Key result
Pharmacist prescribing reduces systolic BP by ~7 mm Hg at 6 months versus usual care.
Why the study?
Hypertension control rates remain suboptimal, and pharmacists' evolving scope of practice and community position may be ideal for improving hypertension care.
Does pharmacist prescribing and management reduce systolic blood pressure in community-dwelling adults with above-target blood pressure?
RCT (n=248)
patient-level
Yes
Does pharmacist prescribing and management reduce systolic blood pressure in community-dwelling adults with above-target blood pressure?
Pharmacist-led prescribing and management of hypertension significantly improves blood pressure control compared to usual care in community-dwelling patients.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“This proves that pharmacist independent prescribing improves the care of patients with hypertension. As the leading cause of preventable death and disability worldwide, this has important public health implications.”
“With a condition like high blood pressure, the treatment is virtually all about drugs-which is a field of medicine that pharmacists excel in. This work shows there is a real opportunity to better utilize pharmacists in our health-care system.”
“Hypertension is a leading risk for death and disability. This research provides an opportunity to take a major step forward to prevent premature death and disability through innovative interdisciplinary collaboration, providing care in the places convenient to Canadians.”
Supports pharmacist prescribing in community hypertension care; extends RCT evidence for collaborative BP management.
BACKGROUND: Hypertension control rates remain suboptimal. Pharmacists' scope of practice is evolving, and their position in the community may be ideal for improving hypertension care. We aimed to study the impact of pharmacist prescribing on blood pressure (BP) control in community-dwelling patients. METHODS AND RESULTS: We designed a patient-level, randomized, controlled trial, enrolling adults with above-target BP (as defined by Canadian guidelines) through community pharmacies, hospitals, or primary care teams in 23 communities in Alberta. Intervention group patients received an assessment of BP and cardiovascular risk, education on hypertension, prescribing of antihypertensive medications, laboratory monitoring, and monthly follow-up visits for 6 months (all by their pharmacist). Control group patients received a wallet card for BP recording, written hypertension information, and usual care from their pharmacist and physician. Primary outcome was the change in systolic BP at 6 months. A total of 248 patients (mean age, 64 years; 49% male) were enrolled. Baseline mean±SD systolic/diastolic BP was 150±14/84±11 mm Hg. The intervention group had a mean±SE reduction in systolic BP at 6 months of 18.3±1.2 compared with 11.8±1.9 mm Hg in the control group, an adjusted difference of 6.6±1.9 mm Hg (P=0.0006). The adjusted odds of patients achieving BP targets was 2.32 (95% confidence interval, 1.17-4.15 in favor of the intervention). CONCLUSIONS: Pharmacist prescribing for patients with hypertension resulted in a clinically important and statistically significant reduction in BP. Policy makers should consider an expanded role for pharmacists, including prescribing, to address the burden of hypertension. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00878566.
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Tsuyuki et al. (2015) conducted an RCT in Hypertension (n=248). Pharmacist prescribing vs. Usual care was evaluated on Change in systolic BP at 6 months (MD 6.6, p=0.0006). Pharmacist prescribing for patients with hypertension significantly reduced systolic blood pressure at 6 months compared with usual care (adjusted difference 6.6 mm Hg; P=0.0006).
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