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

ArticleinAmerican Journal of Hypertension 19(5):528-33 · June 2006with20 Reads
DOI: 10.1016/j.amjhyper.2005.11.009 · Source: PubMed
Abstract
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.
    • "A study by Silva et al. (2013) had a proportion of 1:14 (Silva et al., 2013). Most of the studies found involved more than a pharmacist (Castro et al., 2006; Chua et al., 2012; Simpson et al., 2011; Stewart et al., 2014). Ignorance and the lack of custom team to interact with the pharmacist may have influence on the abandonment of this study. "
    Article · Aug 2015
    • "p = 0.152) Magid et al, 2011 Hunt et al, 2008 Mourao et al, 2013 Zillich et al, 2005 Green et al, 2008 Morgado et al, 2001 Bogden et al, McKenney et al, 1973 Edelman Rothman et al, 2005 Sookaneknun et al, 2004 Santschi Chan et al, 2012 Magid et al, 2013 Subtotal (I-squared = 48.6%, p = 0.013) Al Mazroui et al, 2009 Less than once a month Mehos et al, 2000 Carter et al, 2008 Scott et al, 2006 Vivian et al, 2002 Carter et al, 2009 Irregularly or not specified Chiu et al, 2008 Simpson Taveira et al, 2010 Hennesy et al, 2006 Subtotal (I-squared = 66.9%, p = 0.001) Margolis et al, 2013 Kraemer et al, 2012 Clifford De Castro et al, 2006 Okamoto et al, 2001 Borenstein et al, 2003Figure 3. Forest plot of the mean difference in (A) systolic and (B) diastolic blood pressure with pharmacist care compared with usual care group according to frequency of intervention (once a month or more frequently, less than once a month, irregularly/not specified). n=number of participants. "
    [Show abstract] [Hide abstract] ABSTRACT: Control of blood pressure (BP) remains a major challenge in primary care. Innovative interventions to improve BP control are therefore needed. By updating and combining data from 2 previous systematic reviews, we assess the effect of pharmacist interventions on BP and identify potential determinants of heterogeneity. Randomized controlled trials (RCTs) assessing the effect of pharmacist interventions on BP among outpatients with or without diabetes were identified from MEDLINE, EMBASE, CINAHL, and CENTRAL databases. Weighted mean differences in BP were estimated using random effect models. Prediction intervals (PI) were computed to better express uncertainties in the effect estimates. Thirty-nine RCTs were included with 14 224 patients. Pharmacist interventions mainly included patient education, feedback to physician, and medication management. Compared with usual care, pharmacist interventions showed greater reduction in systolic BP (-7.6 mm Hg, 95% CI: -9.0 to -6.3; I(2)=67%) and diastolic BP (-3.9 mm Hg, 95% CI: -5.1 to -2.8; I(2)=83%). The 95% PI ranged from -13.9 to -1.4 mm Hg for systolic BP and from -9.9 to +2.0 mm Hg for diastolic BP. The effect tended to be larger if the intervention was led by the pharmacist and was done at least monthly. Pharmacist interventions - alone or in collaboration with other healthcare professionals - improved BP management. Nevertheless, pharmacist interventions had differential effects on BP, from very large to modest or no effect; and determinants of heterogeneity could not be identified. Determining the most efficient, cost-effective, and least time-consuming intervention should be addressed with further research.
    Full-text · Article · Mar 2014
    • " 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 ) ."
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Jul 2013
Show more