Brett D. Montgomery, MBBS, DCH, FRACGP
In patients with uncontrolled hypertension, does a pharmacist–physician collaborative model of hypertension management improve 24-hour ambulatory blood pressure (BP)?
Cluster-randomized controlled trial (Collaborative Management of Hypertension Study). Clinicaltrials.gov NCT00201045.
Treatment assignment was unblinded, but physicians and pharmacists in the comanagement group were blinded to 24-hour BP results.†
5 primary care clinics in the Iowa City area.
179 patients 21 to 85 years of age (mean age 61 y, 56% women, 25% had diabetes, 91% white, mean body mass index 32, mean systolic BP 152 mm Hg, mean diastolic BP 85 mm Hg) who had uncontrolled hypertension (patients without diabetes: 145 to 179 mm Hg systolic or 95 to 109 mm Hg diastolic; patients with diabetes: 135 to 179 mm Hg systolic or 85 to 109 mm Hg diastolic) and were receiving 0 to 3 antihypertensive agents with no changes to their regimen in the previous 4 weeks. Exclusion criteria were serious renal or hepatic disease, recent myocardial infarction or stroke, unstable angina, or congestive heart failure (New York Heart Association class III or IV).
Pharmacist–physician hypertension comanagement (n = 101) or usual care (n = 78). Comanagement involved review of patient data and interviews with patients by pharmacists who considered patient factors that might impede achieving target BP and compared patient treatment strategies with clinical guidelines. Pharmacists discussed patient-specific treatment recommendations with physicians, who could adjust medications as needed. The control group received usual care. Physicians in both groups received patients’ clinic BPs from study visits at baseline and 2, 4, 6, 8, and 9 months.
24-hour ambulatory systolic and diastolic BP. BP was measured every 20 minutes during the day (6 am to 10 pm) and every 30 minutes at night (10 pm to 6 am) (SpaceLabs 90217A, SpaceLabs Medical, Washington).
Comanagement reduced systolic and diastolic BP more than usual care (Table). Physicians in the comanagement group accepted and implemented 96% of pharmacists’ recommendations.
In patients with uncontrolled hypertension, a pharmacist–physician collaborative model of hypertension management improved 24-hour ambulatory blood pressure more than usual care.
Pharmacist–physician hypertension comanagement vs usual care in uncontrolled hypertension‡
‡CI defined in Glossary.
§24-h ambulatory blood pressure. Data for 156 patients who completed the 9-mo assessment.
Montgomery BD. Pharmacist–physician hypertension comanagement reduced 24-hour ambulatory blood pressure. Ann Intern Med. ;154:JC2–9. doi: 10.7326/0003-4819-154-4-201102150-02009
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Published: Ann Intern Med. 2011;154(4):JC2-9.
Cardiology, Coronary Risk Factors, Hypertension, Nephrology.
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