Deterioration of blood pressure control after discontinuation of a physician-pharmacist collaborative intervention.
OBJECTIVE
To assess blood pressure control after discontinuation of a physician-pharmacist collaborative intervention.


METHODS
Comparative analysis of data of the patients who received the intervention versus a control group from a prospective, cluster-randomized, 9-month efficacy trial and the same patients' data 18 and 27 months after completion of the trial, abstracted from their medical records.


METHODS
Five primary care medical offices operated by a university health system.


METHODS
One hundred four patients with hypertension; 65 were in the intervention group, and 39 were in the control group.


RESULTS
In the prospective study, patients were randomized to receive a physician-pharmacist collaborative intervention to improve blood pressure control or to the control group. Systolic and diastolic blood pressures were measured by a research nurse at baseline and at the end of the study (9 mo later). In the current study, data were abstracted for blood pressure and blood pressure control at 18 and 27 months (9 and 18 mo, respectively, after discontinuation of the study). At baseline, mean +/- SD systolic blood pressure was 152.5 +/- 9.5 and 150.1 +/- 9.6 mm Hg in the intervention and control groups, respectively (p=0.22). At 9 months, systolic blood pressure decreased to 124.5 +/- 10.7 and 132.0 +/- 15.1 mm Hg (p=0.0038 between groups), and blood pressure was controlled in 78.5% and 48.7% (p=0.0017) of patients in the intervention and control groups, respectively. By 18 months, systolic blood pressure had deteriorated to 131.0 +/- 12.2 and 143.3 +/- 17.5 mm Hg (p<0.001), and blood pressure control rates decreased to 53.9% and 30.8% (p=0.02). By 27 months, systolic blood pressure was 131.3 +/- 13.0 and 141.2 +/- 15.8 mm Hg (p=0.0008), and blood pressure control was 55.4% and 35.9% (p=0.05).


CONCLUSIONS
A sustained positive effect on blood pressure control was noted up to 18 months after discontinuation of a physician-pharmacist collaborative intervention, when compared with a control group. Blood pressure control did deteriorate at a similar rate in both the intervention and control groups, but the percentage of patients with controlled blood pressure remained significantly higher in the intervention group. These results suggest that continued interventions by pharmacists may be necessary to maintain high rates of blood pressure control, especially in those patients whose blood pressure begins to increase.
Carter
Barry L
BL
Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa 52242, USA. barry-carter@uiowa.edu
Doucette
William R
WR
Franciscus
Carrie L
CL
Ardery
Gail
G
Kluesner
Karen M
KM
Chrischilles
Elizabeth A
EA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000517:prevention & control*; D007400:Interprofessional Relations; D008297:Male; D008499:Medical Records; D055118:Medication Adherence; D008875:Middle Aged; D010593:Pharmaceutical Services; D010595:Pharmacists; D010820:Physicians; D017410:Practice Guidelines as Topic; D014481:United States; D055815:Young Adult
D000959:Antihypertensive Agents