Pharmacotherapy 2018 01 13() doi 10.1002/phar.2083
The objectives of this study were to 1) determine if hypertensive patients with comorbid diabetes mellitus (DM) and/or chronic kidney disease (CKD) receiving a pharmacist intervention had a greater reduction in mean blood pressure (BP) and improved BP control at 9 months compared to those receiving usual care and 2) compare Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) guideline and 2014 guideline (JNC-8) BP control rates in patients with DM and/or CKD.
This cluster, randomized trial included 32 medical offices in 15 states. Clinical pharmacists made treatment recommendations to physicians at intervention sites. This post-hoc analysis evaluated mean BP and BP control rates in the intervention and control groups.
The study included 335 patients (227 intervention, 108 control) when mean BP and control rates were evaluated by JNC-7 inclusion and control criteria. When JNC-8 inclusion and control criteria were applied, 241 patients (165 intervention, 76 control) remained and were included in the analysis. The pharmacist-intervention group had significantly greater mean SBP reduction compared to usual care at 9 months (8.64 mm Hg [95% Confidence interval (CI)= -12.8, -4.49, p<0.001]). The pharmacist-intervention group had significantly higher BP control at 9 months than usual care by either the JNC-7 or JNC-8 inclusion and control groups (adjusted odds ratio (OR) 1.97 [95% CI= 1.01, 3.86]; p=0.0470 and 2.16 [95%CI= 1.21, 3.85]; p=0.0102, respectively). PRINCIPAL CONCLUSIONS
This study demonstrated that a physician-pharmacist collaborative intervention was effective in reducing mean systolic BP and improving BP control in patients with uncontrolled hypertension with DM and/or CKD, regardless of which BP guidelines were used. This article is protected by copyright. All rights reserved.