Improving timeliness of antihypertensive treatment intensification through pharmacist-led interventions among older adult patients in Northwest Ethiopia: Multicenter prospective cohort study

Abstract

Background:

Therapeutic inertia is a significant challenge to optimal blood pressure control, resulting in prolonged exposure to high blood pressure and increased cardiovascular risk, especially among older patients in low- and middle-income countries.

Objectives:

The current study assessed the impact of interventions by pharmacists on the time to antihypertensive treatment intensification among older patients with uncontrolled hypertension in Northwest Ethiopia.

Design:

A multicenter prospective cohort study was conducted from January to July 2025 in three tertiary hospitals in Northwest Ethiopia.

Methods:

A total of 422 older hypertensive patients with uncontrolled blood pressure were enrolled and followed up either in the pharmacist-led care or usual care. The interventions by pharmacists included recommendations for treatment intensification, medication review, adherence, and resolution of drug-related problems. The primary outcome was time to antihypertensive treatment intensification. Kaplan–Meier survival analysis and Cox proportional hazards regression were employed to evaluate the time-to-event outcomes and factors.

Results:

Patients receiving pharmacist-led care experienced significantly faster treatment intensification than those receiving usual care, with a median time of 28 days versus 63 days. A higher proportion of patients in the pharmacist-led group achieved treatment intensification within 30, 60, and 90 days. Faster treatment intensification (adjusted hazard ratio (AHR) 2.18) was independently linked to pharmacist-led care. The intervention group showed greater systolic and diastolic blood pressure reductions, as well as a higher percentage of patients who achieved blood pressure control at follow-up. In addition, higher baseline systolic blood pressure was linked to faster intensification of treatment.

Conclusion:

Pharmacist-led interventions significantly reduced therapeutic inertia by accelerating antihypertensive treatment intensification and improving blood pressure control. Integrating pharmacists into multidisciplinary hypertension care may represent an effective and scalable strategy to improve hypertension outcomes in resource-limited settings.

Plain language summary

Can pharmacists help control high blood pressure faster? Evidence from Northwest Ethiopia

High blood pressure is common among older adults and can lead to serious health problems like stroke and heart disease if not properly controlled. Sometimes, treatment is not adjusted quickly enough when blood pressure remains high. This study followed 422 older patients with uncontrolled hypertension in three hospitals in Northwest Ethiopia. Patients who received pharmacist-led care had their medications adjusted much faster than those receiving usual care (28 days vs. 63 days). They also had greater reductions in blood pressure and more often achieved good blood pressure control. These findings show that involving pharmacists in hypertension care can reduce treatment delays and improve patient outcomes, especially in resource-limited settings.

Keywords

hypertension therapeutic inertia pharmacist-led intervention treatment intensification Ethiopia

Introduction

Hypertension is a major global public health challenge and a leading modifiable risk factor for cardiovascular morbidity and mortality. More than 1.28 billion adults worldwide are affected, with nearly two-thirds living in low- and middle-income countries.¹ Uncontrolled hypertension markedly increases the risk of stroke, ischemic heart disease, heart failure, and chronic kidney disease, resulting in substantial preventable premature mortality.² The burden is rising rapidly in sub-Saharan Africa due to population aging, urbanization, unhealthy lifestyles, and limited access to healthcare.³ Ethiopia has a 15% to 30% prevalence of hypertension; however, despite the availability of efficient antihypertensive medications, blood pressure control is still subpar, especially in older adults and those with comorbidities.^4
–7

One of the most important contributors to suboptimal BP (blood pressure) control is clinical (therapeutic) inertia, defined as the failure of healthcare providers to initiate or intensify antihypertensive therapy when treatment goals are not achieved.⁸ Several studies have shown that antihypertensive treatment intensification is frequently delayed, even after repeated documentation of uncontrolled BP.^9
–11 Such delays expose patients to prolonged periods of elevated BP, increasing the risk of stroke, myocardial infarction, renal failure, and all-cause mortality.^12,13 Evidence from cohort studies in high-income countries indicates that the median time to treatment intensification often exceeds 6 months, with even longer delays observed in LMICs (low- and middle-income countries) due to fragmented care systems, workforce shortages, and limited follow-up mechanisms.¹⁴ In Ethiopia, although uncontrolled hypertension is highly prevalent, there is limited empirical evidence assessing the timeliness of treatment intensification and its determinants.^15,16

Pharmacist-led interventions have emerged as an effective strategy to improve hypertension management and reduce therapeutic inertia, particularly in primary care and resource-limited settings. Pharmacists can contribute by identifying uncontrolled BP early, conducting medication reviews, recommending treatment intensification, addressing drug-related problems, improving medication adherence, and providing patient education.¹⁷ Task-sharing and collaborative care models that integrate pharmacists into multidisciplinary healthcare teams have been shown to improve medication optimization and clinical outcomes.¹⁸ Meta-analyses and randomized controlled trials consistently demonstrate that pharmacist-led interventions significantly increase the proportion of patients achieving target BP and reduce systolic BP by approximately 5–9 mmHg compared with usual care.^19
–21

In Ethiopia, doctors and nurses have typically been in charge of managing chronic illnesses, while pharmacists have historically been restricted to dispensing and inventory management responsibilities.²¹ The National Strategic Action Plan for the Prevention and Control of Non-Communicable Diseases is one recent national health sector reform that acknowledges the growing role of pharmacists in maximizing drug use and enhancing treatment results. Pharmacist-led services, including pharmaceutical treatment management, patient counseling, and adherence support, may enhance BP control and medication adherence, according to new research from Ethiopian hospital settings.^22,23 However, there are still a few prospective cohort studies assessing how pharmacist-led interventions affect clinical inertia and time to antihypertensive treatment intensification, two important quality indicators of hypertension care that reflect real-time clinical decision-making.^24,25

Given the high burden of uncontrolled hypertension, the shortage of specialized healthcare providers, and the need for scalable and cost-effective interventions, evaluating pharmacist-led models is particularly important in the Ethiopian context. Therefore, this multicenter prospective cohort study aimed to assess the effect of pharmacist-led interventions on the timeliness of antihypertensive treatment intensification among older adult patients in Northwest Ethiopia. By generating real-world evidence on reducing therapeutic inertia, this study seeks to inform policy, support integration of pharmacists into chronic care teams, and strengthen team-based approaches to improve BP control and reduce cardiovascular risk.

Methods

Study setting, design, and period

A multicenter prospective cohort study was conducted in Northwest Ethiopia at three tertiary-level public hospitals: University of Gondar Comprehensive Specialized Hospital, Felege Hiwot Comprehensive Specialized Hospital, and Debre Tabor Comprehensive Specialized Hospital. These hospitals serve as major referral centers for their respective catchment areas and provide comprehensive outpatient and inpatient care, including chronic disease management services for older adult patients with hypertension.

The study employed a pharmacist-led intervention model aimed at improving the timeliness of antihypertensive treatment intensification among older adult patients receiving routine hypertension care. Eligible participants were prospectively followed to assess treatment intensification practices and related outcomes. The study was conducted over a seven-month period, from January 1, 2025, to July 2025.

Eligibility criteria

Patients 60 years of age or older who had been diagnosed with hypertension and had uncontrolled BP (systolic BP ⩾140 mmHg and/or diastolic BP ⩾90 mmHg) despite receiving antihypertensive medication were included in the study. Patients with secondary hypertension, insufficient medical records, critical illness, or incapacity to participate in follow-up, or refusal to give informed consent were excluded from the study.

Sample size determination and sampling techniques

The sample size for this multicenter prospective cohort study was 422 older adult patients with hypertension. The sample size was determined using the single population proportion formula, assuming a 50% proportion to maximize sample size, a 95% confidence level, and a 5% margin of error, with an allowance for potential loss to follow-up.

The study was conducted at three comprehensive specialized hospitals: University of Gondar Comprehensive Specialized Hospital, Felege Hiwot Comprehensive Specialized Hospital, and Debre Tabor Comprehensive Specialized Hospital. The total sample size was proportionally allocated to each hospital based on the average monthly number of older adult hypertensive patients attending follow-up clinics.

A consecutive sampling technique was employed in each study site, whereby all eligible older adult patients presenting to the hypertension follow-up clinics during the data collection period were enrolled consecutively until the allocated sample size for each hospital was reached. Group assignment was based on the current treatment paradigm at each study site (pharmacist-led care versus usual care), instead of using random assignment.

Data collection instruments, procedures, and quality control

Data were collected using a structured and pretested data collection instrument developed after an extensive review of relevant literature and international hypertension management guidelines. The tool was designed to capture sociodemographic characteristics, clinical and treatment-related variables, BP measurements, pharmacist-led intervention components, and timeliness of antihypertensive treatment intensification. During routine follow-up visits, data were collected using a structured and pretested tool through patient interviews, medical record reviews, and standardized BP measurements conducted by trained personnel.

BP was measured by trained healthcare professionals using validated and calibrated sphygmomanometers, in accordance with standard clinical guidelines. Measurements were taken after the patient had rested for at least 5 min in a seated position, and the average of two readings was recorded. Information on medication regimens, treatment adjustments, comorbidities, and laboratory findings was extracted from patient medical records using a standardized abstraction checklist.

Data collection was carried out by trained clinical pharmacists and nurses under close supervision. Prior to data collection, comprehensive training was provided to ensure a uniform understanding of study objectives, data collection procedures, and ethical considerations. The data collection tool was pretested on 5% of the sample in a non-study setting, and necessary modifications were made to improve clarity and consistency.

To ensure data quality, daily supervision and on-site monitoring were conducted throughout the data collection period. Completed questionnaires were reviewed for completeness and accuracy before data entry (Supplemental File). Double data entry and consistency checks were performed to minimize entry errors. Any discrepancies identified were resolved through cross-verification with source documents. Standard operating procedures were strictly followed across all study sites to maintain consistency and reliability of the collected data.

Statistical analysis

Data were entered, cleaned, and analyzed using the Statistical Package for the Social Sciences (SPSS), version 27. Descriptive statistics were used to summarize participants’ sociodemographic characteristics, clinical profiles, and treatment-related variables. Categorical variables were presented as frequencies and percentages, while continuous variables were summarized using means with standard deviations or medians with interquartile ranges, as appropriate.

The primary outcome was the time to antihypertensive treatment intensification, measured in days from the identification of uncontrolled BP to the initiation or escalation of antihypertensive therapy. Patients who did not experience treatment intensification during the follow-up period were considered censored at their last clinic visit.

Time-to-event analysis was employed because the primary outcome was the time from detection of uncontrolled BP to treatment intensification. Kaplan–Meier survival analysis was used to estimate time to treatment intensification, and differences between groups were compared using the log-rank test. Potential confounding variables were taken into account during the analysis by assessing baseline comparability between groups and incorporating clinically significant variables in the multivariable Cox proportional hazards regression model. Based on statistical significance in bivariable analysis and clinical relevance, variables were selected for the multivariable model. Factors associated with the timeliness of treatment intensification were evaluated using the Cox proportional hazards regression model. Variables with a p-value <0.25 in bivariable Cox regression analysis were included in the multivariable model.

Results were reported as crude hazard ratios (CHR) and AHR with corresponding 95% confidence intervals (CIs). To find variables associated with the time to treatment intensification while taking censored observations into account, Cox proportional hazards regression analysis was used. Schoenfeld residuals and graphical techniques were used to evaluate the proportional hazards assumption. To guarantee model stability, multicollinearity among independent variables was assessed using the variance inflation factor (VIF). A p-value <0.05 was considered statistically significant for all analyses.

Results

Baseline characteristics participants

Baseline characteristics of participants were well balanced between the Pharmacist-Led Care and Usual Care groups. The mean age was similar (67.8 ± 6.1 vs 68.1 ± 6.4 years, p = 0.62), with comparable proportions of females (55.9% vs 57.3%, p = 0.78) and urban residents (59.7% vs 57.8%, p = 0.69). Baseline BP, prevalence of stage 2 hypertension, diabetes mellitus, chronic kidney disease, and use of ⩾2 antihypertensive drugs were also similar between the two groups, with no statistically significant differences (all p > 0.05), indicating successful group comparability before the intervention (Table 1).

Table 1.

Baseline characteristics of older adult participants (N = 422).

Characteristic	Pharmacist-led care (n = 211)	Usual care (n = 211)	p-Value
Age, mean ± SD (years)	67.8 ± 6.1	68.1 ± 6.4	0.62
Female sex, n (%)	118 (55.9)	121 (57.3)	0.78
Urban residence, n (%)	126 (59.7)	122 (57.8)	0.69
Baseline SBP, mean ± SD (mmHg)	162.4 ± 14.6	161.8 ± 15.1	0.71
Baseline DBP, mean ± SD (mmHg)	92.6 ± 9.8	93.1 ± 10.2	0.54
Stage 2 hypertension, n (%)	149 (70.6)	146 (69.2)	0.75
Diabetes mellitus, n (%)	74 (35.1)	78 (37.0)	0.67
Chronic kidney disease, n (%)	41 (19.4)	39 (18.5)	0.81
⩾2 antihypertensive drugs at baseline, n (%)	132 (62.6)	129 (61.1)	0.75

SD: standard deviation; SBP: systolic blood pressure; DBP: diastolic blood pressure; mmHg: millimeters of mercury.

Antihypertensive drugs prescribed and intensified

Among the 422 participants, ACEIs (33.2%), CCBs (23.7%), and ARBs (21.3%) were the most prescribed drugs. Treatment intensification mainly involved dose increases or adding new agents, with the highest for combination therapy (19.0%), followed by CCBs (14.2%) and ACEIs (10.7%), reflecting guideline-based escalation for uncontrolled hypertension (Table 2).

Table 2.

Types of antihypertensive drugs prescribed and intensified (n = 422).

Drug class	Number prescribed, n (%)	Number intensified, n (%)
ACE inhibitors (ACEIs)	140 (33.2%)	45 (10.7%)
Angiotensin receptor blockers (ARBs)	90 (21.3%)	30 (7.1%)
Calcium channel blockers (CCBs)	100 (23.7%)	60 (14.2%)
Diuretics	60 (14.2%)	40 (9.5%)
Beta-blockers	32 (7.6%)	10 (2.4%)
Combination therapy (ACEI/ARB + CCB or diuretic)	–	80 (19.0%)

Types of pharmacist-led interventions

In the pharmacist-led group, the most frequent interventions were treatment intensification (79.6%) and adherence counseling (73.9%), with additional actions including resolving drug-related problems (57.3%), adding new agents (49.3%), and dose escalation (43.6%). Physician acceptance was high (91.7%), indicating effective collaboration (Table 3).

Table 3.

Types of pharmacist-led interventions (n = 211).

Intervention type	Number (%)
Recommendation for treatment intensification	168 (79.6)
Dose escalation of existing therapy	92 (43.6)
Addition of a new antihypertensive agent	104 (49.3)
Identification/resolution of drug-related problems	121 (57.3)
Medication adherence counseling	156 (73.9)
Physician acceptance of recommendations	154 (91.7)

Outcome and time to antihypertensive treatment intensification

Pharmacist-led care led to faster and more frequent treatment intensification (median 28 vs 63 days, p < 0.001) and greater BP reductions (SBP −18.6 vs −10.4 mmHg; DBP −8.9 vs −4.7 mmHg), with more patients achieving controlled BP at follow-up (62.6% vs 40.8%, p < 0.001; Table 4).

Table 4.

Time to antihypertensive treatment intensification.

Outcome	Pharmacist-led care	Usual care	p-Value
Median time to intensification (days), IQR	28 (18–42)	63 (45–88)	<0.001
Intensified within 30 days, n (%)	119 (56.4)	48 (22.7)	<0.001
Intensified within 60 days, n (%)	167 (79.1)	102 (48.3)	<0.001
Intensified within 90 days, n (%)	188 (89.1)	136 (64.5)	<0.001
Mean SBP reduction (mmHg)	−18.6 ± 11.2	−10.4 ± 9.6	<0.001
Mean DBP reduction (mmHg)	−8.9 ± 6.3	−4.7 ± 5.8	<0.001
BP controlled at follow-up, n (%)	132 (62.6)	86 (40.8)	<0.001

DBP: diastolic blood pressure; SBP: systolic blood pressure; HR: hazard ratio.

Kaplan–Meier curve for time to antihypertensive treatment intensification

The Kaplan–Meier curve shows that patients in the pharmacist-led group achieved treatment intensification faster and more consistently than usual care, with the probability of no intensification declining more rapidly over time (Figure 1).

Figure 1.

Kaplan–Meier curve for time to antihypertensive treatment intensification among older adults.

Factors for the time to treatment intensification

After adjustment, pharmacist-led intervention (HR 2.18; 95% CI 1.74–2.74; p < 0.001) and higher baseline systolic BP (per 10 mmHg, HR 1.52; 95% CI 1.01–1.85; p = 0.03) were independently associated with faster antihypertensive treatment intensification (Table 5).

Table 5.

Cox proportional hazards regression for time to treatment intensification (N = 422).

Variable	Crude HR (95% CI)	p-Value	Adjusted HR (95% CI)	p-Value
Pharmacist-led intervention	2.41 (1.96–2.97)	<0.001	2.18 (1.74–2.74)	<0.001
Age (per year increase)	0.98 (0.96–1.00)	0.08	0.99 (0.97–1.01)	0.31
Female sex	1.12 (0.92–1.36)	0.25	1.08 (0.87–1.34)	0.48
Baseline SBP (per 10 mmHg)	1.75 (1.04–1.98)	0.006	1.52 (1.01–1.85)	0.03
Diabetes mellitus	1.27 (1.02–1.58)	0.03	1.19 (0.94–1.50)	0.14
Chronic kidney disease	1.34 (1.02–1.77)	0.04	1.21 (0.90–1.63)	0.21
⩾2 baseline antihypertensive drugs	0.81 (0.66–0.99)	0.04	0.85 (0.68–1.07)	0.16

SBP: systolic blood pressure; HR: hazard ratio.

p-Value less than or equal to 0.005 is statistically significant.

The boldfaced values indicated that they are statistically significant, meaning the p-value is less than 0.005.

Pharmacist-led intervention and higher baseline SBP were significantly associated with treatment intensification, while other factors showed no significant association (Figure 2).

Figure 2.

Forest plot of adjusted hazard ratios for timely antihypertensive treatment intensification among older adults.

Discussion

This multicenter prospective cohort study revealed that pharmacist-led interventions substantially improved the timeliness of antihypertensive treatment intensification among older adults with uncontrolled hypertension in Northwest Ethiopia. By reducing delays in treatment escalation, pharmacist involvement directly addressed therapeutic inertia, a well-recognized barrier to effective hypertension control worldwide, particularly in LMICs.^3,26,27

Therapeutic inertia remains a persistent challenge in hypertension care and is associated with prolonged exposure to elevated BP and increased cardiovascular risk. Previous studies have consistently reported delayed treatment intensification despite repeated documentation of uncontrolled BP, reflecting gaps in clinical decision-making and follow-up systems.^9,11,28,29 In resource-limited settings such as Ethiopia, high patient load, limited consultation time, and workforce shortages may further exacerbate this problem.^16,25,30

The faster treatment intensification observed in the pharmacist-led care group highlights the critical role of pharmacists in overcoming clinical inertia. Pharmacists are uniquely positioned to systematically identify uncontrolled BP, review current therapy, and recommend timely treatment escalation based on guideline targets. Similar improvements in treatment optimization have been reported in both high-income countries and LMICs following the integration of pharmacists into multidisciplinary care teams.^18
–20,31

The high acceptance rate of pharmacist recommendations by physicians observed in this study reflects effective interprofessional collaboration. Collaborative practice models enhance trust, streamline clinical decision-making, and reduce fragmentation of care, all of which are essential for managing chronic conditions such as hypertension. Evidence suggests that such team-based approaches lead to more consistent application of treatment guidelines and improved patient outcomes.^19,21

In addition to improving treatment timeliness, pharmacist-led care resulted in greater reductions in systolic and diastolic BP and a higher proportion of patients achieving controlled BP at follow-up. These findings are consistent with prior randomized trials and meta-analyses demonstrating that pharmacist interventions lead to clinically meaningful improvements in BP control.^20,32 Even modest reductions in BP are known to substantially lower the risk of stroke, myocardial infarction, and heart failure, particularly in older adults.^12,33

Higher baseline systolic BP was associated with faster treatment intensification, suggesting that clinicians may prioritize patients perceived to be at higher immediate cardiovascular risk. While this approach is understandable, it may inadvertently delay appropriate escalation in patients with moderately elevated BP. Pharmacist-led interventions can help standardize care by ensuring that treatment decisions are driven by evidence-based thresholds rather than subjective risk perception alone.^34
–36

The pattern of antihypertensive intensification observed in this study, including increased use of combination therapy and first-line drug classes, aligns well with international hypertension management guidelines. Guideline-concordant prescribing is particularly important in older adults, who often have multiple comorbidities and require careful medication selection to balance efficacy and safety.^37
–39

Medication adherence counseling was a key component of the pharmacist-led interventions. Poor adherence is a major contributor to apparent treatment resistance and may falsely reinforce therapeutic inertia. By addressing adherence barriers, pharmacists help differentiate true uncontrolled hypertension from pseudo-resistance, enabling appropriate and timely treatment escalation.^40,41

The findings of this study are especially relevant to the Ethiopian healthcare system, where the burden of non-communicable diseases is rising rapidly amid limited human and financial resources. National health strategies increasingly recognize the expanded clinical role of pharmacists, and this study provides strong real-world evidence supporting their integration into chronic disease management services.^22,42

From a health systems perspective, pharmacist-led care represents a scalable and potentially cost-effective strategy to improve hypertension outcomes. Task-sharing models that leverage pharmacists’ expertise may help address physician shortages, improve continuity of care, and enhance quality of service delivery in both tertiary and primary care settings.^43,44 In addition to factors related to the healthcare system, new evidence shows that psychosocial and patient-related factors are also important for managing high BP. Recent research indicates that psychological factors, including alexithymia, may affect BP regulation, treatment adherence, and overall clinical outcomes in patients with hypertension.^45,46 In addition, studies involving specific populations, such as pregnant women, suggest that disparities in emotional processing may influence variations in hypertension patterns and disease progression.⁴⁷ These findings highlight the necessity for a more holistic, patient-centered methodology in hypertension management, augmenting pharmacist-led initiatives to enhance treatment outcomes.

Limitations and strengths

This study has notable strengths, including a multicenter prospective design across tertiary hospitals in Northwest Ethiopia, which enhances generalizability, and prospective follow-up with standardized data collection and objective BP measurements, ensuring reliable results. High physician acceptance of pharmacist recommendations also demonstrates strong interprofessional collaboration and real-world feasibility.

Although baseline characteristics between groups were comparable, the observational design and non-random group assignment mean that residual confounding and selection bias cannot be completely ruled out, even after multivariable adjustment. In addition, the study was limited to older adults attending tertiary hospitals in Northwest Ethiopia, which may restrict the generalizability of the findings to primary care settings. Furthermore, the study did not assess cost-effectiveness or patient-reported outcomes. Nonetheless, the multicenter design and prospective follow-up enhance the robustness and real-world relevance of the findings.^16,34

Conclusion

Pharmacist-led interventions significantly reduced therapeutic inertia by accelerating antihypertensive treatment intensification and improving BP control among older adults. These findings support integrating pharmacists into multidisciplinary hypertension care teams as a practical and scalable strategy to enhance the quality of hypertension management in resource-limited settings.

Supplemental Material

sj-docx-1-taj-10.1177_27558428261452289 – Supplemental material for Improving timeliness of antihypertensive treatment intensification through pharmacist-led interventions among older adult patients in Northwest Ethiopia: Multicenter prospective cohort study

Supplemental material, sj-docx-1-taj-10.1177_27558428261452289 for Improving timeliness of antihypertensive treatment intensification through pharmacist-led interventions among older adult patients in Northwest Ethiopia: Multicenter prospective cohort study by Samuel Berihun Dagnew, Tigabu Eskeziya Zerihun, Desalegn Addis Mussie, Tilaye Arega Moges, Samuel Agegnew Wondm, Fasil Bayafers Tamene, Getachew Yitayew Tarekegn, Woretaw Sisay Zewdu and Abel Temeche Kassaw in Sage Open Chronic Disease

Footnotes

Acknowledgements

For their cooperation during the study, the hospital administration and study participants are greatly appreciated by the authors.

ORCID iDs

Samuel Berihun Dagnew

Tigabu Eskeziya Zerihun

Desalegn Addis Mussie

Tilaye Arega Moges

Fasil Bayafers Tamene

Getachew Yitayew Tarekegn

Woretaw Sisay Zewdu

Abel Temeche Kassaw

Ethical considerations

Ethical clearance was obtained from the Debre Tabor University Ethical Review Committee (IRERC) with approval number DTU/Re/214/2024, and a letter of authorization was given by the medical director of the three hospitals. The study was conducted in accordance with the principles of the Declaration of Helsinki.

Consent to participate

Written informed consent was obtained from all participants before enrollment. Participants were adequately informed about the purpose of the study, procedures involved, potential risks and benefits, and their right to refuse or withdraw from the study at any time without any effect on their routine medical care. Confidentiality of participant information was strictly maintained by using anonymous data collection tools and restricting access to the data to the research team only.

Author contributions

Samuel Berihun Dagnew: Conceptualization; Data curation; Formal analysis; Funding acquisition; Investigation; Methodology; Project administration; Software; Validation; Writing – original draft; Writing – review & editing.

Tigabu Eskeziya Zerihun: Data curation; Methodology; Project administration; Supervision; Visualization; Writing – review & editing.

Desalegn Addis Mussie: Formal analysis; Methodology; Resources; Supervision; Validation; Writing – review & editing.

Tilaye Arega Moges: Funding acquisition; Methodology; Project administration; Supervision; Visualization; Writing – review & editing.

Samuel Agegnew Wondm: Investigation; Methodology; Resources; Supervision; Validation; Writing – review & editing.

Fasil Bayafers Tamene: Data curation; Methodology; Software; Supervision; Validation; Writing – review & editing.

Getachew Yitayew Tarekegn: Formal analysis; Funding acquisition; Resources; Supervision; Visualization; Writing – review & editing.

Woretaw Sisay Zewdu: Funding acquisition; Resources; Visualization; Writing – review & editing.

Abel Temeche Kassaw: Data curation; Methodology; Software; Supervision; Validation; Writing – review & editing.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declare that there is no conflict of interest.

Data availability statement

The dataset used to support the findings of this investigation is described in the article and the Supplemental Files.

Supplemental material

Supplemental material for this article is available online.

References

Kario

Okura

Hoshide

, et al. The WHO global report 2023 on hypertension warning the emerging hypertension burden in globe and its treatment strategy. Hypertens Res 2024; 47(5): 1099–1102.

Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396(10258): 1223–1249.

Ataklte

Erqou

Kaptoge

, et al. Burden of undiagnosed hypertension in sub-saharan Africa: a systematic review and meta-analysis. Hypertension 2015; 65(2): 291–298.

Awoke

Alemu

, et al. Prevalence and associated factors of hypertension among adults in Gondar, Northwest Ethiopia: a community based cross-sectional study. BMC Cardiovasc Disord 2012; 12: 113.

Kibret

Mesfin

YM.

Prevalence of hypertension in Ethiopia: a systematic meta-analysis. Public Health Rev 2015; 36: 14.

Tiruneh

Bukayaw

Yigizaw

, et al. Prevalence of hypertension and its determinants in Ethiopia: A systematic review and meta-analysis. PLoS One 2020; 15(12): e0244642.

Isaac Derick

Khan

. Prevalence, awareness, treatment, control of hypertension, and availability of hypertension services for patients living with human immunodeficiency virus (HIV) in Sub-Saharan Africa (SSA): a systematic review and meta-analysis. Cureus 2023; 15(4): e37422.

Phillips

Branch

WT Cook

, et al. Clinical inertia. Ann Intern Med 2001; 135(9): 825–834.

Okonofua

Simpson

Jesri

, et al. Therapeutic inertia is an impediment to achieving the Healthy People 2010 blood pressure control goals. Hypertension 2006; 47(3): 345–351.

10.

Sarganas

Knopf

Grams

, et al. Trends in antihypertensive medication use and blood pressure control among adults with hypertension in Germany. Am J Hypertens 2016; 29(1): 104–113.

11.

Berlowitz

Ash

Hickey

, et al. Inadequate management of blood pressure in a hypertensive population. N Engl J Med 1998; 339(27): 1957–1963.

12.

Wright

Jr Williamson

Whelton

, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 2015; 373(22): 2103–2116.

13.

Reisin

Graves

Yamal

, et al. Blood pressure control and cardiovascular outcomes in normal-weight, overweight, and obese hypertensive patients treated with three different antihypertensives in ALLHAT. J Hypertens 2014; 32(7): 1503–1513.

14.

Bouabdallaoui

Tardif

Waters

, et al. Time-to-treatment initiation of colchicine and cardiovascular outcomes after myocardial infarction in the colchicine cardiovascular outcomes trial (COLCOT). Eur Heart J 2020; 41(42): 4092–4099.

15.

Berhe

Taxis

Haaijer-Ruskamp

, et al. Hypertension treatment practices and its determinants among ambulatory patients: retrospective cohort study in Ethiopia. BMJ Open 2017; 7: e015743.

16.

Abaynew

Hussien

A qualitative study on barriers to treatment and control of hypertension among patients at dessie referral hospital, Northeast Ethiopia, Ethiopia: healthcare workers’ perspective. Integr Blood Press Control 2021; 14: 173–178.

17.

Santschi

Chiolero

Burnand

, et al. Impact of pharmacist care in the management of cardiovascular disease risk factors a systematic review and meta-analysis of randomized trials. Arch Int Med 2011; 171: 1441–1453.

18.

Joshi

Pham

Deng

, et al. Cost-effectiveness of a pharmacist-led medication therapy management clinic for management of type 2 diabetes. J Am Pharm Assoc (2003) 2025; 65(1): 102253.

19.

Machado

Bajcar

Guzzo

, et al. Sensitivity of patient outcomes to pharmacist interventions. Part II: systematic review and meta-analysis in hypertension management. Ann Pharmacother 2007; 41(11): 1770–1781.

20.

Morgado

Rolo

Castelo-Branco

Pharmacist intervention program to enhance hypertension control: a randomised controlled trial. Int J Clin Pharm 2011; 33(1): 132–140.

21.

Nkansah

Mostovetsky

, et al. Effect of outpatient pharmacists’ non-dispensing roles on patient outcomes and prescribing patterns. Cochrane Database Syst Rev 2010; 2010(7): Cd000336.

22.

Surya

Angelica and Insani

WN.

Pharmacist-led digital health interventions to improve treatment outcomes in patients with hypertension–a systematic review. J Multidiscip Healthc 2025; 18: 5275–5287.

23.

Bulo

Woldu

Beyene

, et al. The impact of a medication therapy management service on the outcomes of hypertension treatment follow-up care in an Ethiopian tertiary hospital: a pre-post interventional study. Clin Med Insights Cardiol 2024; 18: 11795468241274720.

24.

Gil-Guillén

Orozco-Beltran

Pérez

, et al. Clinical inertia in diagnosis and treatment of hypertension in primary care: quantification and associated factors. Blood Press 2010; 19(1): 3–10.

25.

Arakawa

Imazu

Morinaga

, et al. Overcoming clinical inertia in the treatment of hypertension. Intern Med 2025; 64(3): 359–366.

26.

Kario

Okura

Hoshide

, et al. The WHO global report 2023 on hypertension warning the emerging hypertension burden in globe and its treatment strategy. Hypertension Res 2024; 47(5): 1099–1102.

27.

Murray

Aravkin

Zheng

, et al. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of disease study 2019. Lancet 2020; 396(10258): 1223–1249.

28.

Phillips

Branch

WT Cook

, et al. Clinical inertia. Ann Int Med 2001; 135(9): 825–834.

29.

McInnis

Fodor

Moy Lum-Kwong

, et al. Antihypertensive medication use and blood pressure control: a community-based cross-sectional survey (ON-BP). Am J Hypertens 2008; 21(11): 1210–1215.

30.

Berhe

Taxis

Haaijer-Ruskamp

, et al. Hypertension treatment practices and its determinants among ambulatory patients: retrospective cohort study in Ethiopia. BMJ Open 2017; 7(8): e015743.

31.

Santschi

Chiolero

Burnand

, et al. Impact of pharmacist care in the management of cardiovascular disease risk factors: a systematic review and meta-analysis of randomized trials. Arch Int Med 2011; 171(16): 1441–1453.

32.

Cheema

Sutcliffe

Singer

, The impact of interventions by pharmacists in community pharmacies on control of hypertension: a systematic review and meta-analysis of randomized controlled trials. Br J Clin Pharmacol 2014; 78(6): 1238–1247.

33.

Law

Morris

Wald

NJ.

Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 2009; 338: b1665.

34.

Gil-Guillén

Orozco-Beltrán

Márquez-Contreras

, et al. Is there a predictive profile for clinical inertia in hypertensive patients? An observational, cross-sectional, multicentre study. Drugs Aging 2011; 28(12): 981–992.

35.

Niriayo

Girmay

Tesfay

, et al. Therapeutic inertia and contributing factors among ambulatory patients with hypertension. BMC Cardiovasc Disord 2024; 24(1): 523.

36.

Montgomery

Harding

Fahey

Shared decision making in hypertension: the impact of patient preferences on treatment choice. Fam Pract 2001; 18(3): 309–313.

37.

Whelton

Carey

Aronow

, 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(6): e13–e115.

38.

Williams

Mancia

Spiering

, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J 2018; 39(33): 3021–3104.

39.

Unger

Borghi

Charchar

, et al. 2020 international society of hypertension global hypertension practice guidelines. Hypertension 2020; 75(6): 1334–1357.

40.

Burnier

Egan

BM.

Adherence in hypertension. Circ Res 2019; 124(7): 1124–1140.

41.

Vrijens

Antoniou

Burnier

, et al. Current situation of medication adherence in hypertension. Front Pharmacol 2017; 8: 100.

42.

Tesema

AG.

IMPROVING THE PREVENTION AND MANAGEMENT OF NON-COMMUNICABLE DISEASES IN ETHIOPIA. The George Institute for Global Health, University of New South Wales, Australia, https://knowledge-action-portalcom/en/news_and_events/country-stories/8901, 2024. 7.

43.

Chisholm-Burns

Lee

Spivey

, et al. US pharmacists’ effect as team members on patient care: systematic review and meta-analyses. Med Care 2010; 48(10): 923–933.

44.

Gessessew

Ab Barnabas

Prata

, et al. Task shifting and sharing in Tigray, Ethiopia, to achieve comprehensive emergency obstetric care. Int J Gynaecol Obstet 2011; 113(1): 28–31.

45.

Arikan

Özel

Aslan

, et al. Rapid AI-assisted Poincaré plot analysis for early detection of subclinical left ventricular dysfunction in hypertensive patients admitted to the emergency department: a prospective observational study. Cardiovasc J Afr 2025; 36: 491–498.

46.

Ardahanlı

Akhan

Aslan

, et al. The relationship between blood pressure regulation and alexithymia variability in newly diagnosed essential hypertension patients. J Surg Med 2021; 5(8): 768–771.

47.

Ardahanlı

An examination of alexithymia levels in pregnant women with and without gestational hypertension. Lokman Hekim Health Sci 2025; 53: 249–259.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.03 MB

0.00 MB