Collaboration between pharmacists and physicians in the community can improve treatment of hypertensive patients leading to better blood pressure (BP) control according to a cluster-randomised controlled trial.

There is evidence that patients with hypertension may not receive appropriate increase in treatment if their initial antihypertensive therapy does not sufficiently control their BP, and some small studies that suggest doctor-pharmacist collaboration can be helpful in managing such patients. This study aimed to evaluate the effect of such collaboration using a robust study design. It involved patients from six community family medicine clinics in Iowa, USA, all of which had existing clinical pharmacists in post. Clinics were randomised to intervention or control, and a random sample of patients with poorly controlled hypertension was identified at each. All clinics received educational materials on BP management before the study began. In the intervention group, the clinical pharmacists undertook greatly increased collaboration with the physician and direct patient care; those in the control group continued normal working but abstained from direct patient care. Primary outcome was adherence to hypertension guidelines; secondary outcomes included BP control in the identified patients.

There were 402 study patients (control n=210, intervention n=192). Baseline adherence to guidelines was 49.4% (SD 19.3) in the control group and 40.4% (SD 22.6) in the intervention group. Over the study period, adherence improved to 53.4% (SD 18.1) and 62.8% (SD 13.5) at 6 months respectively (adjusted mean difference 9.6%; 95% CI, –2.3 to 21.5).

BP control improved significantly in the intervention group, mean BP decreasing by 6.8/4.5 mm Hg in the control group and 20.7/9.7 mm Hg in the intervention group (P < .05 for between-group systolic BP comparison). Adjusted difference in systolic BP was –12.0 (95% CI, –24.0 to 0.0) mm Hg). Compared to the control group, significantly more patients in the intervention group had controlled BP at the end of the study (29.9% vs. 63.9%; adjusted odds ratio, 3.2; 95% CI, 2.0-5.1; P < .001).

The authors conclude that the collaboration achieved significant improvements in BP control in hypertensive patients, and suggest that this team-based approach to the management of hypertension was highly effective. They comment that further studies are needed in larger and more diverse populations to address some of the limitations of their study, however the results suggest that allocating practice-based clinical pharmacists to provide more direct patient management may be beneficial.