Pharmacist-Led Interventions Improve Blood Pressure, Cholesterol After Stroke

Blood pressure and cholesterol control improved in stroke patients who had a monthly visit with either a pharmacist or nurse, but those who saw a pharmacist had significantly greater improvements.

Pharmacists who actively managed care for patients after a stroke helped to significantly improve their blood pressure control and cholesterol levels, according to the results of a new study conducted in Canada. The study found that interventions led by nurses were also associated with improvements in blood pressure and cholesterol control, although patients managed by pharmacists experienced significantly greater improvements.

The study, published online on April 14, 2014, in the Canadian Medical Association Journal, compared case management led by pharmacists with that led by nurses for patients who had recently suffered a minor ischemic stroke or transient ischemic attack and whose systolic blood pressure or low-density lipoprotein (LDL) cholesterol levels were higher than recommended by guidelines. The study included 279 patients who were randomly assigned to pharmacist- or nurse-led care and had a monthly visit for 6 months with either a pharmacist or nurse. Nurses measured blood pressure and LDL levels, counseled patients on lifestyle changes, and faxed measurements as well as a list of current medications to the patient’s primary care provider. Pharmacists performed the same tasks as nurses, but also initiated or titrated antihypertensive and lipid-lowering therapy as needed.

The results indicated that patients in both groups experienced considerable improvements, although improvements were significantly greater in patients managed by pharmacists. After 6 months, 43.4% of patients managed by pharmacists met both systolic blood pressure and LDL goals, compared with 30.9% of patients managed by nurses, an absolute difference of 12.5%. A majority of patients had already achieved systolic blood pressure targets at baseline, and a high proportion of patients in both groups met targets at 6 months: 80.4% of patients in the pharmacist group met blood pressure goals, compared with 89.7% of those in the nurse group. A significantly greater proportion of patients managed by pharmacists, however, met LDL targets, contributing to the greater overall improvement. At the end of the study, 51.1% of patients managed by pharmacists met their LDL targets, compared with 33.8% of those managed by nurses.

The effects were even greater when the analysis was restricted to the 220 patients in the study who did not withdraw early and who attended at least 1 visit after the initial visit. Given these restrictions, both targets were met by 52.7% of patients in the pharmacist group and by 35.5% of patients in the nurse group.

The improvements in blood pressure control and LDL levels observed in the study occurred despite the fact that more than three-fourths of patients were already taking an antihypertensive or lipid-lowering medication at baseline, the study authors note. They suggest that allowing pharmacists to actively titrate medication may have contributed to the increase in improvements.

“We believe that both approaches hold great promise, not only for patients with stroke or transient ischemic attack but also for all patients with, or at high risk of, vascular disease, and our study provides much-needed information on their comparative effectiveness,” they conclude.