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The Pharmaceutical Journal Vol 265 No 7114 September 16, 2000
Pharmacy Practice Research
Papers presented at the British Pharmaceutical Conference, Birmingham, September 10 to 13, 2000 pR5

Impact of a practice pharmacist on patients taking antihypertensive medication

By J. M. Thomas* and R. Walker

Introduction The reduction of elevated blood pressure has been shown to reduce the risk of cardiovascular mortality and morbidity.1 While there is considerable evidence for the benefit of drug treatment in reducing blood pressure,2 it is unclear whether the provision of additional, practice-based support by a pharmacist can bring about improved outcomes. The present study was therefore undertaken to determine the effect of a practice pharmacist on blood pressure control in patients attending a hypertension clinic.

Method Individuals from one medical practice aged 45 to 64 years with a diagnosis of hypertension and receiving antihypertensive medication were eligible for the study. Patients were randomly allocated to receive normal or additional care and followed up over 12 months.
At the outset all patients attended the hypertension clinic to have their blood pressure (BP) measured and were referred to the practice pharmacist (JMT) for confirmation of their current medication. The normal care group received no counselling or contact with the pharmacist for 12 months. The additional care group were counselled by the pharmacist.
After three months, patients in the additional care group were recalled for measurement of their BP and further counselling by the pharmacist. A computerised Dundee risk score was used to explain the effect of changes in BP, cholesterol and smoking habits on coronary heart disease risk. Patients were also given an information pack.
At six months, the additional care group were sent an audio tape and leaflets on high BP, and at nine months they received further support material. At 12 months, all patients returned to the clinic to have their BP measured.
Throughout the study BP was measured by a practice nurse blind to previous measurements. Results were analysed on an intention to treat basis using SPSS version 6.1 and Student's t test for matched samples. All results are expressed as mean + standard deviation.

Focal points

  • This study investigated whether provision of additional support by a practice pharmacist could improve blood pressure control in patients with hypertension
  • Over a 12-month period patients receiving additional support demonstrated significant reductions in systolic and diastolic blood pressure
  • No changes in blood pressure were seen in patients who received normal care
  • A practice pharmacist providing support to patients with hypertension can improve blood pressure control

Results One-hundred-and-seventeen patients attended the clinic. Fifty-eight were allocated to additional care and 59 to normal care. Comparison of BP between the two groups at baseline revealed no difference in systolic BP, although a lower (P=0.050) diastolic BP was observed in the normal care group of 88.2+7.6mmHg compared with 91.6+10.2mmHg in the additional care group.
Fifty-seven (99 per cent) patients from the additional care group returned after three months. Blood pressure at three months compared with baseline showed a reduction in systolic BP from 151.2+17.4 to 140.1+16.2mmHg (P<0.001) and a reduction in diastolic BP from 91.6+10.2 to 85.8+8.6mmHg (P<0.001).
At 12 months, 51 (88 per cent) of the additional care group and 52 (88 per cent) of the normal care group returned for review and their results were compared with those recorded at baseline.
No significant changes in BP were seen in the normal care group. However, at 12 months the additional care group demonstrated significant reductions in systolic BP from 151.2+17.4 to 145.9+18.1mmHg (P=0.018) and diastolic BP from 91.6+10.2 to 87.2+9.2mmHg (P=0.001).

Discussion The results demonstrate the positive benefit of additional support provided by a practice pharmacist on blood pressure control over a 12-month period. There is now a need to undertake further work to determine the optimum nature of the support required, identify if the results can be sustained and ascertain whether there is an impact on clinical outcomes such as mortality and morbidity.

*Caerphilly local health group, Ystrad Mynach; Gwent health authority, Pontypool; Welsh school of pharmacy, Cardiff university

References

1. Collins R, Peto R, MacMahon S et al. Blood pressure, stroke and coronary heart disease. Part 2. Short-term reductions in blood pressure: overview of randomised drug trials in epidemiological context. Lancet 1990;335:827-38.
2. Ramsay LE, Williams B, Johnston GD et al. British Hypertension Society guidelines for hypertension management 1999: summary. BMJ 1999;319: 630-5.