The impact of pharmacist‐led interventions on blood pressure control among patients with chronic kidney disease: A randomized controlled trial

Abstract

Introduction Only about 50% of patients with high blood pressure (BP) and chronic kidney disease (CKD) comorbidity have their BP controlled. Objectives The objectives of the study were to determine whether pharmacist‐led interventions reduce mean BP and improve BP control in hypertensive patients with CKD compared with usual care. Methods This 12‐month prospective, double‐blind, randomized, controlled trial was conducted at two major hospitals in Nigeria. Seventy‐four participants were randomized to the usual care arm serving as the control and 73 participants were randomized to the intervention arm. The intervention arm received home BP monitors, and pharmacological and nonpharmacological (education and training on self‐management of CKD and hypertension, and text messages) interventions. Results Baseline characteristics were similar between the intervention (n = 73) and usual care (n = 74) participants. However, significantly more females were in the intervention arm compared with the usual care arm (71.2% vs 52.7%; P = .021). Compared with the usual care arm, systolic BP (SBP) significantly decreased by 7.12 mmHg from baseline (P = .020) in the intervention arm. Higher proportions of patients gained BP control from baseline to 6 months (27.4% vs 13.5%, P = .095), and from baseline to 12 months (20.5% vs 8.1%, P = .096) in the intervention arm than the usual care. There were no statistical differences, but clinical differences were observed. Conclusion This trial demonstrates that including a clinical pharmacist in a team care setting can improve BP reduction and control in patients with CKD and hypertension. Trial registration http://clinicaltrials.gov NCT05254392.

Does home blood pressure monitoring improve blood pressure‐related outcomes in people living with chronic kidney disease? A systematic review

“…Where reported, the mean age was 56.7 (± 7.7) years. Nine studies were RCTs, 14,[16][17][18][19][20][21][22][23] while nine were of quasi-experimental design. 15,[24][25][26][27][28][29][30][31] Five studies were conducted in people undergoing hemodialysis (HD), seven in people with NDD-CKD, and the remaining either conducted in mixed samples or renal transplant receivers (RTRs).…”

“…BP, blood pressure; DBP, diastolic blood pressure; SBP, systolic blood pressure.effects that may have occurred early during the intervention or following its completion. For example, the largest RCT22 included in the review showed no effect on SBP and DBP at 12 months (the length of the intervention) following a comprehensive intervention involving education, counseling, and blood pressure reviews. However, a significantly lower SBP (−8.5 mmHg) was observed in the intervention arm at an intermediate analysis at 6 months, with a clinically significant proportion of participants in the intervention also achieving targets for blood pressure control from baseline to 6 months (27.4% vs. 13.5%) and from 6 to 12 months (20.5% vs. 8.1%).…”