Pharmacist-Physician Comanagement of Hypertension and Reduction in 24-Hour Ambulatory Blood Pressures

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 (Delta) SBP, 15.2 (11.5) vs 5.5 (13.5) (P <.001); nighttime Delta SBP, 12.2 (14.8) vs 3.4 (13.3) (P<.001); and 24-hour Delta SBP, 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.