An Evaluation of a Clinical Pharmacy-Directed Intervention on Blood Pressure Control

Main Article Content

Caroline E. Kicklighter
Kent M. Nelson
Tammy L. Humphries
Thomas Delate


Blood pressure, Hypertension, Pharmaceutical Services, Professional Role


Objective: To compare short and long term blood pressure control with clinical pharmacy specialist involvement to traditional physician management.

Setting: A non-profit health maintenance organization in the United States covering approximately 385,000 lives.

Methods: This analysis utilized a prospective parallel design. Adult patients with a baseline Blood pressure³140/90 mmHg and receiving at least one antihypertensive medication were eligible for the study. Eligible hypertension management patients at one medical office were referred to the office’s clinical pharmacy specialist (intervention cohort) while at another comparable medical office they received usual physician-directed care (control cohort). The primary outcome measure was achievement of a goal BP (<140/90 mmHg) during a six month follow-up. Medical records were also reviewed approximately 1.5 years post enrollment to assess long-term BP control after clinical pharmacy-managed patients returned to usual care. Multivariate analyses were performed to adjust for baseline cohort differences.

Results: One hundred-thirteen and 111 subjects in the intervention and control cohorts completed the study, respectively. At the end of the follow-up period, clinical pharmacy-managed subjects were more likely to have achieved goal BP (64.6%) and received a thiazide diuretic (68.1%) compared to control subjects (40.7% and 33.3%, respectively) (adjusted p=0.002 and p<0.001, respectively). The proportion of clinical pharmacy-managed subjects with controlled BP decreased to 22.2% after returning to usual care (p<0.001).

Conclusion: Clinical pharmacy involvement in hypertension management resulted in increased BP control. Loss of long-term control after discontinuation of clinical pharmacy management supports a change in care processes that prevent patients from being lost to follow-up.


Download data is not yet available.
Abstract 901 | PDF Downloads 648


1. Wolf-Maier K, Cooper RS, Banegas JR, Giampaoli S, Hense H, Joffres M, et al. Hypertension and blood pressure levels in 6 European countries, Canada, and the US. JAMA 2003; 289: 2363–2369.

2. Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet 1997; 349: 1436–1442.

3. Collins R, Peto R, MacMahon S, Hebert P, Fiebach NH, Eberlein KA, et al. Blood pressure, stroke, and coronary heart disease. Part 2: short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet 1990;335:827-38.

4. Neal B, MacMahon S, Chapman N. Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Blood Pressure Lowering Treatment Trialists’ Collaboration. Lancet 2000;356:1955-64.

5. Hajjar I, Kitchen TA. Trends in prevalence awareness, treatment, and control of hypertension in the United States, 1988-2000. JAMA 2003;290:199-206.

6. Wolf-Maier K, Cooper RS, Kramer H, Banegas JR, Giampaoli S, Joffres MR et al. Hypertension treatment and control in five European countries, Canada, and the United States. Hypertension 2004;43:10-17.

7. Berlowitz DR, Ash AS, Hickey EC, Friedman RH, Glickman M, Kader B, et al. Inadequate management of blood pressure in a hypertensive population. N Engl J Med 1998;339:1957-63.

8. Hyman DJ, Pavlik VN. Characteristics of patients with uncontrolled hypertension in the United States. N Eng J Med 2001;345:479-86.

9. Vivian EM. Improving blood pressure control in a pharmacist-managed hypertension clinic. Pharmacotherapy 2002;22:1533-40.

10. Borenstein JE, Graber G, Saltiel E, Wallace J, Seonyoung R, Jackson A. Physician-pharmacist comanagement of hypertension: a randomized, comparative trial. Pharmacotherapy 2003:23:209-16.

11. Bogden PE, Abbott Rd, Williamson P, Onopa JK, Koontz LM. Comparing standard care with a physician and pharmacist team approach for uncontrolled hypertension. J Gen Intern Med 1998;13:740-5.

12. Mehos BM, Saseen JJ, MacLaughlin EJ. Effect of pharmacist intervention and initiation of home blood pressure monitoring in patients with uncontrolled hypertension. Pharmacotherapy 2000;20:1384-9.

13. Alsuwaidan S, Malone DC, Billups SJ, Carter BL. Characteristics of ambulatory care clinics and pharmacists in Veterans Affairs Medical Centers. Impact of Managed Pharmaceutical Care on Resource Utilization and Outcomes in Veterans Affairs Medical Centers, IMPROVE investigators. Am J Health Syst Pharm 1998;55:68-72.

14. National High Blood Pressure Education Program. The fifth report of the Joint National Committee on detection, evaluation, and treatment of high blood pressure. Arch Intern Med 1993;153:154-83.

15. Gosse P, Bougaleb M, Egloff P, Lemetayer P, Clementy J. Clinical significance of white-coat hypertension. Journal of Hypertension 1994;12(8):S43-7.

16. Kramarow E, Lentzner H, Rooks R, Weeks J, Sayday S. Health and aging chart book: health, United States, 1999. Hyattsville, MD: National Center for Health Statistics, 1999.

17. The sixth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). Arch Intern Med 1997;157:2413-46.

18. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Isso JL, et al. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 2003;42:1206-1252.

19. Fischer MA, Avorn J. Economic implications of evidence-based prescribing for hypertension. Can better care cost less? JAMA 2004;291:1850-6.

20. Cheng C, Studdifor JS, Chambers CV, Diamond JJ, Paynter N. The reliability of patient self-reported blood pressures. J Clin Hypertens 2002;4:259-64.