Effect of pharmaceutical care on blood pressure control and health-related quality of life in patients with resistant hypertension

Souza, Wesley Angelino de; Yugar‐Toledo, Juan Carlos; Bergsten-Mendes, Gun; Sabha, Maricene; Moreno, Heitor

doi:10.2146/ajhp060547

Cited by 44 publications

(38 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The remaining 7 studies were not included because the data were not extractable 56,58,60 and a comparison contemporary control group was not used. [18][19][20]57 Effects on SBP. Sensitive outcomes were reported in 11 of 13 studies evaluating SBP.…”

Section: Control Groupmentioning

confidence: 99%

“…12 One systematic review, which included studies from 1978 to 2006, assessed pharmacist interventions in hypertensive patients in order to enhance patients' adherence to medication and reduce systolic BP (SBP) and diastolic BP (DBP). 13 Since then, several important RCTs [14][15][16][17] and non-RCTs [18][19][20] have been conducted to assess the effect of pharmacist interventions on medication adherence and BP control in hypertensive patients.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Pharmacist interventions to enhance blood pressure control and adherence to antihypertensive therapy: Review and meta-analysis

Morgado

Morgado²,

Mendes

et al. 2011

American Journal of Health-System Pharmacy

143

107

View full text Add to dashboard Cite

Purpose. Pharmacist interventions to enhance blood pressure (BP) control and adherence to antihypertensive therapy in adults with essential hypertension were reviewed. Methods. A literature search was conducted to identify relevant articles describing pharmacist interventions intended to improve adherence to antihypertensive medications. Studies were included if they described a pharmacist intervention to improve medication adherence and analyzed adherence to therapy and BP control as outcomes. A fixed-effects model was used to combine data from randomized controlled trials. Results. A total of 15 studies were identified, testing 16 different interventions and containing data on 3280 enrolled patients. Although 87.5% of the interventions resulted in significant improvements in treatment outcomes, only 43.8% of the interventions were associated with significant increases in medication adherence. All interventions that increased antihypertensive medication adherence also significantly reduced BP. Almost all the interventions that were effective in increasing adherence to medication were complex, including combinations of different strategies. Metaanalysis of 2619 patients in 8 studies found that pharmacist interventions significantly reduced systolic blood pressure (SBP) (p < 0.001) and diastolic blood pressure (DBP) (p = 0.002) and that the meta-analytic differences in SBP and DBP changes from baseline to endpoint in intervention and control groups were -4.9 ± 0.9 mm Hg (p < 0.001) and -2.6 ± 0.9 mm Hg (p < 0.001), respectively. Conclusion. A literature review and metaanalysis showed that pharmacist interventions can significantly improve medication adherence, SBP, DBP, and BP control in patients with essential hypertension. Interventions were complex and multifaceted and included medication management in all analyzed studies.

show abstract

Section: Control Groupmentioning

confidence: 99%

mentioning

confidence: 99%

Pharmacist interventions to enhance blood pressure control and adherence to antihypertensive therapy: Review and meta-analysis

Morgado

Morgado²,

Mendes

et al. 2011

American Journal of Health-System Pharmacy

143

107

View full text Add to dashboard Cite

show abstract

“…The prevalence of diabetes was similar in both groups 15.3% in the UCRH and 17.5% in the CRH (P ¼ 0.55). Patients were evaluated for adherence to treatment, 8 and underwent clinical optimization of antihypertensive therapy. 9 Office BP was measured at least three times with the patients in a seated position, using a digital BP monitor (OMRON Healthcare Inc., Bannockburn, IL, USA).…”

Section: Subjectsmentioning

confidence: 99%

Non-dipping pattern relates to endothelial dysfunction in patients with uncontrolled resistant hypertension

et al. 2011

View full text Add to dashboard Cite

Resistant hypertension (RHTN) includes both patients whose blood pressure (BP) is uncontrolled on three or more medications (uncontrolled RHTN (UCRH)) and patients whose BP is controlled with use of four or more drugs (controlled RHTN (CRH)). It is unknown whether endothelial function and nocturnal drop demonstrate a similar pattern in patients with CRH and UCRH. We examined circadian BP patterns and vascular function in these patients. In all, 40 CRH and 26 UCRH patients, and 25 normotensives underwent biochemical testing, ambulatory BP monitoring, determination of brachial artery responses to endothelial-dependent (flow-mediated; dilation (FMD)) and independent (nitroglycerin mediated) stimuli. The nighttime drop in systolic BP (SBP) and diastolic BP (DBP) was less pronounced in UCRH than in CRH (SBP, 1.9±1.6 versus 4.9 ± 1.7%; DBP, 7.5 ± 1.8 versus 10.9 ± 1.8%, UCRH and CRH, respectively; Po0.05). FMD was greater in control group compared with RHTN patients. Patients with UCRH had significantly impaired FMD compared with CRH (5.9 ± 2.3% versus 7.1 ± 5.1%; Po0.0001). Therefore, UCRH patients have less nocturnal dipping and a more impaired endothelial response compared with CRH patients. These findings suggest that important differences among patients with RHTN may allow identify subgroups with increased cardiovascular risk.

show abstract

“…Patients with secondary forms of hypertension, impaired renal function, ischemic heart disease, liver disease, stroke, peripheral vascular disease, dyslipidemia, diabetes, smokers or any other major diseases were excluded. Patients were submitted to investigation with included adherence to treatment [13][14][15] and clinical optimization of antihypertensive therapy. 12 Ambulatory BP monitoring (Spacelabs 90207, Spacelabs Inc, Redmon, WA, USA) was used only to exclude pseudoresistanse to hypertensive treatment and as an auxiliary method to characterize UCRH and CRH.…”

Section: Patient Populationmentioning

confidence: 99%

Characteristics of resistant hypertension: ageing, body mass index, hyperaldosteronism, cardiac hypertrophy and vascular stiffness

et al. 2010

View full text Add to dashboard Cite

Resistant hypertension (RHTN) includes patients whose blood pressure (BP) is controlled with the use of four or more antihypertensive medications, and is referred to as 'controlled resistant hypertension' (CRH). While specifically comparing patients with CRH and uncontrolled resistant hypertension (UCRH), we hoped to identify distinguishing characteristics that would provide insight into factors contributing to resistance to antihypertensive therapies. RHTN patients were identified as controlled (CRH, n ¼ 43) or uncontrolled (UCRH, n ¼ 47). No statistical differences were observed between the CRH and UCRH subgroups with respect to age and gender. The body mass index, aldosterone-renin ratio and pulse wave velocity (PWV) were significantly higher in UCRH patients. Although both subgroups showed increased cardiac mass, left ventricular mass index was significantly higher in UCRH compared with CRH patients. Multivariate linear regression analysis indicated that PWV was significantly dependent on age in both UCRH and CRH patients; however, the influence of ageing was more pronounced in the former subgroup. Older age, greater vascular stiffness, higher aldosterone levels and greater left ventricular hypertrophy were significantly associated with lack of BP control in patients with RHTN. These findings suggest important possibilities in terms of preventing and better treating RHTN.

show abstract

Effect of pharmaceutical care on blood pressure control and health-related quality of life in patients with resistant hypertension

Abstract: The pharmaceutical care provided by a pharmacist in an ambulatory care clinic in Brazil improved BP, adherence to antihypertensive medications, and the social functioning of patients with resistant hypertension.

Cited by 44 publications

References 21 publications

Pharmacist interventions to enhance blood pressure control and adherence to antihypertensive therapy: Review and meta-analysis

Pharmacist interventions to enhance blood pressure control and adherence to antihypertensive therapy: Review and meta-analysis

Non-dipping pattern relates to endothelial dysfunction in patients with uncontrolled resistant hypertension

Characteristics of resistant hypertension: ageing, body mass index, hyperaldosteronism, cardiac hypertrophy and vascular stiffness

Contact Info

Product

Resources

About