Pharmacists May be the Health Care Professionals Best Suited to Treat Hypertension
Hypertension interventions led by pharmacists and community health workers were more successful in lowering BP than those led by nurses and physicians.
Intervention to reduce hypertension delivered by pharmacists and community health workers proved more effective than those implemented by other health care professionals, including nurses and physicians, according to a new meta-analysis led by Katherine Mills, PhD, MSPH, associate professor and vice chair of epidemiology at Tulane University School of Public Health and Tropical Medicine.1
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For the meta-analysis, published online July 19 in Circulation: Cardiovascular Quality and Outcomes, Mills and colleagues retrieved 100 publications that included 116 comparisons of interventions targeting barriers to optimal blood pressure (BP) control that reported the type of professional who led the intervention. The final analysis included 90 474 study participants with hypertension.
The researchers found that interventions led by pharmacists had the most significant effect on systolic BP (SBP), with a reduction of 7.3 mm Hg (95% CI, −9.1 to −5.6). That success was followed by community health-worker led interventions, which yielded a reduction of 7.1 mm Hg (95% CI, −10.8 to −3.4), and by interventions guided by health educators, for a reduction of 5.2 mm Hg (95% CI, −7.8 to −2.6) mm Hg.
Interventions led by multiple health care professionals were also effective, resulting in mean SBP reductions of 4.2 mm Hg (95% CI, –6.1 to –2.4) as were nurse-led interventions ( –3 mm Hg; 95% CI, –4.2 to –1.9) and physician-led interventions (–2.4 mm Hg ; 95% CI, –3.4 to –1.5), according to the study.
Reductions observed in diastolic BP (DBP) were similarly greatest for interventions led by pharmacists (-3.9 mm Hg; 95% CI, −5.2 to −2.5) and by community health workers (−3.7 mm Hg; 95% CI, −6.6 to −0.8) mm Hg for community health worker–led interventions.
Lead author Mills said the results were not a surprise. “The good news is that all healthcare professionals were effective at delivering interventions,” she said in a Tulane news release. But she added that when considering the widely variable needs of individuals with hypertension, pharmacists may be uniquely suited for the role.
“Blood pressure can require more time to manage than is often available in primary care visits. One of the big challenges is getting the right combinations and doses of antihypertensive medications, and that can be difficult for some patients requiring repeated visits, Mills said. "Having someone lead an effort who doesn’t have the same time constraints may be the most effective approach.
The researchers stratified the 116 comparisons in the meta-analysis by type of health care professional leading the intervention: pharmacists, community health care workers, health educators, multiple health care professionals, and physicians. Only 13.8% of persons with hypertension globally have blood pressure at target control levels, Mills et al wrote, and results of past investigations to evaluate the relative efficacy of methods designed to reduce obstacles to optimal control have been variable.
Having found in a previous analysis of hypertension studies that there was a wide range in the degree of BP reduction, Mills and her team took an interest in the characteristics of the studies that might be associated with greater success. They proposed that the type of health care professional delivering the intervention could play an important role.
“Blood pressure can require more time to manage than is often available in primary care visits. One of the big challenges is getting the right combinations and doses of antihypertensive medications, and that can be difficult for some patients requiring repeated visits. Having someone lead an effort who doesn’t have the same time constraints may be the most effective approach."
The team’s pairwise comparisons, after multivariable adjustment, found significantly greater reductions in both SBP and DBP associated with pharmacist-led interventions compared with those led by multiple health care professionals, nurses, and physicians. Reductions in SBP were significantly greater when interventions were led by community health workers and health educators than by physicians.
“This study underscores the importance of a team-based care approach to helping keep blood pressure under control,” Lawrence J Fine, MD, a senior advisor in the clinical applications and prevention branch in the Division of Cardiovascular Sciences at the National Heart, Lung, and Blood Institute, said in the Tulane news release. Team members other than physicians and other traditional medical professionals can be equally as effective and should be tapped as a resource in the US given the nationwide decline in BP control in recent years, he added.
“Hypertension doesn’t often have symptoms, so it is commonly not the first concern of patients during brief primary care visits if they have multiple health issues. The goal is to determine who should lead these interventions and what the best strategy is to address this important health issue,” Mills concluded.2
