Community pharmacist intervention in hypertension management

Abstract

Community pharmacists contribute in hypertension management by conducting point-of-care blood pressure (BP) measurement, monitoring adherence, providing patient education and collaborating with physicians. This research focuses on community pharmacist contribution in team-based care for patients with hypertension. The aims were to assess: 1) antihypertensive pharmacotherapy, BP control, self monitoring of BP and therapy adherence in patients with uncomplicated hypertension and other comorbidities, and 2) outcomes of the collaboration between community pharmacists and general practitioners (GPs) in hypertension management. Five community pharmacies and 20 patients from each pharmacy (N=100) were selected by convenience sampling. Patients recruited had uncomplicated hypertension or hypertension with atrial fibrillation, coronary artery disease, heart failure, diabetes mellitus, asthma and/or stroke. A data collection sheet, audit tool to compare antihypertensive therapy and BP control to current evidence-based guidelines, and a self-monitoring BP record sheet were developed and validated by an expert panel. BP was measured with a validated automated device at recruitment (t1) and after 14 days (t2). The MUAH-16 questionnaire was used to evaluate therapy adherence (maximum score 112). Pharmacotherapy and BP values not according to guidelines at t1 were discussed with the GP and action taken was recorded. Of the 100 patients (45% male, mean age 69 years), 31% had uncomplicated hypertension and 35% self-monitor their BP. Mean adherence score was 99 (range 67- 110). Compliance to guidelines for antihypertensive pharmacotherapy was 98% and 77% for BP control. After discussion with the GP, cases of non-compliance to guidelines (23%) had dose increased (n=12) or decreased (n=1), medication added (n=8) or stopped (n=2). A significant decrease in systolic (10 mmHg) and diastolic (7 mmHg) BP between t1 and t2 in patients who had BP level not in accordance with guidelines at t1 was observed (p<0.001). This study assessed appropriateness of pharmacotherapy and BP control in hypertension management according to evidence-based guidelines. In the majority of patients, antihypertensive therapy and BP control were according to guideline recommendations and therapy adherence was high. Study findings highlight a need for further BP self-monitoring and support findings from previous international studies which demonstrated improved hypertension management through community pharmacist-GP collaboration.