Abstract
Hypertension is an increasingly common health problem that affects more than 1 billion people throughout the world. Antihypertensive drugs are the current pharmacotherapy of choice, however uncontrolled blood pressure (BP) accounts for 7.1 million deaths worldwide each year. Little is known about the efficacy of clinical pharmacist’s pharmaceutical care on BP control and medication adherence. The aim of this study was to describe if pharmaceutical care could improve antihypertensive medication adherence and BP control, especially by clinical pharmacists recommendations. This report evaluates the clinical pharmacist interventions during a prospective randomized controlled trial. Out patients with essential hypertension were enrolled in a bimestrial follow-up during 6-month period study; patients were randomly allocated either intervention group (IG) or to control group (CG). Pharmacist interventions involved recommendations to physicians, educational and counseling directly to the patient. The main outcome measure for this analysis was the measure of systolic blood pressure (SBP), diastolic blood pressure (DBP), BP control and medication adherence using a validated questionnaire assessed at the baseline visit and the end of pharmaceutical care. Data from 278 patients were included and analyzed (139 in CG and 139 in IG). There were no significant differences (P < 0.05) in both groups at the baseline. Changes in drug therapy were recommended 192 times for IG patients, the majority of these, involved adding a new antihypertensive drug (42.7%); the largest numbers of pharmacist recommendations (39.6%) were made at the baseline visit. At the end, BP was controlled among significant patients more in IG (76.4%) than in CG (50.6%) (P = 0.0000). Significant lower SBP (-8.5 mmHg, P = 0.0001) and DBP (-4.7 mmHg, P = 0.0013) levels were observed in IG. Low medication adherence, there was also significantly difference between two groups at the end (24.8% versus 41.7%, P = 0.0014). Clinical pharmacist recommendations for alterations in pharmacotherapy intervention can significantly improve medication adherence and BP control in patients with hypertension. Clinical pharmacist recommendations can complement physicians in the management of hypertensive patients. Pharmacist interventions are effective in improving anti-hypertensive medication adherence and reducing systolic and diastolic blood pressure. Pharmacists can effectively participate in health education and promotion to improve blood pressure control. Key words: Blood pressure, clinical pharmacist, hypertension, clinical pharmacy, medication adherence, pharmaceutical care.
Highlights
At home and abroad, it was proved that high blood pressure can be prevented and controlled by comprehendsive interventions (Levey et al, 2003)
The main outcome measure for this analysis was the measure of systolic blood pressure (SBP), diastolic blood pressure (DBP), BP control and medication adherence using a validated questionnaire assessed at the baseline visit and the end of pharmaceutical care
Patients included in the main study were recruited from the current patient population showed at the clinics, patient inclusion and exclusion criteria were provided in Table 1, eligible participants were all adults of age 21 to 85 and with an established medical diagnosis of hypertension, whether their BP was controlled or not
Summary
It was proved that high blood pressure can be prevented and controlled by comprehendsive interventions (Levey et al, 2003). Antihypertensive therapy clearly reduces the risks of cardiovascular disease and extends the patients’ life; large portions of the hypertensive population are either untreated or inadequately treated as lack of adherence to blood pressure (BP)-lowering medication being a major factor. Patients with hypertension may fail to follow their medication, because of a symptomless nature of their condition, long duration of therapy, side effects of medication, complicated drug regimens, lack of understanding about hypertension management and risks, problem of economic status and individual differences among medications. 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. Our study shows that clinical pharmacist can take advantage for hypertensive patients, make a comprehensive analysis on the drugs prescribed to the patients and prevent irrational medication so as to improve medication safety and efficiency significantly
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