Format

Send to

Choose Destination
Pharmacotherapy. 2018 Mar;38(3):309-318. doi: 10.1002/phar.2083. Epub 2018 Feb 23.

Pharmacist Intervention for Blood Pressure Control in Patients with Diabetes and/or Chronic Kidney Disease.

Author information

1
Department of Pharmacy Practice & Science, College of Pharmacy, University of Iowa, Iowa City, Iowa.
2
Division of Health Outcomes and Pharmacy Practice, College of Pharmacy, University of Texas, Austin, Texas.
3
Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa.
4
Department of Pharmacy Practice, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas.
5
Northeast Iowa Medical Education Foundation, Waterloo, Iowa.
6
Department of Family and Community Medicine, The University of Texas Health Sciences Center at San Antonio, San Antonio, Texas.
7
UNC Eshelman School of Pharmacy and the Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
8
Wisconsin Research and Education Network, University of Wisconsin, Madison, Wisconsin.
9
Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa.

Abstract

OBJECTIVES:

The objectives of this study were to 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 with those receiving usual care; and 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.

METHODS:

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.

MAIN RESULTS:

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 systolic blood pressure reduction compared with usual care at 9 months (8.64 mm Hg; 95% confidence interval [CI] -12.8 to -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 OR 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.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00935077.

KEYWORDS:

chronic kidney disease; diabetes; hypertension; team-based care

PMID:
29331037
PMCID:
PMC5867244
DOI:
10.1002/phar.2083
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Wiley Icon for PubMed Central
Loading ...
Support Center