Pharmacist-led intervention combats hypertension

Mar 8 2013

By Eleanor McDermid, Senior medwireNews Reporter

A home-based intervention led by clinical pharmacists and involving an internet monitoring tool results in marked reductions in blood pressure (BP), say researchers.

More than two-thirds of the patients who used the online tool - the American Heart Association's "Heart360" tool - found it easy to use. Also, 58% of the 162 patients in this group were very or completely satisfied with their hypertension treatment, compared with 42% of the 164 patients who were randomly assigned to receive usual care.

During the 6-month study period, patients in the intervention group measured their BP at least three times a week and uploaded the results to the Heart360 tool. Their clinical pharmacists could access the uploaded data, adjust medication as needed, and communicate with the patients via telephone or secure email.

"Clinical pharmacy specialists are ideally suited to deliver the intervention because of their expertise in medication therapy management," comment David Magid (Kaiser Permanente Colorado, Denver, USA) and team in Circulation: Cardiovascular Quality and Outcomes.

More than half (52%) of the patients said their encounters with their clinical pharmacists were very or extremely useful. Patients in this group were more likely than those in the usual care group to start taking an extra antihypertensive during the study, at 70% versus 25%, and were more likely to have a dose adjustment, at 43% versus 12%.

At baseline, patients in the intervention group had slightly higher BP than those in the usual care group, at 148.8/89.6 versus 145.5/88.0 mmHg. But over the course of the study, they achieved significantly larger reductions in BP - 12.4 mmHg larger for systolic BP and 5.7 mmHg larger for diastolic BP. The final BPs were 128.1/79.1 mmHg in the intervention group and 137.4/83.1 mmHg in the usual care group.

Significantly more patients in the intervention than usual care group achieved their BP goal, at 51.7% versus 21.9%.

Magid et al partly attribute the success of the intervention to the online monitoring tool, which they say gave patients "a simple and efficient way to transmit BP measurements to their clinical pharmacy specialist while keeping patients engaged by providing them with feedback on their progress toward attaining BP control and easy-to-read educational information."

They conclude: "Future research should focus on translating the intervention to other settings and patient populations and to assessing the sustainability and cost-effectiveness."

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