 59 ]; interacting with a member of the multidisciplinary team; [ 15 – 17 , 19 – 21 , 23 – 25 , 27 , 31 , 32 , 34 – 38 , 40 – 43 ] requesting and monitoring laboratory parameters; [ 15 , 23 , 25 , 27 , 33 , 34 , 36 , 37 , 43 ] assessing appropriateness of medications prescribed for hospitalised patients at each point of care; [ 17 , 22 , 29 , 30 , 35 – 38 , 40 , 57 ]. Fewer studies described pharmacist processes at out-patient, pharmacist-led clinics relating to the management of specific CKD complications, such as anaemia; [ 34 , 39 , 44 ] hypertension and diabetes; [ 54 ] managing hypertension through telemedicine; [ 41 ] optimising dyslipidaemia management; [ 37 , 45 ] improving haemoglobin A1c levels (HbA1c); [ 43 ] and emphasising smoking cessation. [ 37 , 43 ] Development of protocols and compiling and updating guidelines were also described in two studies [ 22 , 34 ].…”

“…Intervention in the management of BP in CKD and haemodialysis resulted in achieving target BP in the intervention versus the control group [ 32 , 54 , 55 ], significant reductions in mean systolic and diastolic BP in a group of kidney transplant recipients [ 41 ], and significant reduction in systolic and diastolic BP in diabetic nephropathy [ 43 ]. Only one article showed that pharmacists’ intervention in an intensive care unit (ICU) setting reduced the length of ICU stay [ 38 ].…”

Impact of pharmacist intervention for blood pressure control in patients with chronic kidney disease: A meta‐analysis of randomized clinical trials

“…These studies aimed to (a) achieve close collaboration among medical staff, (b) adequately review therapeutic interventions and (c) improve patient adherence to HTN treatment. In particular, pharmacists played a principal role in assessing the HTN medication regimen 10‐14 …”

Development and implementation of blood pressure screening and referral guidelines for German community pharmacists

“…There are numerous randomized controlled trials of pharmacist‐led and interdisciplinary interventions investigating the impact on BP reduction, BP control rates, and reduced cardiovascular risk 10,12,13,24,28‐33 as well as several systematic reviews and meta‐analyses published 34‐37 . These data indicate that compared with usual BP management, interventions by pharmacists working in community pharmacies were associated with clinically important improvement in BP control, whether or not hypertension was associated with cardiovascular comorbidities.…”