Improving blood pressure control through pharmacist interventions: a meta-analysis of randomized controlled trials.
BACKGROUND
Control of blood pressure (BP) remains a major challenge in primary care. Innovative interventions to improve BP control are therefore needed. By updating and combining data from 2 previous systematic reviews, we assess the effect of pharmacist interventions on BP and identify potential determinants of heterogeneity.


RESULTS
Randomized controlled trials (RCTs) assessing the effect of pharmacist interventions on BP among outpatients with or without diabetes were identified from MEDLINE, EMBASE, CINAHL, and CENTRAL databases. Weighted mean differences in BP were estimated using random effect models. Prediction intervals (PI) were computed to better express uncertainties in the effect estimates. Thirty-nine RCTs were included with 14 224 patients. Pharmacist interventions mainly included patient education, feedback to physician, and medication management. Compared with usual care, pharmacist interventions showed greater reduction in systolic BP (-7.6 mm Hg, 95% CI: -9.0 to -6.3; I(2)=67%) and diastolic BP (-3.9 mm Hg, 95% CI: -5.1 to -2.8; I(2)=83%). The 95% PI ranged from -13.9 to -1.4 mm Hg for systolic BP and from -9.9 to +2.0 mm Hg for diastolic BP. The effect tended to be larger if the intervention was led by the pharmacist and was done at least monthly.


CONCLUSIONS
Pharmacist interventions - alone or in collaboration with other healthcare professionals - improved BP management. Nevertheless, pharmacist interventions had differential effects on BP, from very large to modest or no effect; and determinants of heterogeneity could not be identified. Determining the most efficient, cost-effective, and least time-consuming intervention should be addressed with further research.
Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.
Valérie
V
Santschi
Arnaud
A
Chiolero
April L
AL
Colosimo
Robert W
RW
Platt
Patrick
P
Taffé
Michel
M
Burnier
Bernard
B
Burnand
Gilles
G
Paradis
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D003157:Community Pharmacy Services; D003299:Cooperative Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D033183:Interdisciplinary Communication; D054539:Medication Therapy Management; D010348:Patient Care Team; D010353:Patient Education as Topic; D010595:Pharmacists; D024382:Professional Role; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D000959:Antihypertensive Agents
hypertension; pharmacist; prediction interval; systematic review; team‐based care