Abstract

Hypertension is an increasingly common health problem that affects more than 1 billion people throughout the world. Antihypertensive drugs are the current pharmacotherapy of choice, however uncontrolled blood pressure (BP) accounts for 7.1 million deaths worldwide each year. Little is known about the efficacy of clinical pharmacist’s pharmaceutical care on BP control and medication adherence. The aim of this study was to describe if pharmaceutical care could improve antihypertensive medication adherence and BP control, especially by clinical pharmacists recommendations. This report evaluates the clinical pharmacist interventions during a prospective randomized controlled trial. Out patients with essential hypertension were enrolled in a bimestrial follow-up during 6-month period study; patients were randomly allocated either intervention group (IG) or to control group (CG). Pharmacist interventions involved recommendations to physicians, educational and counseling directly to the patient. The main outcome measure for this analysis was the measure of systolic blood pressure (SBP), diastolic blood pressure (DBP), BP control and medication adherence using a validated questionnaire assessed at the baseline visit and the end of pharmaceutical care. Data from 278 patients were included and analyzed (139 in CG and 139 in IG). There were no significant differences (P < 0.05) in both groups at the baseline. Changes in drug therapy were recommended 192 times for IG patients, the majority of these, involved adding a new antihypertensive drug (42.7%); the largest numbers of pharmacist recommendations (39.6%) were made at the baseline visit. At the end, BP was controlled among significant patients more in IG (76.4%) than in CG (50.6%) (P = 0.0000). Significant lower SBP (-8.5 mmHg, P = 0.0001) and DBP (-4.7 mmHg, P = 0.0013) levels were observed in IG. Low medication adherence, there was also significantly difference between two groups at the end (24.8% versus 41.7%, P = 0.0014). Clinical pharmacist recommendations for alterations in pharmacotherapy intervention can significantly improve medication adherence and BP control in patients with hypertension. Clinical pharmacist recommendations can complement physicians in the management of hypertensive patients. Pharmacist interventions are effective in improving anti-hypertensive medication adherence and reducing systolic and diastolic blood pressure. Pharmacists can effectively participate in health education and promotion to improve blood pressure control.

Key words: Blood pressure, clinical pharmacist, hypertension, clinical pharmacy, medication adherence, pharmaceutical care.