Pharmacists Play an Essential Role in Managing Hypertension

About half of US adults have hypertension, and only about 1 in 4 (24%) individuals have it under control, according to the CDC.¹

Evidence shows that individuals with hypertension might be at an increased risk for severe coronavirus disease 2019 (COVID-19).²

Therefore, it is extremely important to ensure that individuals with hypertension are well controlled and are educated about COVID-19 precautions, including frequent handwashing, mask-wearing, and social distancing as the pandemic persists.² Pharmacists can play an essential role in hypertension management through medication therapy management (MTM) services (see FIGURE).

PILOT PROGRAM

One recent study evaluated a pharmacist-led MTM pilot program for patients with hypertension in partnership with 8 community pharmacies.³ Changes in use of blood pressure (BP) self-management tools and barriers to medication adherence before and after the MTM services were evaluated. The results showed improvements in BP self-monitoring (P <.001). Also, study participants who had difficulty remembering to take their antihypertensive medications had a 60% decrease in forgetting in the pharmacist-led program. Most patients also rated the pharmacist’s overall ability and care as very good.³

In 2014, the Ohio Department of Health collaborated with 3 federally qualified health center practice sites to evaluate the effect of MTM counseling sessions on patients with hypertension.4 Other collaborators involved were the Health Services Advisory Group, the Ohio Association of Community Health Centers, the Ohio Pharmacists Association, and the Ohio State University College of Pharmacy. Pharmacists administered MTM services to 500 patients with hypertension. After 6 months, hypertension control increased to 68.6%.⁴

One randomized clinical trial evaluated the use of a collaborative pharmacist— primary care provider team approach to MTM services in patients with hypertension and 166 participants were enrolled in the study, with an average age of 67.7 years.⁵ Individuals were 18 and older with a diagnosis of hypertension, with a most recent BP measurement of greater than 140/>90 mm Hg (>130/>80 mm Hg if individuals also have diabetes) and were taking at least 1 antihypertensive medication.

The study results showed that the average reduction in systolic blood pressure was significantly greater in the pharmacist-physician MTM group than the physician group alone (P = .008). Also, the collaborative group that included the pharmacist had significantly fewer physician visits (P <.001).⁵ This study showed the importance of including a pharmacist as part of the multidisciplinary team.

In an interview, Amanda Bowman, PharmD, BCACP, primary care clinical pharmacist at SSM Health in Madison, Wisconsin, discussed her role in providing MTM services as part of a multidisciplinary team in the family and internal medicine department in a primary-care practice. She is involved in direct patient care and manages a variety of disease states including hypertension.

“I provide guideline-driven care, by ensuring appropriate goals, treatment, and follow-up [are] provided,” Bowman said.

Collaborative practice agreements are used, allowing Bowman to initiate medications independently, adjust drug dosages, discontinue therapies, and actively monitor labs.

Patients are followed longitudinally through frequent visits to evaluate their medication regimen efficacy and assess for adverse effects [AEs].

“Individuals are discharged from care when blood pressure goals are met and patients are stable. This practice necessitates trust between the provider, pharmacist, and patient, truly allowing me to practice at the top of my license and provide the best possible patient care,” Bowman said.

MTM CASE STUDY AND COUNSELING PEARLS

TL is a 60-year-old man who recently received a diagnosis of hypertension and was prescribed lisinopril 10 mg once daily. The pharmacist recommends that he take the lisinopril in the evening, which evidence shows may provide better BP control and reduce the risk of heart attacks and stroke.6 During a comprehensive medication review, the pharmacist discusses possible (AEs), including a cough.⁷ One possible serious AE is angioedema or swelling that usually affects the face, lips, and tongue and can cause breathing problems.⁷ Individuals who develop angioedema should receive emergency medical attention and the medication should be discontinued. TL should have lab monitoring because lisinopril can cause hyperkalemia, and the pharmacist recommends that the patient avoid taking potassium supplements.⁷ Lifestyle modifications play an important role in hypertension control, so the pharmacist recommends diet and exercise as part of the CMR.

JENNIFER GERSHMAN, PHARMD, CPH, is a drug information pharmacist and Pharmacy Times® contributor who resides in South Florida.

REFERENCES

• CDC. Facts about hypertension. Updated September 8, 2020. Accessed October 4, 2020. https://www.cdc.gov/bloodpressure/facts.htm
• CDC. People with certain medical conditions. Updated December 1, 2020. Accessed December 8, 2020.https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html
• Thompson H, Swander L, Cohen R, et al. Hypertension-focused medication therapy management: a collaborative pilot program uniting pharmacists, public health, and health insurers in Wisconsin. Prev Chronic Dis. 2020;17:200058. doi:10.5888/pcd17.200058
• CDC. Community pharmacists and medication therapy management. Updated June 25, 2020. Accessed October 4, 2020. https://www.cdc.gov/dhdsp/pubs/guides/best-practices/pharmacist-mtm.htm
• Hirsch JD, Steers N, Adler DS, et al. Primary care-based, pharmacist-physician collaborative medication-therapy management of hypertension: a randomized, pragmatic trial. Clin Ther. 2014;36(9):1244-1254. doi:10.1016/j.clinthera.2014.06.030
• Hermida RC, Crespo JJ, Dominguez-SardiñaM, et al. Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia chronotherapy trial. Eur Heart J. 2019;ehz754. doi:10.1093/eurheartj/ehz754
• Mayo Clinic. Lisinopril (oral route). Updated October 1, 2020. Accessed December 9, 2020. https://www.mayoclinic.org/drugs-supplements/lisinopril-oral-route/description/drg-20069129