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Coronary Artery Disease and Hypertension: Outcomes of a Pharmacist‐Managed Blood Pressure Program
Author(s) -
McConnell Karen J.,
Zadvorny Emily B.,
Hardy Angela M.,
Delate Thomas,
Rasmussen Jon R.,
Merenich John A.
Publication year - 2006
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.26.9.1333
Subject(s) - medicine , blood pressure , coronary artery disease , cardiology , diabetes mellitus , myocardial infarction , population , pharmacist , angiotensin converting enzyme , cohort , pharmacy , nursing , endocrinology , environmental health
Study Objective . To assess the effectiveness of a pharmacist‐managed service in improving hypertension control among patients with coronary artery disease. Design . Prospective cohort study Setting . Health maintenance organization. Patients . Three hundred seventy‐six patients with uncontrolled hypertension and coronary artery disease. Intervention . Pharmacist‐managed, physician‐supervised population‐management approach to optimize evidence‐based drug management. Measurements and Main Results . Blood pressure reduction and control were evaluated, as well as the use of angiotensin‐converting enzyme inhibitors and generic antihypertensive drugs during 7‐month follow‐up. At baseline, mean ± SD age was 70.4 ± 8.8 years, 247 (65.7%) were men, 201 (53.5%) had a history of myocardial infarction, and 237 (63.0%) had diabetes mellitus. Baseline mean systolic blood pressure was 151 mm Hg, and none had achieved their blood pressure goal. During follow‐up, mean systolic blood pressure decreased 16.1 mm Hg overall (p<0.001), and 179 (47.6%) patients achieved their goal blood pressure (p<0.001). Blood pressure reductions were 14.7 and 18.4 mm Hg in patients with and patients without diabetes, respectively (p<0.001). The target dose for angiotensin‐converting enzyme inhibitors was achieved in 252 (67.0%) patients compared with 102 (27.1%) at baseline (p<0.001). Generic fill rates for antihypertensive drugs continued to be higher than 95% during follow‐up (p=0.723). Conclusion . A pharmacist‐managed, physician‐supervised population‐management approach in patients with coronary artery disease significantly improved blood pressure control. Clinically meaningful reductions in blood pressure were achieved by using evidence‐based, cost‐effective drug regimens.