Hypertension Care Management Program Provided by Clinical Pharmacists Reduces Blood Pressure among Veterans
Lowering blood pressure with antihypertensive drugs decreases morbidity and mortality from cardiovascular and renal complications; however, more than 27% of patients with high blood pressure do not take these medications. Moreover, as many as 30% of patients who do take antihypertensive drugs still fail to achieve their target blood pressure. This study evaluated the effectiveness of a hypertensive care management program provided by clinical pharmacists in collaboration with primary care physicians within four VA primary care teams at one urban Midwest VAMC. As part of this program, clinical pharmacists (n=6) met individually with 573 Veterans with hypertension (433 of whom completed the program), arranged their drug therapy, and provided patient counseling. Blood pressure (BP) goals were based on national guidelines from the Joint National Committee, the DoD, and VA: systolic BP less than 130 mm Hg and diastolic BP less than 80 mm Hg for Veterans with diabetes and/or chronic kidney disease (CKD); systolic BP less than 140 mm Hg and diastolic BP less than 90 mm Hg for all other Veterans. Using VA medical record data, investigators compared BP measurements at the final pharmacist care management visit with measurements from the initial visit. The secondary outcome was the overall number of Veterans who reached their goal BP at the final visit compared with the initial visit. Data were collected for 18 months, which included the one-year program period (6/07--5/08) and a minimum six-month follow-up.
- Veterans referred to the hypertension care management program provided by VA clinical pharmacists had a significant reduction in blood pressure, and most met their BP treatment goals.
- Overall, the change in mean systolic BP at the final visit was –11.2 mm Hg from the initial visit, whereas the change in mean diastolic BP at the final visit was –4.6 mm Hg from the initial visit.
- By the final visit, 431 (75%) Veterans had reached their BP treatment goals, which was 99.5% of the 433 Veterans who completed the program.
- For Veterans with diabetes or chronic kidney disease, both systolic and diastolic BP measurements were significantly reduced from the initial pharmacist visit to the final pharmacist visit. Approximately 60% of all Veterans in the program with diabetes and 56% of those with CKD reached their BP goals.
- Findings may not be due specifically to the pharmacists’ role, but rather to the scope of the intervention. Thus, it is possible that a similar intervention using other healthcare providers would achieve similar results.
- Pharmacists were responsible for collecting BP measurements, which may have introduced bias.
Dr. Zillich was supported by an HSR&D Research Career Development Award and is part of HSR&D’s Center of Excellence on Implementing Evidence-Based Practice, Indianapolis, IN.
Bex S, Boldt A, Needham S, Bolf S, Walston C, Ramsey D, Schmelz A, and Zillich A. Effectiveness of a Hypertension Care Management Program Provided by Clinical Pharmacists for Veterans. Pharmacotherapy January 2011;31(1):31-38.