Online Pharmacist Care Produces Long-Term Blood Pressure Control

A hypertension treatment program in which patients received online guidance from pharmacists led to improved blood pressure control even a year after the program ended.

Patients whose blood pressure was monitored through the Internet by a pharmacist-led team had improved blood pressure control a full year after the program ended, according to the findings of a study published online on May 20, 2013, in JAMA Internal Medicine

In the original study, 778 patients with uncontrolled blood pressure registered to use a patient website that shared their electronic health records with health care providers for the purposes of helping to improve their blood pressure control. The participants were randomly assigned to receive either usual care; home blood pressure monitoring and online training; or home blood pressure monitoring, online training, and online communication with pharmacists. After 1 year, participants in the third group, including online pharmacist communication, were twice as likely to have controlled blood pressure (under 140/90 mm/Hg) as were participants in the other groups.

In the newly released study, researchers set out to determine whether the intervention had lasting effects on participants’ blood pressure control. The researchers measured blood pressure for 618 returning patients taken 6 to 18 months after their intervention ended. They measured changes in systolic and diastolic blood pressure compared to baseline as well as adherence to antihypertensive drugs.

The researchers found that patients in all 3 groups had lower blood pressure compared to their baseline readings. However, participants in the pharmacist group had a significantly greater reduction in systolic blood pressure compared with those in both other groups. Average systolic blood pressure for those in the pharmacy group was 134, compared with 138 for those in the usual care group and 141 for those in the online training group. There was no significant difference among the groups for diastolic blood pressure. Each group had high rates of adherence to antihypertensive medications, but adherence was significantly higher in the pharmacist and online training groups than in the usual care group.

The researchers also found that 60% of patients in the pharmacist group had controlled blood pressure a year after the intervention, compared with 52% of usual care patients and 48% of online training patients. The portion of patients whose blood pressure was controlled differed even more by group in patients with a baseline systolic blood pressure reading over 160 mm/Hg; 56% of these patients in the pharmacist group had controlled blood pressure, compared with just 34% in the usual care group and 23% in the online training group.

The researchers conclude that online pharmacist interventions continued to improve blood pressure in patients more than other intervention methods even a year after the program’s end. However, they note that longer studies should be undertaken to determine just how long-lasting the effects of this sort of intervention may be.