title: Physician-pharmacist cooperation program for blood pressure control in patients with hypertension: a randomized-controlled trial.
abstract: BACKGROUND
  The aim of the trial was to evaluate the effectiveness of a program of cooperation between physician and pharmacist to reduce cardiovascular risk factors in patients with mild to moderate hypertension by promoting better blood pressure (BP) control, appropriate changes in antihypertensive medications, and beneficial changes in lifestyle.
  
  
  METHODS
  The 132 subjects in this randomized, controlled trial were in the age range of 40-79 years. The inclusion criteria were: systolic BP (SBP) ranging from 140-179 mm Hg and/or diastolic BP (DBP) ranging from 90-99 mm Hg and treatment-naive (untreated for hypertension); or on a regimen of medication for hypertension. Of these 132 subjects, 124 (94%) were already receiving treatment with antihypertensive medications. Equal numbers of subjects were randomly assigned to one of two groups: a physician-pharmacist intervention group (n = 66) and a control group (n = 66).
  
  
  RESULTS
  The 6-month follow-up rate was 97% in both groups. At 6 months, the mean decrease in SBP/DBP, as measured at home in the morning, was 2.9/3.3 mm Hg in the intervention group relative to baseline (P = 0.02 and P < 0.0001 for SBP and DBP, respectively). The mean decrease in home morning SBP in the intervention group was not significantly greater than in the control group. However, the DBP decline was significantly greater in the intervention than control groups, which showed a mean decrease of 2.8 mm Hg (confidence interval: -5.5 to -0.1; P = 0.04). The percentage of patients in whom control of home morning BP was achieved was 53% in the intervention group and 47% in the control group (P = 0.40). A higher percentage of patients in the intervention group, relative to the control group, were able to reduce the use of antihypertensive medications (31 vs. 8%, P < 0.0001), and fewer patients in this group required additional medications or increases in dosage relative to the controls (11 vs. 28%, P = 0.03). Patients of the intervention group were more likely to show reduction in body mass index and sodium intake and to stop smoking, as compared with the control group.
  
  
  CONCLUSIONS
  A program of cooperation between physician and pharmacist was successful in reducing cardiovascular risk factors in patients with mild to moderate hypertension by promoting better blood pressure (BP) control, appropriate changes in antihypertensive medications, and beneficial changes in lifestyle.
authors.affiliation: Department of Public Health Medicine, Institute of Community Medicine, University of Tsukuba, Japan. h-tobari@umin.ac.jp
authors.forename: Hiroko
authors.initials: H
authors.lastname: Tobari
authors.forename: Takanori
authors.initials: T
authors.lastname: Arimoto
authors.forename: Nobutake
authors.initials: N
authors.lastname: Shimojo
authors.forename: Kiyomi
authors.initials: K
authors.lastname: Yuhara
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Noda
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Yamagishi
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Iso
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D003376:Counseling; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007564:Japan; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D018579:Patient Selection; D010595:Pharmacists; D010820:Physicians; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents