Pharmacist-Physician Comanagement of Hypertension and Reduction in 24-Hour Ambulatory Blood Pressures

Abstract

Background Pharmacist-physician co-management of hypertension has been shown to improve office blood pressures (BP). We sought to describe the effect of such a model on 24-hour ambulatory BPs. Methods We performed a prospective, cluster-randomised controlled clinical trial in 179 patients with uncontrolled hypertension from five primary care clinics in Iowa City, Iowa. Patients were randomized by clinic to receive pharmacist-physician collaborative management of hypertension (intervention) or usual care (control) for a 9-month period. In the intervention group, pharmacists helped patients identify barriers to BP control, counselled on lifestyle and dietary modifications, and adjusted antihypertensive therapy in collaboration with the patient’s primary care provider. Patients were seen by pharmacists a minimum every 2 months. Ambulatory BP was obtained at baseline and study end. Results Baseline and end of study ambulatory BP profiles were evaluated for 175 patients. Ambulatory BPs were reduced to a greater extent in the intervention compared to control group (daytime ΔSBP [SD] 15.2[11.5] vs 5.5[13.5], p<0.001; nighttime ΔSBP [SD] 12.2[14.8] vs 3.4[13.3], p<0.001; 24-hour ΔSBP [SD] 14.1[11.3] vs 5.5[12.5], p<0.001). More patients in the intervention group had BP controlled at the end of the study (75% vs 50.7%, p<0.001) as defined by overall 24-hour ambulatory BP monitoring. Conclusions Pharmacist-physician collaborative management of hypertension achieved consistent and significantly greater reduction in 24-hour BP and a high rate of BP control.

Health Coaching to Improve Hypertension Treatment in a Low-Income, Minority Population

“…Although there was no control group, this magnitude is greater than the SBP reductions in control groups of 7 other studies using health coaching, which ranged from 2 to 14 mm Hg. [12][13][14][15][16][17][18] Patients had an average of 0.9 fewer primary care offi ce visits in the 6-month study period compared with the 6 months before the study, and this difference was maintained in the 6 months after the study.…”

“…10 When compared with usual care, the combination of home monitoring with home titration of antihypertensive medications is associated with better blood pressure control. 11 Using nurses or pharmacists to coach patients and assist in home titration reduces blood pressure compared with usual care, [12][13][14][15][16][17][18] but these changes involve expensive health care professionals rarely present in primary care.…”

Effectiveness of Dader Method for Pharmaceutical Care on Control of Blood Pressure and Total Cholesterol in Outpatients with Cardiovascular Disease or Cardiovascular Risk: EMDADER-CV Randomized Controlled Trial

“…12 Some studies have shown that pharmacist participation in designing, implementing, and monitoring therapeutic programs in patients with CVD or CV risk factors could (a) improve the patient's knowledge, 13 (b) facilitate adoption of and outcomes from lifestyle interventions, 14 (c) improve the identification of candidates and the results of primary 15 or secondary 16 prevention, and (d) increase the percentage of patients with high CV risk who achieve the goals related to BP [17][18][19][20] and lipid 9,21 levels. In contrast, other randomized controlled trials (RCTs) have found that community pharmacist intervention did not lead to improvements in primary outcome measures (e.g., hospital admissions 22 or the proportion of patients receiving appropriate medication 23 ).…”

Effect of clinical pharmacists pharmaceutical care intervention to control hypertensive outpatients in China

“…Zhao et al 49 and the results of the clinical therapy eventually. Green et al (2008) and Weber et al (2010) studies showed that pharmacist-physician co-management team can improve control blood pressures and 24 h ambulatory blood pressures. How to improve the medication compliance of the patients decides whether the patients can get a systematical and long-period treatment, and whether the blood pressure can be maintained at a controllable level; thereby, the probability of complications can be reduced.…”