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Pharmacist interventions to improve blood pressure control in primary care: a cluster randomised trial

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Abstract

Background

High blood pressure (BP) is the single largest contributor to mortality world-wide.

Aim

To investigate the effectiveness of a pharmacists-led intervention to improve BP control using automated office blood pressure (AOBP).

Method

In this prospective parallel group, unblinded, cluster-randomised trial, 54 pharmacies enrolled pre-treated patients with uncontrolled AOBP above 135/85 mmHg. In the interventional group, pharmacists referred patients to the treating physician for therapy intensification in a structured fashion. In the control group, AOBP was recorded until the end of the trial. The primary endpoint was the proportion of patients achieving BP control at the threshold of 135/85 mmHg after 10 weeks. Key secondary endpoints were systolic AOBP reductions after 10 and 20 weeks.

Results

A total of 497 patients were included between 2017 and 2019. In the interventional and control group, 61.5% and 19.8% of patients underwent a therapy modification within 20 weeks. The primary endpoint was achieved in 38.8% in the interventional group and 31.2% in the control group (mean difference 7.6%, 95% CI −8.1; 23.3, p = 0.336). Mean systolic AOBP reductions were greater in the interventional vs. control group at 10 and 20 weeks (14.3 ± 7.4 vs. 6.9 ± 7.0 mmHg, mean difference 7.3 mmHg, 95% CI 3.2;11.5, p < 0.001, and 15.5 ± 9.0 vs. 9.8 ± 7.5 mmHg, mean difference 5.8 mmHg, 95% CI 0.8;10.7, p = 0.023). Atrial fibrillation was newly detected in 7.8% of patients.

Conclusion

Through a pragmatic pharmacist-led disease management program, BP control was improved over time, without significant differences between groups. Greater systolic AOBP reductions were observed in the interventional vs. control group. (Pharmacists Intervention to Improve Hypertension Management in Primary Care:APOTHECARE; ClinicalTrials.gov registration NCT03274531).

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Acknowledgements

We would like to acknowledge the Pharmacists College of Austria (Apothekerkammer Zentrale), Mag. Elisabeth Biermeier of the Pharmacists College of Lower Austria, Assoc. Prof. DDr. Philipp Saiko of the Pharmacists College of Vienna, the Health Insurance Fund of Lower Austria (NÖGUS) as well as all participating pharmacists in Lower Austria and Vienna, who willingly supported our research.

Funding

The work was supported by the Pharmacists College of Lower Austria (Apothekerkammer Niederösterreich) and the Health Insurance Fund of Lower Austria (NÖGUS).

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Authors and Affiliations

  1. 3rd Medical Department, Cardiology, Wilhelminenhospital (Klinik Ottakring), Vienna, Austria

    Miklos Rohla & Kurt Huber

  2. Pharmacists College of Lower Austria, Vienna, Austria

    Heinz Haberfeld

  3. Institute for Cardiometabolic Diseases, Karl Landsteiner Society, St. Pölten, Austria

    Miklos Rohla, Maximilian Tscharre & Thomas W. Weiss

  4. Department of Internal Medicine, Cardiology and Nephrology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria

    Maximilian Tscharre

  5. Medical School, Sigmund Freud University, Vienna, Austria

    Kurt Huber & Thomas W. Weiss

  6. 3rd Medical Department, University Hospital St Poelten, Lower Austria, Austria

    Thomas W. Weiss

  7. Department of Cardiology, Bern University Hospital, Bern, Switzerland

    Miklos Rohla

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  1. Miklos Rohla
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Corresponding author

Correspondence to Miklos Rohla.

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Conflicts of interest

MR received speaker and advisory fees from Daiichi Sankyo, Sanofi Aventis and COR2ED outside the submitted work. HH and MT report no conflicts of interest. KH received lecturing fees and advisory honoraria from Boehringer Ingelheim, Pfizer/BMS, Bayer, Daiichi Sankyo, Sanofi-Aventis, AstraZeneca, and Eli Lilly outside the submitted work. TWW received lecturing fees and advisory honoraria from Daiichi Sankyo, Boehringer Ingelheim and Pfizer/BMS outside the submitted work.

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Rohla, M., Haberfeld, H., Tscharre, M. et al. Pharmacist interventions to improve blood pressure control in primary care: a cluster randomised trial. Int J Clin Pharm 45, 126–136 (2023). https://doi.org/10.1007/s11096-022-01452-1

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  • DOI: https://doi.org/10.1007/s11096-022-01452-1

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