Pharmacist intervention significantly increased the achievement of target blood pressure compared to non-intervention in patients with chronic kidney disease (OR 1.53).
Meta-Analysis (n=2,573)
Does pharmacist intervention improve the achievement of blood pressure goals in adult patients with chronic kidney disease and uncontrolled hypertension?
Pharmacist interventions, particularly when combined with home-based blood pressure telemonitoring, significantly improve blood pressure control in patients with chronic kidney disease.
Effect estimate: OR 1.53 (95% CI 1.15-2.04)
p-value: p=<0.01
WHAT IS KNOWN AND OBJECTIVE: Hypertension (HTN) and chronic kidney disease (CKD) are recognized as silent killers because they are asymptomatic conditions that contribute to the burden of multiple comorbidities. The achievement of a blood pressure (BP) goal can dramatically reduce the risks of CKD. In this study, we aimed to assess the effectiveness of pharmacist intervention on BP control in patients with CKD and evaluate the usefulness of home-based BP telemonitoring. METHODS: The terms "chronic kidney disease," "pharmacist," "BP" and "randomized controlled trial (RCT)" were used five databases to search for information regarding pharmacist intervention on BP control in patients with CKD. The inclusion criteria were as follows: (a) studies for adult patients with uncontrolled HTN and (b) studies with adequate data for meta-analysis. The primary outcome was an evaluation of achievement of BP goal in patients with CKD. The secondary outcome was usefulness of home-based BP telemonitoring by pharmacists in patients with CKD. RESULTS AND DISCUSSION: Six RCTs were identified and included in the meta-analysis with a total of 2573 patients (mean age 66.0 years and 63.9% male). Pharmacist interventions resulted in significantly better BP control vs usual care (OR = 1.53, 95% CI = 1.15-2.04, P < .01). Pharmacist interventions using home-based BP telemonitoring were significantly superior to control/usual care (OR = 2.03, 95% CI = 1.49-2.77, P < .01), whereas pharmacist interventions without home-based BP telemonitoring did not significantly improve BP control compared to that with control/usual care (OR = 1.30, 95% CI = 0.97-1.75, P = .08). Home-based BP telemonitoring supported team-based care for HTN in these studies. In addition, patient self-monitoring with telemedicine devices might enhance patients' abilities to manage their condition by pharmacist instruction. WHAT IS NEW AND CONCLUSION: The findings of this meta-analysis showed that pharmacist interventions with home-based BP telemonitoring improve BP control among adult patients with CKD.
Nakanishi et al. (Sat,) conducted a meta-analysis in Chronic kidney disease with uncontrolled hypertension (n=2,573). Pharmacist intervention vs. Non-intervention (usual care) was evaluated on Achievement of target blood pressure (OR 1.53, 95% CI 1.15-2.04, p=<0.01). Pharmacist intervention significantly increased the achievement of target blood pressure compared to non-intervention in patients with chronic kidney disease (OR 1.53).