BETHESDA, MD 14 June 2012—A federal task force recently concluded that a team-based approach to controlling hypertension benefits patients, particularly when pharmacists are part of the team.
According to the Centers for Disease Control and Prevention (CDC), which appointed the members of the Community Preventive Services task force, multidisciplinary teams that included a primary care provider plus a nurse, "with or without a pharmacist," helped patients lower their blood pressure.
But those teams that included a pharmacist outperformed other teams in helping patients keep their hypertension under control.
Overall, the use of team-based hypertension care resulted in a 12.0 percentage point increase in the proportion of patients whose blood pressure was 140/90 mm Hg or less, according to CDC.
The agency did not provide the figures for teams that included pharmacists but stated that the median improvement in blood pressure control was "considerably higher" than for the teams without a pharmacist. Hypertension control was greatest when team members were able to change medication regimens independently or after consultation with a primary care provider.
The task force's initial findings were released May 15 and are based on an analysis of data from 49 studies. The final report from the group is expected to be published next May.
"This analysis shows that when primary care physicians and other health care professionals with different expertise and approaches work together to support their patients, they can find the right formula for getting blood pressure under control," said CDC Director Thomas R. Frieden in a statement released with the recommendations.
Clinical pharmacist Heather E. Olivier said the team approach "definitely seems to be working better for a number of disease states, and hypertension can be one of them."
Olivier called hypertension, hyperlipidemia, and diabetes the "big three" diseases that adversely affect population health because of their association with cardiovascular disease, heart attack, and stroke. She said pharmacists have an important role to play in helping patients manage their health.
"I also think that getting pharmacists involved in more office-based care will allow for better health outcomes," she said.
Before starting her new job with a managed care company, Olivier established a pharmacist-run hypertension-management clinic associated with the emergency department at the Interim Louisiana State University (LSU) Public Hospital in New Orleans.
The hypertension clinic serves low-income patients with newly diagnosed uncomplicated hypertension and acts as a bridge from urgent care to ongoing primary care provided by the health system.
The clinic uses a collaborative model involving nurses and a pharmacist, with a physician available to authorize recommended changes to the medication regimen [see April 15, 2012, AJHP Case Study].
"It's important that pharmacists, nurses, physicians—the whole medical team—work together collaboratively to make sure that patients' blood pressure is being well controlled," Olivier said. "The most important thing is the patient."
The protocol in use at LSU calls for an emergency department physician to initiate antihypertensive treatment using an algorithm, order laboratory tests, and refer patients to the pharmacist-managed clinic.
The patients then come to the clinic, ideally within two weeks after starting antihypertensive therapy. A pharmacist is responsible for counseling the patient and evaluating the medication regimen.
Olivier said the pharmacist must do a thorough counseling job and not assume that the patient has already received adequate medication information from the referring physician or elsewhere.
"I think it's important for the pharmacists to ask the right questions and make sure that they get good feedback from the patient and that the patient knows what they're supposed to do," Olivier said. "Sometimes they don't understand that 'one tablet twice a day' doesn't mean you take two at the same time or take one at 8:00 and one at noon."
She said her clinic patients appreciated learning that they had hypertension, and they were receptive to her counseling. She speculated that the perception that pharmacists are one of the most accessible and trusted health care professionals may help patients feel comfortable seeking advice from pharmacists and, in turn, improving their health.
Although she is no longer involved in the LSU hypertension clinic, Olivier's current work includes medication counseling services for managed care patients.
"It gives pharmacists the opportunity to be able to have that one-on-one time with the patient," she said. "We have the time and we have, maybe, the resources to reach out and explain to them in detail what their medications are for and how to take them."
According to CDC, hypertension was a primary or contributing cause of death for 336,00 Americans in 2007. The agency estimated that the effective treatment of all patients with hypertension could prevent about 46,000 deaths each year.
The Joint National Committee (JNC) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure last updated its national guidelines for managing hypertension—known as JNC 7—in 2003. Those guidelines note the proven effectiveness of pharmacists in helping patients achieve their blood pressure goal.
The National Heart, Lung, and Blood Institute stated that the committee's newest report, known as JNC 8, is expected to be released sometime this year for public review and comments.