Pharmacy World & Science

, Volume 31, Issue 3, pp 406–412 | Cite as

Relationship between cardiovascular risk factors and high blood pressure by community pharmacists in Spain

  • Sebastián R. Martínez PérezEmail author
  • Pedro D. Armando
  • Andrea C. Molina Guerra
  • Mercé Martí Pallarés
  • Fernando Martínez Martínez
Research Article


Objectives The aim of this study is to determine the influence that different risk factors (age, gender, obesity, smoking, inactivity, diabetes mellitus and previous diagnosis of arterial hypertension) have on arterial pressure, and to determine the prevalence of patients that have high blood pressure and hypertension but have not received drug-treatment for arterial hypertension. Setting 42 Spanish community pharmacies. Method Observational and descriptive study. Patients included in the study were over 18 years of age, not receiving pharmacological treatment for arterial hypertension and not pregnant. Two measurements of arterial pressure were taken from each patient on the first day of the study and two other measurements on a later day. The average of these four measurements was taken as the arterial pressure value for the patient. All measurements were taken in the participating community pharmacies, always by the pharmacist and following the same protocols. The measurements were noted in the patients’ records along with data about the seven risk factors being studied, allowing them to be related with the patient’s arterial pressure value. Results The number of patients invited to join the study was 3,760, of whom 2,574 agreed to participate, with 2,094 completing the study. It was found that an increase in the number of risk factors led to a corresponding rise in the percentage of patients with high blood pressure and arterial hypertension. The risk of having arterial hypertension was 4.23 times higher in patients aged 65 years and over. It was also 2.88 times greater in those who had been previously diagnosed with arterial hypertension, 2.79 times higher in overweight or obese patients, 2.69 times more in diabetics and 2.22 times higher in men compared with in women. Prevalence of high blood pressure in patients not receiving pharmacological treatment for arterial hypertension was 33.6%, and prevalence of arterial hypertension was 22.8%. Conclusions Of the people studied, 22.8% had arterial hypertension. For the risk factors identified, those most related to the presence of arterial hypertension were, in descending order: being 65 years old or over, previous diagnosis of arterial hypertension, being overweight or obese, being diabetic and being male.


Age Community pharmacy Diabetes Gender Hypertension Obesity Prevalence Risk factor Spain 



The authors are grateful to the community pharmacists at the 43 Spanish pharmacies who participated in this study and would also like to thank the communication media (magazines and periodicals), official colleges of pharmacists, pharmaceutical cooperatives and professional associations of pharmacists that collaborated in publishing this study and provided free use of their facilities. The authors would also like to thank Mr. Daniel Ross for revision of the manuscript.


The authors declare that no funding of any kind has been received for this study.

Conflicts of interests

The authors declare no conflicts of interest or financial interest in any product or service mentioned in this article.


  1. 1.
    Moser M. Management of hypertension, part I. Am Fam Physician. 1996;53(7):2295–302.PubMedGoogle Scholar
  2. 2.
    Guidelines Committee. Guidelines for the management of arterial hypertension. The task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007;25:1105–87. doi: 10.1097/HJH.0b013e3281fc975a.CrossRefGoogle Scholar
  3. 3.
    Guidelines Committee. European society of hypertension––European society of cardiology guidelines for the management of arterial hypertension. J Hypertens. 2003;21(6):1011–53. doi: 10.1097/00004872-200306000-00001.CrossRefGoogle Scholar
  4. 4.
    Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289(19):2560–72. doi: 10.1001/jama.289.19.2560.
  5. 5.
    Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The Six Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 6 report. Arch Intern Med. 1997;157:2413–46. doi: 10.1001/archinte.157.21.2413.
  6. 6.
    Guidelines Sub-Committee. World Health Organization (WHO)/International society of hypertension (ISH) statement on management of hypertension. J Hypertens. 2003;21(11):1983–92. doi: 10.1097/00004872-200311000-00002.CrossRefGoogle Scholar
  7. 7.
    Williams B, et al. Guidelines for management of hypertension: report of the fourth working party of the British hypertension society, 2004––BHS IV. J Human Hypertens. 2004; 18(3): 139–85.Google Scholar
  8. 8.
    Marín R, de la Sierra A, Armario P, Campo C, Banegas JR, Gorostidi M. Guía sobre el diagnóstico y tratamiento de la hipertensión arterial en España 2005. Med Clin (Barc). 2005;125(1):36–46. doi: 10.1157/13076404. Guidelines on the diagnosis and treatment of arterial hypertension in Spain 2005.CrossRefGoogle Scholar
  9. 9.
    De Backer G, Ambrosioni E, Borch-Johnsen K, Brotons C, Cifkova R, Dallongeville J, et al. European guidelines on cardiovascular disease prevention in clinical practice. Third joint task force of European and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of eight societies and by invited experts). Eur Heart J. 2003; 24: 1601–10.Google Scholar
  10. 10.
    Williams B, Poulter NR, Brown MJ, Davis M, McInnes GT, Potter JF, et al. BHS guidelines working party, for the British Hypertension Society. British Hypertension Society guidelines for hypertension management 2004 (BHS-IV): summary. BMJ. 2004; 328: 634–40.Google Scholar
  11. 11.
    Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al. American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Kidney disease as a risk factor for development of cardiovascular disease. A statement from the American Heart Association Councils on Kidney in cardiovascular disease, high blood pressure research, clinical cardiology, and epidemiology and prevention. Circulation. 2003; 108: 2154–69.Google Scholar
  12. 12.
    American Diabetes Association. Position statement. Hypertension management in adults with diabetes. Diabetes Care. 2004;27(Suppl 1):65–67. doi: 10.2337/diacare.27.2007.S65.Google Scholar
  13. 13.
    Gired X, Mourad JJ, Vaïsse B, Poncelet P, Mallion JM, Herpin D. Estimation du nombre des sujets traités pour une HTA, una diabète ou une hyperlipidémie en France: étude FLASH 2002. Arch Mal Coeur. 2003;96:750–3. Estimation of the number of subjects treated for ATH, diabetes, or hyperlipidemia in France: FLAHS study 2002.Google Scholar
  14. 14.
    Banegas JR, Rodríguez-Artalejo F, Ruilope LM, Graciani A, Luque M, de la Cruz-Troca JJ, et al. Hypertension magnitude and management in the elderly population of Spain. J Hypertens. 2002;20:2157–64.PubMedCrossRefGoogle Scholar
  15. 15.
    Banegas JR, Segura J, Ruilope LM, Luque M, García-Robles R, Campo C, et al. Blood pressure control and physician management of hypertension in hospital hypertension units in Spain. Hypertension. 2004;43:1338–44. doi: 10.1161/01.HYP.0000127424.59774.84.PubMedCrossRefGoogle Scholar
  16. 16.
    Banegas JR, Rodríguez Artalejo F. El problema de la hipertensión arterial en España. Rev Clin Esp. 2002;202:12–5. The problem of hypertension in Spain.Google Scholar
  17. 17.
    De la Figuera M, Arnau JM, Brotons C. Hipertensión arterial en Atención Primaria. [Arterial hypertension in primary care]. Badalona: Euromedice; 2002. ISBN 84-931353-0-5.Google Scholar
  18. 18.
    Whelton PK. Hypertension epidemiology. Lancet. 1994;344:101–6. doi: 10.1016/S0140-6736(94)91285-8.PubMedCrossRefGoogle Scholar
  19. 19.
    Lloyd-Jones DM, Larson MG, Leip EP, Beiser A, D′Agostino RB, Kannel WB, et al. Lifetime risk for developing congestive heart failure The Framingham heart study. Circulation. 2002;106:1–5.CrossRefGoogle Scholar
  20. 20.
    Mataix J, García torres L. Hipertensión arterial. [Arterial hypertension]. En: Mataix J. Nutrición y alimentación humana. [Nutricion and human alimentation]. Madrid: Ergon; 2002. ISBN 84-8473-088-3.Google Scholar
  21. 21.
    Mayo Nápoles J, Pila Pérez R, Hernández Mandado P, Pila Peláez R, Guerra Rodríguez C. Hipertensión arterial en el joven: factores de riesgo. Rev Med Uruguay. 2000;16:24–30. Arterial hypertension in the young: risk factors.Google Scholar
  22. 22.
    Zillich AJ, Sutherland JM, Kumbera PA, Carter BL. Hypertension outcomes through blood pressure monitoring and evaluation by pharmacists (HOME study). J Gen Intern Med. 2005;20:1091–6. doi: 10.1111/j.1525-1497.2005.0226.x.PubMedCrossRefGoogle Scholar
  23. 23.
    Machado M, Bajcar J, Guzzo GC, Einarson TR. Sensitivity of patient outcomes to pharmacist interventions part II: systematic review and meta-analysis in hypertension management. Ann Pharmacother. 2007;41(11):1770–81. doi: 10.1345/aph.1K311.PubMedCrossRefGoogle Scholar
  24. 24.
    Oparah AC, Adje DU, Enato EF. Outcomes of pharmaceutical care intervention to hypertensive patients in a Nigerian community pharmacy. Int J Pharm Pract. 2006;14(2):115–22. doi: 10.1211/ijpp.14.2.0005.CrossRefGoogle Scholar
  25. 25.
    Mason JD, Colley CA. Effectiveness of an ambulatory care clinical pharmacist: a controlled trial. Ann Pharmacother. 1993;27:555–8.PubMedGoogle Scholar
  26. 26.
    Lobas NH, Lepinski PW, Abramowitz PW. Effects of pharmaceutical care on medication cost and quality of patient care in an ambulatory-care clinic. Am J Hosp Pharm. 1992;49:1681–8.PubMedGoogle Scholar
  27. 27.
    Expert Panel on the Identification. Evaluation, and treatment of overweight and obesity in adults. Executive summary of the clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults; Executive summary. Am J Clin Nutr. 1998;68:899–917.Google Scholar
  28. 28.
    Consenso SEEDO’2000 para la evaluación del sobrepeso y la obesidad y el establecimiento de criterios de intervención terapéutica. Sociedad Española para el Estudio de la Obesidad (SEEDO). Med Clin (Barc). 2000;115:587–97. Consensus SEEDO’2000 for the evaluation of overweight and obese people, and the establishment of therapeutic intervention. Spanish Society for the Study of Obesity (SEEDO).Google Scholar
  29. 29.
    McAlister FA, Straus SE. Evidence based treatment of hypertension: measurement of blood pressure an evidence based review. BMJ. 2001;322:908–11. doi: 10.1136/bmj.322.7291.908.PubMedCrossRefGoogle Scholar
  30. 30.
    O’Brien E, Waeber B, Parati G, Staessen J, Myers MG. Blood pressure measuring devices: recommendations of the European Society of Hypertension. BMJ. 2001;322:531–6. doi: 10.1136/bmj.322.7285.531.PubMedCrossRefGoogle Scholar
  31. 31.
    Martínez Pérez SR, Sánchez Alonso FJ, Baena Parejo MI. Efectos de la intervención farmacéutica en pacientes con presión arterial elevada sin tratamiento farmacológico. Seguim Farmacoter. 2004;2(3):181–8. Effects of pharmaceutical intervention in patients with high blood pressure without pharmacological treatment.Google Scholar
  32. 32.
    Carrión Valero L, Carballo Herencia JA, Divisón Garrote JA, Massó Orozco J, Artigao Rodenas LM, Sanchís Domenech C, et al. La oficina de farmacia puede mejorar el grado de conocimiento de la hipertensión arterial. Hipertension. 2002;19(7):299–304. Community pharmacies could improve awareness on arterial hypertension.Google Scholar
  33. 33.
    Velázquez MO, Lara EA, Martínez MMY, Márquez FF. La detección integrada como un instrumento para vincular la prevención primaria, el tratamiento temprano y la vigilancia epidemiológica en diabetes e hipertensión arterial. Rev Endocrinol Nutr. 2000;8(4):129–35. Detection integrated as an instrument linked to primary care, early treatment and epidemiological vigilance in diabetes and arterial hypertension.Google Scholar
  34. 34.
    Martínez Pérez SR, Sánchez Alonso FJ. Determinación de factores de riesgo en pacientes con diferentes valores de presión arterial. Pharm Care Esp. 2006;8(5):200–8. Determination of risk factors en patients with different values of arterial pressure.Google Scholar
  35. 35.
    Erthun WO, Agbani EO, Bolaji EE. Positive benefits of a pharmacist-managed hypertension clinic in Nigeria. Public Health. 2005;119(9):792–8. doi: 10.1016/j.puhe.2004.11.009.CrossRefGoogle Scholar
  36. 36.
    Hourihan F, Krass I, Chen T. Rural community pharmacy: a feasible site for a health promotion and screening service for cardiovascular risk factors. Aust J Rural Health. 2003;11(1):28–35. doi: 10.1046/j.1440-1584.2003.00468.x.PubMedCrossRefGoogle Scholar
  37. 37.
    Carter BL, Elliot WJ. Role of pharmacist in the detection, management, and control of hypertension: national call to action. Pharmacotherapy. 2000;20(2):119–22. doi: 10.1592/phco. Scholar
  38. 38.
    Borenstein JE, Graber G, Saltiel E, Wallace J, Ryu S, Archi J, et al. Physician-pharmacist comanagement of hypertension: a randomized, comparative trial. Pharmacotherapy. 2003;23(2):209–16. doi: 10.1592/phco. Scholar
  39. 39.
    Zillich AJ, Milchak JL, Carter BL, Doucette WR. Utility of a questionnaire to measure physician-pharmacist collaborative relationships. J Am Pharm Assoc. 2006;46(4):453–8. doi: 10.1331/154434506778073592.CrossRefGoogle Scholar
  40. 40.
    Park JJ, Nelly P, Carter BL, Burgess PP. Comprehensive pharmaceutical care in the chain setting: drug therapy monitoring and counselling by pharmacists contributed to improved blood pressure control in study patients. J Am Pharm Assoc. 1996;36:443–51.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  • Sebastián R. Martínez Pérez
    • 1
    Email author
  • Pedro D. Armando
    • 2
  • Andrea C. Molina Guerra
    • 1
  • Mercé Martí Pallarés
    • 3
  • Fernando Martínez Martínez
    • 4
  1. 1.Farmacia Ldo. Sebastián R. Martínez PérezGranadaEspaña
  2. 2.Pharmacology DepartmentFaculty of Chemical Sciences, National University of CórdobaHaya de la Torre y Medina Allende s/n, Ciudad UniversitariaArgentina
  3. 3.Pharmaceutical Care Foundation of Spainentlo 2ª 08037 BarcelonaEspaña
  4. 4.Pharmaceutical Care Research GroupFaculty of Pharmacy, University of GranadaGranadaEspaña

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