VASCULAR AGE AS A KEY FOR A TEAM-BASED APPROACH TO MANAGE BLOOD PRESSURE AND CARDIOVASCULAR RISK BETWEEN COMMUNITY PHARMACISTS AND PRIMARY HEALTH CARE CENTERS (TOGETHER)

Abstract

Objective: Hypertension (HTN) is the main cause of premature death worldide. Previous studies in Portugal, Austria and Spain have shown that estimating arterial stiffness in Community Farmacies (CPh) improves its management. The main objective is to evaluate whether empowering hypertensive subjects by determining arterial stiffness in CPh increases the rate of HTN control. Secondary objective is to establish paths of lasting cooperation between Primary Care (PC) doctors and CPh. Design and method: TOGETHER is a randomized study in Portugal, Austria and Spain. All consecutive expected 1260 subjects entering CPh will be offered blood pressure measurement and ambulatory blood pressure monitoring (ABPM) for those cases with high values. 140 CPh will be randomly grouped into a usual care arm (health education associated with HTN and communication of the results to PC). In the experimental care group, early vascular aging (EVA) will additionally be assessed estimating oscillometric pulse wave velocity. The concept and therapeutic options of EVA will be explained to patients and PC. HTN will be treated by PC according to usual clinical practice. After 6 months a second evaluation with ABPM will be performed and HTN control will be compared between the two arms. The degree of patient-doctor interaction and economic implications will be determined through validated surveys. Results: TOGETHER will address five fundamental unmet needs: 1) lack of HTN screening programs; 2) the concept of cardiovascular risk is difficult to understand. The EVA concept (“Your arteries are 10 years older than you”) is simple and more informative; 3) understanding CV risk on an individual basis (individual EVA) should improve patient adherence and reduce physician inertia; 4) TOGETHER will implement health educational programs, combined with the concept of EVA; 5) there is an objective need to improve collaboration and develop a team-based approach to HTN care between CPh and PC. Conclusions: The complementary strengths and organizational settings of CPh and PC will allow TOGETHER to create new strategies for early identification and intervention in HTN, ranging from lifestyle to medical treatment, taking social, economic, and behavioral aspects into account.