Hypertension Patients Benefit from Pharmacist Care

By Jane Farrell

Patients with high blood pressure fare better when a pharmacist is part of their health-care team, according to new research from the University of Iowa.

The investigators, who published their findings in the Journal of the American Society of Hypertension, showed that teams that included pharmacists gave more hands-on and tailored medication regimens to patients. That translated into better blood pressure control when compared to patients who worked mostly with a doctor for medication guidance.

“We’ve known for more than 40 years that including pharmacists on medical care teams improved blood pressure control and the management of many chronic conditions,” says Barry Carter, UI pharmacy professor who led the research teams on both papers. “However, we have had little evidence that such programs could be scaled up and implemented in a large number of diverse medical offices, with wide geographic distribution and serving high numbers of minority populations. This study is the first to address all of these issues and, importantly, demonstrated that subjects from racial and ethnic minority groups had the same degree of blood pressure improvements as the entire population. We also demonstrated, especially in the minority groups, that the effect could be sustained for a full two years after the intervention ended.”

For the studies, UI researchers enrolled 625 patients from various racial backgrounds with uncontrolled hypertension from 32 medical offices across 15 states in the U.S. They then evaluated how well patients were able to control their blood pressure when getting care from a medical team that included a pharmacist compared to being treated by a physician only. The study took place between March 2010 and June 2013. The pharmacists were embedded in the medical office and had long-standing relationships with the physicians, an important distinction from community pharmacists who may not have such relationships with local physicians.

According to a news release from the university, the researchers measured patients’ blood pressure control, the degree and intensity of care they received, and how well they followed medication recommendations.

The team found that patients who saw a medical team that included a clinical pharmacist showed a systolic blood pressure drop of 6.1 mmHg nine months later compared to those who did not see a clinical pharmacist during the same time. A reduction of that scale would reduce the chances of death by stroke by 23 percent, the researchers note.

“That means, if you saw a care team with a clinical pharmacist, your blood pressure was more likely to be lower,” says Tyler Gums, a postdoctoral researcher in the UI College of Pharmacy and corresponding author on the Journal of the American Society of Hypertension paper.

Moreover, patients in the pharmacist-included care teams had their medications adjusted an average of 4.9 times during the nine-month period, of which three instances involved dose increases or added medications, according to the study. Patients who saw physicians only averaged one adjusted medication and less than one instance of dose increases or added medications in the same period, the researchers found.

“Clinical pharmacists were able to contribute to the care team by tailoring blood pressure medications for each patient and spent extra time educating patients on how to decrease their blood pressure,” Gums explained.