Pharmaceutical Care Program for Patients With Uncontrolled Hypertension. Report of a Double-Blind Clinical Trial With Ambulatory Blood Pressure Monitoring

Department of Drug Production and Control, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
American Journal of Hypertension (Impact Factor: 2.85). 06/2006; 19(5):528-33. DOI: 10.1016/j.amjhyper.2005.11.009
Source: PubMed


Pharmaceutical care programs may be an option to improve blood pressure (BP) control in patients with uncontrolled hypertension. The aim of this study was to evaluate the efficacy of pharmaceutical care programs in treating patients with resistant hypertension.
In a double-blind randomized clinical trial, 71 patients with uncontrolled BP were enrolled in a pharmaceutical care program or in a control group and underwent a series of cognitive tests. The primary outcome was change in ambulatory BP (ABP) between the baseline evaluation and the final visit 6 months later. The secondary outcomes were the frequency of drug-related problems and adherence as determined by plasma levels of hydrochlorothiazide.
The delta-values between the intervention and control groups for ABP in the different daily periods, with the corresponding 95% confidence limits, adjusted for age and baseline BP were: 3 (-1 to 5), 2 (-2 to 4), and 5 (-1 to 6) mm Hg for 24 h, daily and nightly systolic BP, respectively. The corresponding values for diastolic BP were 1 (-1 to 3), 0 (-2 to 2), and 3 (-1 to 4) mm Hg, respectively. Hydrochlorothiazide was detected in the plasma in 21 of 27 patients in the intervention group that attended to all appointments and 24 of 30 patients in the control group (P = .904).
The pharmaceutical care program tested in this trial was feasible and showed a trend for better BP control in patients with uncontrolled hypertension.

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    • " been conducted on Pharmaceutical Care within the Family Health Strategy initiative , making it difficult to compare the findings of the present study with others reported in the literature . The majority of previous studies on Pharmaceutical Care in hypertensive patients were conducted in outpatient clinics and community pharmacies ( Castro et al . , 2006 ; Lyra Jr et al . , 2008 ; Morgado et al . , 2011 ; Aguiar et al . , 2012 ) ."
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    ABSTRACT: The aim of Pharmaceutical Care programs is to improve patients' quality of life, and such programs are particularly effective in the case of chronic diseases such as hypertension. The objective of this longitudinal study was to analyze a Pharmaceutical Care model for hypertensive patients receiving care within the Family Health Strategy (FHS). All patients were being seen by an FHS team affiliated to a primary healthcare unit in Goiânia, Goiás, Brazil. Fourteen patients participated in the study, with each patient receiving six home visits during the Pharmaceutical Care. Overall, 142 drug-related problems were reported, the most common concerning the ineffectiveness of treatment (33.8%). A total of 135 pharmaceutical interventions were performed, 92.6% of which involved pharmacist-patient communication, with 48.8% of these interventions being implemented. Cardiovascular risk decreased in three patients and remained unchanged in nine. In hypertensive patients with diabetes, fasting glucose levels were reduced in six out of nine cases. The Pharmaceutical Care model proposed here was effective in detecting drug-related problems and in proposing interventions to resolve or prevent these problems. Consequently, this may have contributed towards improving clinical parameters, such as fasting glucose levels and cardiovascular risk in hypertensive patients receiving care within the FHS.
    Brazilian Journal of Pharmaceutical Science 07/2013; 49(3):609. DOI:10.1590/S1984-82502013000300023 · 0.26 Impact Factor
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    • "The conrtibution of ABPM in the assessment of treatment effectiveness, could be more prominent in the setting of RH, where it has been shown to possess a pivotal role in haemodynamic load evaluation [27]. Additionally, apart from just testing the efficacy of different drugs, ABPM has been used in the evaluation of the implementation of certain therapeutic strategies in resistant hypertensives by evaluating patients' compliance [28]. "
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    ABSTRACT: ABPM constitutes a valuable tool in the diagnosis of RH. The identification of white coat RH and masked hypertension (which may fulfill or not the definition of RH) is of great importance in the clinical management of such patients. Moreover, the various ABPM components such as average BP values, circadian BP variability patterns, and ambulatory BP-derived indices, such as ambulatory arterial stiffness index (AASI), add significantly to the risk stratification of RH. Lastly, ABPM may indicate the need for implementation of specific therapeutic strategies, such as chronotherapy, that is, administration-time dependent therapy, and the evaluation of their efficacy.
    04/2011; 2011:285612. DOI:10.4061/2011/285612
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    ABSTRACT: There are many underlining reasons for resistant hypertension. In many patients, however, the main reason is lack of adherence to treatment. There are few investigations about lack of adherence in patients with resistant hypertension, but mostly on adherence at all. Few strategies have shown efficacy to improve adherence. We have shown recently that pharmaceuti- cal care improves the control of blood pressure. It may be used together with other approaches to improve the control of blood pressure in patients with resistant hypertension.
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