Pharmacist Monitoring Keeps Patient BP Under Control-July 2008

Pharmacist-assisted care via the Internet and the use of home blood pressure monitoring (HBPM) significantly improved blood pressure (BP) control in patients with hypertension, according to a study reported in the Journal of the American Medical Association (June 25, 2008).

The researchers randomly assigned 778 participants in the Group Health Cooperative (

Seattle

,

Washington

) previously diagnosed with hypertension or high BP to 3 groups. The first group received the “usual care” with an educational pamphlet. These participants were told their BP remained too high and recommended to consult their physician.

The second group received the usual care and a free Omron-brand home BP monitor and training to check their BP at least twice a week. The participants also were taught how to use Group Health’s Web site to access their electronic medical records and how to securely send messages to their physicians.

The final group was identical to the second, but included a pharmacist tracking participants’ progress. Every 2 weeks, this group sent their BP readings to pharmacists using secure messaging. The pharmacists were allowed to adjust dosages and switch medications, if warranted.

Pharmacist monitoring made a significant difference. The patients in this group saw their systolic reading drop by an average of 14.2 points after 1 year. Overall, 56% of the patients in the pharmacist-intervention group got their BP under control, defined as an average reading of 140/90 mm Hg, compared with 31% in the usual-care group and 36% in the tutoring-and-free-monitor group.

The researchers concluded, “Our findings demonstrate the effectiveness of using home BP monitoring combined with pharmacy care over the Web to improve BP control for patients with essential hypertension.” The researchers recommend more studies to determine whether similar care can be applied to other chronic diseases, be implemented in other settings, and decrease costs.

The current study adds to the growing evidence of routine HBPM in helping patients with hypertension and the critical role pharmacists play as part of the health care team. The American Heart Association, the American Society of Hypertension, and the Preventative Cardiovascular Nurses Association recently issued a joint scientific statement on HBPM and detailed recommendations on their use.