Pharmacist Interventions in the Management of Blood Pressure Control and Adherence to Antihypertensive Medications: A Systematic Review of Randomized Controlled Trials
Restricted accessReview articleFirst published online June, 2021
Pharmacist Interventions in the Management of Blood Pressure Control and Adherence to Antihypertensive Medications: A Systematic Review of Randomized Controlled Trials
Pharmacists are ideally positioned to promote optimal use and assess the adherence of prescription medications in patients with chronic diseases. This systematic review of randomized controlled trials (RCTs) ascertains the effectiveness of pharmacist interventions to improve blood pressure (BP) control and medication adherence in patients with hypertension.
Data Sources:
Electronic databases were searched for studies in English published between January 1, 1995, and January 31, 2018. Eligibility criteria included patients with a diagnosis of hypertension tested with RCT where pharmacist-led interventions occurred. The primary outcome was BP control and the secondary outcome was adherence to hypertensive medication. Quality of studies was assessed using the Cochrane Risk of Bias Tool.
Data Synthesis:
Thirty-five studies met the inclusion–exclusion criteria and were included in this study. Major themes included pharmacist-led interventions with medication counseling, patient education, distribution of interventions materials, individualized care plans, and check-in meetings. The vast majority of trials (n = 29) showed statistically significant improvement in BP in the intervention groups at follow-up. Of the 35 studies, most (n = 20) assessed medication adherence; several trials (n = 9) showed statistically significant improvement in medication adherence in patients receiving additional pharmaceutical care services. None of the RCTs was considered to have a high risk of bias.
Conclusion:
Pharmacist-led interventions improved BP control and medication adherence through education, counseling, or a combination of both. Future research is needed to determine the most effective pharmacists’ interventions in managing hypertension and to assess the cost-effectiveness of these interventions.
WheltonPKCareyRMAronowWS, et al.2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(19):e127–e248.
2.
FisherNDCurfmanG. Hypertension—a public health challenge of global proportions. JAMA. 2018;320(17):1757–1759.
3.
Centers for Disease Control and Prevention. High Blood Pressure Fact Sheet. Atlanta, GA: Centers for Disease Control and Prevention; 2016.
4.
BenjaminEJBlahaMJChiuveSE, et al.Heart disease and stroke statistics—2017 update: a report from the American Heart Association. Circulation. 2017;135(10): e146–e603.
5.
MeraiRSiegelCRakotzM, et al.CDC grand rounds: a public health approach to detect and control hypertension. MMWR Morb Mortal Wkly Rep. 2016;65(45):1261–1264.
6.
YoonSSFryarCDCarrollMD. Hypertension Prevalence and Control Among Adults: United States, 2011-2014. NCHS Data Brief. Hyattsville, MD: National Center for Health Statistics; 2015;(220):1–8. DHHS publication no. (PHS) 2016–1209.
7.
MuellerMPurnellTSMensahGA, et al.Reducing racial and ethnic disparities in hypertension prevention and control: what will it take to translate research into practice and policy?Am J Hypertens. 2015;28(6):699–716.
8.
HoAKBartelsCMThorpeCT, et al.Achieving weight loss and hypertension control among obese adults: a US multidisciplinary group practice observational study. Am J Hypertens. 2016;29(8):984–991.
9.
LinP-HTysonCCBatchBC, et al.Nutrition, Lifestyle, and Hypertension. Nutrition in the Prevention and Treatment of Disease (Fourth Edition). Amsterdam: Elsevier; 2017:625–655.
10.
CareyRMWheltonPK. Prevention, detection, evaluation, and management of high blood pressure in adults: synopsis of the 2017 American College of Cardiology/American Heart Association hypertension guideline. Ann Intern Med. 2018;168(5):351–358.
11.
JackeviciusCAMamdaniMTuJV. Adherence with statin therapy in elderly patients with and without acute coronary syndromes. JAMA. 2002;288(4):462–467.
12.
CramerJRosenheckRKirkG, et al.Medication compliance feedback and monitoring in a clinical trial: predictors and outcomes. Value Health. 2003;6(5):566–573.
13.
VrijensBAntoniouSBurnierM, et al.Current situation of medication adherence in hypertension. Fronts Pharmacol. 2017;8:100.
14.
OsterbergLBlaschkeT. Adherence to medication. N Eng J Med. 2005;353(5):487–497.
15.
HymanDPavlikV. Medication adherence and resistant hypertension. J Hum Hypertens. 2015;29(4):213–218.
16.
Calderón-LarrañagaADiazEPoblador-PlouB, et al.Non-adherence to antihypertensive medication: the role of mental and physical comorbidity. Int J Cardiol. 2016;207:310–316.
17.
BrownMTBussellJDuttaS, et al.Medication adherence: truth and consequences. Am J Med Sci. 2016;351(4):387–399.
18.
LeeJKGraceKATaylorAJ. Effect of a pharmacy care program on medication adherence and persistence, blood pressure, and low-density lipoprotein cholesterol: a randomized controlled trial. JAMA. 2006;296(21):2563–2571.
19.
EussenSRvan der ElstMEKlungelOH, et al.A pharmaceutical care program to improve adherence to statin therapy: a randomized controlled trial. Ann Pharmacother. 2010;44(12):1905–1913.
20.
StrandLMCipolleRJMorleyPC. Pharmaceutical Care: An Introduction. Kalamazoo, MI: Upjohn; 1992:14–29.
21.
HeplerCDStrandLM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47(3):533–543.
22.
CipolleRJStrandLMMorleyPC. Pharmaceutical Care Practice: The Patient-centered Approach to Medication Management. New York, NY: McGraw Hill Professional; 2012.
23.
OmboniSSalaE. The pharmacist and the management of arterial hypertension: the role of blood pressure monitoring and telemonitoring. Expert Rev Cardiovasc Ther. 2015;13(2):209–221.
24.
Di PaloKEKishT. The role of the pharmacist in hypertension management. Curr Opin Cardiol. 2018;33(4):382–387.
25.
HigginsJPAltmanDGGøtzschePC, et al.The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343: d5928.
26.
HennessySLeonardCEYangW, et al.Effectiveness of a two-part educational intervention to improve hypertension control: a cluster-randomized trial. Pharmacotherapy. 2006;26(9):1342–1347.
27.
MehosBMSaseenJJMacLaughlinEJ. Effect of pharmacist intervention and initiation of home blood pressure monitoring in patients with uncontrolled hypertension. Pharmacotherapy. 2000;20(11):1384–1389.
28.
GarçaoJACabritaJ. Evaluation of a pharmaceutical care program for hypertensive patients in rural Portugal. J Am Pharm Assoc. 2002;42(6):858–864.
29.
SookaneknunPRichardsRMSanguansermsriJ, et al.Pharmacist involvement in primary care improves hypertensive patient clinical outcomes. Ann Pharmacother. 2004;38(12):2023–2028.
30.
MagidDJOlsonKLBillupsSJ, et al.A pharmacist-led, American Heart Association Heart360 Web-enabled home blood pressure monitoring program. Circ Cardiovasc Qual Outcomes. 2013;6(2):157–163. CIRCOUTCOMES. 112.968172.
31.
MargolisKLAscheSEBergdallAR, et al.Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: a cluster randomized clinical trial. JAMA. 2013;310(1):46–56.
32.
EdelmanDFredricksonSKMelnykSD, et al.Medical clinics versus usual care for patients with both diabetes and hypertension: a randomized trial. Ann Intern Med. 2010;152(11):689–696.
33.
MourãoAOMFerreiraWRMartinsMAP, et al.Pharmaceutical care program for type 2 diabetes patients in Brazil: a randomised controlled trial. Int J Clin Pharm. 2013;35(1):79–86.
34.
OkamotoMPNakahiroRK. Pharmacoeconomic evaluation of a pharmacist-managed hypertension clinic. Pharmacotherapy. 2001;21(11):1337–1344.
35.
MagidDJHoPMOlsonKL, et al.A multimodal blood pressure control intervention in 3 healthcare systems. Am J Manag Care. 2011;17(4): e96–103.
36.
MorgadoMRoloSCastelo-BrancoM. Pharmacist intervention program to enhance hypertension control: a randomised controlled trial. Int J Clin Pharm. 2011;33(1):132–140.
37.
CliffordRMDavisWABattyKT, et al.Effect of a pharmaceutical care program on vascular risk factors in type 2 diabetes: the Fremantle Diabetes Study. Diabetes Care. 2005;28(4):771–776.
38.
JarabASAlqudahSGMukattashTL, et al.Randomized controlled trial of clinical pharmacy management of patients with type 2 diabetes in an outpatient diabetes clinic in Jordan. J Manag Care Pharm. 2012;18(7):516–526.
39.
KraemerDFKradjanWABiancoTM, et al.A randomized study to assess the impact of pharmacist counseling of employer-based health plan beneficiaries with diabetes: the EMPOWER study. J Pharm Pract. 2012;25(2):169–179.
40.
SolomonDKPortnerTSBassGE, et al.Part 2. Clinical and economic outcomes in the hypertension and COPD arms of a multicenter outcomes study. J Am Pharm Assoc (Wash). 1998;38(5):574–585.
41.
ChiuCCWuSSLeePY, et al.Control of modifiable risk factors in ischemic stroke outpatients by pharmacist intervention: an equal allocation stratified randomized study. J Clin Pharm Ther. 2008;33(5):529–535.
42.
BorensteinJEGraberGSaltielE, et al.Physician-pharmacist comanagement of hypertension: a randomized, comparative trial. Pharmacotherapy. 2003;23(2):209–216.
43.
NetoPROMarušićSde Lyra JúniorDP, et al.Effect of a 36-month pharmaceutical care program on the coronary heart disease risk in elderly diabetic and hypertensive patients. J Pharm Pharm Sci. 2011;14(2):249–263.
44.
VivianEM. Improving blood pressure control in a pharmacist-managed hypertension clinic. Pharmacotherapy. 2002;22(12):1533–1540.
45.
WongMCLiuKQWangHH, et al.Effectiveness of a pharmacist-led drug counseling on enhancing antihypertensive adherence and blood pressure control: a randomized controlled trial. J Clin Pharmcol. 2013;53(7):753–761.
46.
ZhaoP-XWangCQinL, et al.Effect of clinical pharmacists pharmaceutical care intervention to control hypertensive outpatients in China. Afr J Pharm Pharmacol. 2012;6(1):48–56.
47.
JamesPAOparilSCarterBL, et al.2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–520
48.
ChanC-WSiuS-CWongCK, et al.A pharmacist care program: positive impact on cardiac risk in patients with type 2 diabetes. J Cardiovasc Pharmacol Ther. 2012;17(1):57–64.
49.
NemerovskiCWYoungMMarianiN, et al.Project ImPACT: hypertension outcomes of a pharmacist-provided hypertension service. Innov Pharm. 2013;4(3).
50.
Al MazrouiNRKamalMMGhabashNM, et al.Influence of pharmaceutical care on health outcomes in patients with Type 2 diabetes mellitus. Br J Clin Pharmacol. 2009;67(5):547–557.
51.
WangJWuJYangJ, et al.Effects of pharmaceutical care interventions on blood pressure and medication adherence of patients with primary hypertension in China. Clin Res Regul Aff. 2011;28(1):1–6.
52.
CarterBLBergusGRDawsonJD, et al.A cluster randomized trial to evaluate physician/pharmacist collaboration to improve blood pressure control. J Clin Hypertens. 2008;10(4):260–271.
53.
PlanasLGCrosbyKMMitchellKD, et al.Evaluation of a hypertension medication therapy management program in patients with diabetes. J Am Pharm Assoc. 2009;49(2):164–170.
54.
ZillichAJSutherlandJMKumberaPA, et al.Hypertension outcomes through blood pressure monitoring and evaluation by pharmacists (HOME study). J Gen Intern Med. 2005;20(12):1091–1096.
55.
De CastroMSFuchsFDCosta SantosM, et al.Pharmaceutical care program for patients with uncontrolled hypertension: report of a double-blind clinical trial with ambulatory blood pressure monitoring. Am J Hypertens. 2006;19(5):528–533.
56.
BennettMGoodeJ-VR. Recognition of community-based pharmacist practitioners: essential health care providers. J Am Pharm Assoc. 2016;56(5):580–583.
57.
FrazierKRMcKeirnanKCKherghehpoushS, et al.Rural patient perceptions of pharmacist-provided chronic condition management in a state with provider status. J Am Pharm Assoc. 2019;59(2):210–216.
58.
IsettsBJBuffingtonDECarterBL, et al.Evaluation of pharmacists’ work in a physician-pharmacist collaborative model for the management of hypertension. Pharmacotherapy. 2016;36(4):374–384.
59.
BajorekBLemayKSMaginP, et al.Implementation and evaluation of a pharmacist-led hypertension management service in primary care: outcomes and methodological challenges. Pharm Pract (Granada). 2016;14(2):723.
60.
Centers for Disease Control and Prevention. Using the Pharmacist Patient Care Process to Manage High Blood Pressure: A Resource Guide for Pharmacists. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2016.
61.
DaltonKByrneS. Role of the pharmacist in reducing healthcare costs: current insights. Integr Pharm Res Pract. 2017;6:37–46.
62.
SchuesslerTJRuisingerJFHareSE, et al.Patient satisfaction with pharmacist-led chronic disease state management programs. J Pharm Pract. 2016;29(5):484–489.
63.
GanguliAClewellJShillingtonAC. The impact of patient support programs on adherence, clinical, humanistic, and economic patient outcomes: a targeted systematic review. Patient Prefer Adherence. 2016;10:711–725.
64.
MnatzaganianCLRuppVMaC.The DanielKInouye College of Pharmacy scripts: provider status for pharmacists: why it matters for other healthcare providers. Hawai’i J Med Public Health. 2015;74(9):319–321.
65.
BinghamJScovisNTaylorAM, et al.Past, present, and continued need for provider status legislation: Navigating clinical practice with significant sustainability barriers. J Am College Clin Pharm. 2018;1(1):32–37.
66.
HarperPC. Pharmacist provider status legislation: projections and prospects. J Am Pharm Assoc. 2015;55(2):203–207.
67.
FornosJAAndresNFAndresJC, et al.A pharmacotherapy follow-up program in patients with type-2 diabetes in community pharmacies in Spain. Pharmacy World and Science2006;28(2):65–72.
68.
GreenBBCookAJRalstonJD, et al.Effectiveness of home blood pressure monitoring, Web communication, and pharmacist care on hypertension control: a randomized controlled trial. Jama2008;299(24):2857–2867.
69.
HuntJSSiemienczukJPapeG, et al.A randomized controlled trial of team-based care: impact of physician-pharmacist collaboration on uncontrolled hypertension. Journal of General Internal Medicine2008;23(12):1966–1972.
70.
ScottDMBoydSTStephanM, et al.Outcomes of pharmacist-managed diabetes care services in a community health center. American Journal of Health-System Pharmacy2006;63(21):2116–2122.
71.
SimpsonSHMajumdarSRTsuyukiRT, et al.Effect of adding pharmacists to primary care teams on blood pressure control in patients with type 2 diabetes: a randomized controlled trial. Diabetes Care2011;34(1):20–26.
