title: Coronary artery disease and hypertension: outcomes of a pharmacist-managed blood pressure program.
abstract: OBJECTIVE
  To assess the effectiveness of a pharmacist-managed service in improving hypertension control among patients with coronary artery disease.
  
  
  METHODS
  Prospective cohort study. Setting. Health maintenance organization.
  
  
  METHODS
  Three hundred seventy-six patients with uncontrolled hypertension and coronary artery disease.
  
  
  METHODS
  Pharmacist-managed, physician-supervised population-management approach to optimize evidence-based drug management.
  
  
  RESULTS
  Blood pressure reduction and control were evaluated, as well as the use of angiotensin-converting enzyme inhibitors and generic antihypertensive drugs during 7-month follow-up. At baseline, mean +/- SD age was 70.4 +/- 8.8 years, 247 (65.7%) were men, 201 (53.5%) had a history of myocardial infarction, and 237 (63.0%) had diabetes mellitus. Baseline mean systolic blood pressure was 151 mm Hg, and none had achieved their blood pressure goal. During follow-up, mean systolic blood pressure decreased 16.1 mm Hg overall (p<0.001), and 179 (47.6%) patients achieved their goal blood pressure (p<0.001). Blood pressure reductions were 14.7 and 18.4 mm Hg in patients with and patients without diabetes, respectively (p<0.001). The target dose for angiotensin-converting enzyme inhibitors was achieved in 252 (67.0%) patients compared with 102 (27.1%) at baseline (p<0.001). Generic fill rates for antihypertensive drugs continued to be higher than 95% during follow-up (p=0.723).
  
  
  CONCLUSIONS
  A pharmacist-managed, physician-supervised population-management approach in patients with coronary artery disease significantly improved blood pressure control. Clinically meaningful reductions in blood pressure were achieved by using evidence-based, cost-effective drug regimens.
authors.affiliation: Clinical Pharmacy Cardiac Risk Service, Kaiser Permanente of Colorado, Aurora, Colorado 80011, USA. karen.mcconnell@kp.org
authors.forename: Karen J
authors.initials: KJ
authors.lastname: McConnell
authors.forename: Emily B
authors.initials: EB
authors.lastname: Zadvorny
authors.forename: Angela M
authors.initials: AM
authors.lastname: Hardy
authors.forename: Thomas
authors.initials: T
authors.lastname: Delate
authors.forename: Jon R
authors.initials: JR
authors.lastname: Rasmussen
authors.forename: John A
authors.initials: JA
authors.lastname: Merenich
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000503:physiopathology; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D010595:Pharmacists
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents