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Tsuyuki RT, Houle SKD, Charrois TL, Kolber MR, Rosenthal MM, Lewanczuk R, Campbell NRC, Cooney D, McAlister FA. Randomized Trial of the Effect of Pharmacist Prescribing on Improving Blood Pressure in the Community: The Alberta Clinical Trial in Optimizing Hypertension (RxACTION). Circulation 2015; 132:93-100. [PMID: 26063762 DOI: 10.1161/circulationaha.115.015464] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 05/06/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hypertension control rates remain suboptimal. Pharmacists' scope of practice is evolving, and their position in the community may be ideal for improving hypertension care. We aimed to study the impact of pharmacist prescribing on blood pressure (BP) control in community-dwelling patients. METHODS AND RESULTS We designed a patient-level, randomized, controlled trial, enrolling adults with above-target BP (as defined by Canadian guidelines) through community pharmacies, hospitals, or primary care teams in 23 communities in Alberta. Intervention group patients received an assessment of BP and cardiovascular risk, education on hypertension, prescribing of antihypertensive medications, laboratory monitoring, and monthly follow-up visits for 6 months (all by their pharmacist). Control group patients received a wallet card for BP recording, written hypertension information, and usual care from their pharmacist and physician. Primary outcome was the change in systolic BP at 6 months. A total of 248 patients (mean age, 64 years; 49% male) were enrolled. Baseline mean±SD systolic/diastolic BP was 150±14/84±11 mm Hg. The intervention group had a mean±SE reduction in systolic BP at 6 months of 18.3±1.2 compared with 11.8±1.9 mm Hg in the control group, an adjusted difference of 6.6±1.9 mm Hg (P=0.0006). The adjusted odds of patients achieving BP targets was 2.32 (95% confidence interval, 1.17-4.15 in favor of the intervention). CONCLUSIONS Pharmacist prescribing for patients with hypertension resulted in a clinically important and statistically significant reduction in BP. Policy makers should consider an expanded role for pharmacists, including prescribing, to address the burden of hypertension. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00878566.
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Affiliation(s)
- Ross T Tsuyuki
- From EPICORE Centre/COMPRIS, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., T.L.C., M.R.K., M.M.R., F.A.M.), Department of Medicine, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., M.M.R., R.L., F.A.M.), Mazankowski Alberta Heart Institute (R.T.T., S.K.D.H., R.L., F.A.M.), Faculty of Pharmacy and Pharmaceutical Sciences (T.L.C.), and Department of Family Medicine, Faculty of Medicine and Dentistry (M.R.K.), University of Alberta, Edmonton, Canada; School of Pharmacy, University of Waterloo, Kitchener, ON, Canada (R.T.T., S.K.D.H.); Department of Medicine, Faculty of Medicine, University of Calgary, AB, Canada (N.R.C.C.); and Alberta College of Pharmacists, Edmonton, Canada (D.C.).
| | - Sherilyn K D Houle
- From EPICORE Centre/COMPRIS, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., T.L.C., M.R.K., M.M.R., F.A.M.), Department of Medicine, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., M.M.R., R.L., F.A.M.), Mazankowski Alberta Heart Institute (R.T.T., S.K.D.H., R.L., F.A.M.), Faculty of Pharmacy and Pharmaceutical Sciences (T.L.C.), and Department of Family Medicine, Faculty of Medicine and Dentistry (M.R.K.), University of Alberta, Edmonton, Canada; School of Pharmacy, University of Waterloo, Kitchener, ON, Canada (R.T.T., S.K.D.H.); Department of Medicine, Faculty of Medicine, University of Calgary, AB, Canada (N.R.C.C.); and Alberta College of Pharmacists, Edmonton, Canada (D.C.)
| | - Theresa L Charrois
- From EPICORE Centre/COMPRIS, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., T.L.C., M.R.K., M.M.R., F.A.M.), Department of Medicine, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., M.M.R., R.L., F.A.M.), Mazankowski Alberta Heart Institute (R.T.T., S.K.D.H., R.L., F.A.M.), Faculty of Pharmacy and Pharmaceutical Sciences (T.L.C.), and Department of Family Medicine, Faculty of Medicine and Dentistry (M.R.K.), University of Alberta, Edmonton, Canada; School of Pharmacy, University of Waterloo, Kitchener, ON, Canada (R.T.T., S.K.D.H.); Department of Medicine, Faculty of Medicine, University of Calgary, AB, Canada (N.R.C.C.); and Alberta College of Pharmacists, Edmonton, Canada (D.C.)
| | - Michael R Kolber
- From EPICORE Centre/COMPRIS, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., T.L.C., M.R.K., M.M.R., F.A.M.), Department of Medicine, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., M.M.R., R.L., F.A.M.), Mazankowski Alberta Heart Institute (R.T.T., S.K.D.H., R.L., F.A.M.), Faculty of Pharmacy and Pharmaceutical Sciences (T.L.C.), and Department of Family Medicine, Faculty of Medicine and Dentistry (M.R.K.), University of Alberta, Edmonton, Canada; School of Pharmacy, University of Waterloo, Kitchener, ON, Canada (R.T.T., S.K.D.H.); Department of Medicine, Faculty of Medicine, University of Calgary, AB, Canada (N.R.C.C.); and Alberta College of Pharmacists, Edmonton, Canada (D.C.)
| | - Meagen M Rosenthal
- From EPICORE Centre/COMPRIS, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., T.L.C., M.R.K., M.M.R., F.A.M.), Department of Medicine, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., M.M.R., R.L., F.A.M.), Mazankowski Alberta Heart Institute (R.T.T., S.K.D.H., R.L., F.A.M.), Faculty of Pharmacy and Pharmaceutical Sciences (T.L.C.), and Department of Family Medicine, Faculty of Medicine and Dentistry (M.R.K.), University of Alberta, Edmonton, Canada; School of Pharmacy, University of Waterloo, Kitchener, ON, Canada (R.T.T., S.K.D.H.); Department of Medicine, Faculty of Medicine, University of Calgary, AB, Canada (N.R.C.C.); and Alberta College of Pharmacists, Edmonton, Canada (D.C.)
| | - Richard Lewanczuk
- From EPICORE Centre/COMPRIS, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., T.L.C., M.R.K., M.M.R., F.A.M.), Department of Medicine, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., M.M.R., R.L., F.A.M.), Mazankowski Alberta Heart Institute (R.T.T., S.K.D.H., R.L., F.A.M.), Faculty of Pharmacy and Pharmaceutical Sciences (T.L.C.), and Department of Family Medicine, Faculty of Medicine and Dentistry (M.R.K.), University of Alberta, Edmonton, Canada; School of Pharmacy, University of Waterloo, Kitchener, ON, Canada (R.T.T., S.K.D.H.); Department of Medicine, Faculty of Medicine, University of Calgary, AB, Canada (N.R.C.C.); and Alberta College of Pharmacists, Edmonton, Canada (D.C.)
| | - Norm R C Campbell
- From EPICORE Centre/COMPRIS, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., T.L.C., M.R.K., M.M.R., F.A.M.), Department of Medicine, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., M.M.R., R.L., F.A.M.), Mazankowski Alberta Heart Institute (R.T.T., S.K.D.H., R.L., F.A.M.), Faculty of Pharmacy and Pharmaceutical Sciences (T.L.C.), and Department of Family Medicine, Faculty of Medicine and Dentistry (M.R.K.), University of Alberta, Edmonton, Canada; School of Pharmacy, University of Waterloo, Kitchener, ON, Canada (R.T.T., S.K.D.H.); Department of Medicine, Faculty of Medicine, University of Calgary, AB, Canada (N.R.C.C.); and Alberta College of Pharmacists, Edmonton, Canada (D.C.)
| | - Dale Cooney
- From EPICORE Centre/COMPRIS, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., T.L.C., M.R.K., M.M.R., F.A.M.), Department of Medicine, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., M.M.R., R.L., F.A.M.), Mazankowski Alberta Heart Institute (R.T.T., S.K.D.H., R.L., F.A.M.), Faculty of Pharmacy and Pharmaceutical Sciences (T.L.C.), and Department of Family Medicine, Faculty of Medicine and Dentistry (M.R.K.), University of Alberta, Edmonton, Canada; School of Pharmacy, University of Waterloo, Kitchener, ON, Canada (R.T.T., S.K.D.H.); Department of Medicine, Faculty of Medicine, University of Calgary, AB, Canada (N.R.C.C.); and Alberta College of Pharmacists, Edmonton, Canada (D.C.)
| | - Finlay A McAlister
- From EPICORE Centre/COMPRIS, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., T.L.C., M.R.K., M.M.R., F.A.M.), Department of Medicine, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., M.M.R., R.L., F.A.M.), Mazankowski Alberta Heart Institute (R.T.T., S.K.D.H., R.L., F.A.M.), Faculty of Pharmacy and Pharmaceutical Sciences (T.L.C.), and Department of Family Medicine, Faculty of Medicine and Dentistry (M.R.K.), University of Alberta, Edmonton, Canada; School of Pharmacy, University of Waterloo, Kitchener, ON, Canada (R.T.T., S.K.D.H.); Department of Medicine, Faculty of Medicine, University of Calgary, AB, Canada (N.R.C.C.); and Alberta College of Pharmacists, Edmonton, Canada (D.C.)
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Martínez-Orozco MJ, Perseguer-Torregrosa Z, Gil-Guillén VF, Palazón-Bru A, Orozco-Beltran D, Carratalá-Munuera C. Suitability of antiplatelet therapy in hypertensive patients. J Hum Hypertens 2014; 29:40-5. [PMID: 24694801 DOI: 10.1038/jhh.2014.25] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 02/14/2014] [Accepted: 02/18/2014] [Indexed: 11/09/2022]
Abstract
Antiplatelet therapy (AT) is indicated in hypertensive patients with increased cardiovascular risk. The literature about the adequate or inadequate prescription of AT is scarce. We conducted a prospective descriptive study to quantify therapeutic inertia and non-guideline-recommended prescription (NGRP) of AT (aspirinor clopidogrel or both), and to assess associated factors, calculating the adjusted odds ratios (ORs) from multivariate models. In 2007-2009, 712 primary health-care hypertensive patients in a Spanish region were enrolled. Inertia was defined as the lack of an AT prescription, despite being indicated by guidelines, whereas NGRP was defined as AT prescription when there was no guideline recommendation. We also recorded cardiovascular variables. Inertia and NGRP were quantified for primary and secondary prevention. Of 108 patients in secondary prevention, 53 had inertia (49.1%, 95% confidence interval (CI): 39.6-58.5%). Associated profile: female (OR=0.460, P=0.091), no dyslipidemia (OR=0.393, P=0.048), no coronary heart disease (OR=0.215, P=0.001) and high diastolic blood pressure (OR=1.076, P=0.016). In primary prevention, NGRP was present in 69 of 595 patients (11.6%, 95% CI: 9.0-14.2%). Associated profile: male (OR=1.610, P=0.089), smoking (OR=2.055, P=0.045), dyslipidemia (OR=3.227, P<0.001) and diabetes (OR=2.795, P<0.001). Although certain factors were clearly associated with these phenomena much still remains to be learnt.
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Affiliation(s)
- M J Martínez-Orozco
- 1] Miguel Martínez Community Pharmacy, Benimantell, Spain [2] Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain
| | - Z Perseguer-Torregrosa
- 1] Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain [2] Zeneida Perseguer Community Pharmacy, Petrel, Spain
| | - V F Gil-Guillén
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain
| | - A Palazón-Bru
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain
| | - D Orozco-Beltran
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain
| | - C Carratalá-Munuera
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain
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