Evidence for pharmacist care in the management of hypertension.

Abstract

Hypertension is a major risk factor for cardiovascular diseases and mortality, affecting about 20% to 30% of North American adults.1,2 Although treatment of hypertension can substantially reduce this risk,3 hypertension in primary care remains underdetected, undertreated and poorly controlled.2,4,5 For example, despite substantial improvement, half of North American–treated patients with hypertension remain uncontrolled.2,4,5 Innovative models of care are therefore needed to improve patient outcomes, particularly in light of the heavy workload and shortage of family physicians in most health care systems. Some authors advocate a greater use of community-based models of care6 with the involvement of nonphysician clinicians, such as pharmacists and nurses, as a promising avenue to improve hypertension care and, more broadly, chronic disease management.7-9 Given their accessibility and drug therapy expertise, pharmacists are a logical choice and a valuable asset to improve hypertension management—alone or via team-based care.7,10-13 Indeed, there have been many trials of pharmacist care. We recently combined and updated 2 systematic reviews and meta-analyses of randomized controlled trials evaluating the effect of pharmacist interventions—alone or as part of collaborative care—on blood pressure outcomes among outpatients.12,14 Details about the type of pharmacist intervention (including description and frequency), the involvement of other health care professionals within collaborative care setting, the care setting and the characteristics of participants were also examined.14 The research methods (search strategy, study selection and data extraction) are given in detail in the original publication.14