Document Detail


Pharmacist-physician comanagement of hypertension and reduction in 24-hour ambulatory blood pressures.
MedLine Citation:
PMID:  20937921     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Pharmacist-physician comanagement of hypertension has been shown to improve office blood pressures (BPs). We sought to describe the effect of such a model on 24-hour ambulatory BPs.
METHODS: We performed a prospective, cluster-randomized, controlled clinical trial, enrolling 179 patients with uncontrolled hypertension from 5 primary care clinics in Iowa City, Iowa. Patients were randomized by clinic to receive pharmacist-physician collaborative management of hypertension (intervention) or usual care (control) for a 9-month period. In the intervention group, pharmacists helped patients to identify barriers to BP control, counseled on lifestyle and dietary modifications, and adjusted antihypertensive therapy in collaboration with the patients' primary care providers. Patients were seen by pharmacists a minimum of every 2 months. Ambulatory BP was measured at baseline and at study end.
RESULTS: Baseline and end-of-study ambulatory BP profiles were evaluated for 175 patients. Mean (SD) ambulatory systolic BPs (SBPs), reported in millimeters of mercury, were reduced more in the intervention group than in the control group: daytime change in (Δ) SBP, 15.2 (11.5) vs 5.5 (13.5) (P < .001); nighttime ΔSBP, 12.2 (14.8) vs 3.4 (13.3) (P < .001); and 24-hour ΔSBP, 14.1 (11.3) vs 5.5 (12.5) (P < .001). More patients in the intervention group than in the control group had their BP controlled at the end of the study (75.0% vs 50.7%) (P < .001), as defined by overall 24-hour ambulatory BP monitoring.
CONCLUSION: Pharmacist-physician collaborative management of hypertension achieved consistent and significantly greater reduction in 24-hour BP and a high rate of BP control. Trial Registration  clinicaltrials.gov Identifier: NCT00201045.
Authors:
Cynthia A Weber; Michael E Ernst; Genesis S Sezate; Shimin Zheng; Barry L Carter
Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Archives of internal medicine     Volume:  170     ISSN:  1538-3679     ISO Abbreviation:  Arch. Intern. Med.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-12     Completed Date:  2010-11-15     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  0372440     Medline TA:  Arch Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1634-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Pharmacy Practice and Science, The University of Iowa, Iowa City, 52242, USA.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00201045
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MeSH Terms
Descriptor/Qualifier:
Antihypertensive Agents / therapeutic use*
Blood Pressure / drug effects*
Blood Pressure Monitoring, Ambulatory*
Circadian Rhythm*
Female
Humans
Hypertension / drug therapy*
Interdisciplinary Communication*
Iowa
Male
Middle Aged
Pharmacists*
Physicians*
Prospective Studies
Treatment Outcome
Grant Support
ID/Acronym/Agency:
1 R01 HL069801-01A1/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Antihypertensive Agents
Comments/Corrections
Comment In:
Ann Intern Med. 2011 Feb 15;154(4):JC2-9   [PMID:  21320936 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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