Physician‐Pharmacist Co‐Management and 24‐Hour Blood Pressure Control

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Abstract
The objectives of this study were to compare indices of 24‐hour blood pressure (BP) following a physician‐pharmacist collaborative intervention and to describe the associated changes in antihypertensive medications. This was a secondary analysis of a prospective, cluster‐randomized clinical trial conducted in 6 family medicine clinics randomized to co‐managed (n=3 clinics, 176 patients) or control (n=3 clinics, 198 patients) groups. Mean ambulatory systolic BP (SBP) was significantly lower in the co‐managed vs the control group: daytime BP 122.8 mm Hg vs 134.4 mm Hg (P<.001); nighttime SBP 114.8 mm Hg vs 123.7 mm Hg (P<.001); and 24‐hour SBP 120.4 mm Hg vs 131.8 mm Hg (P<.001), respectively. Significantly more drug changes were made in the co‐managed than in the control group (2.7 vs 1.1 changes per patient, P<.001), and there was greater diuretic use in co‐managed patients (79.6% vs 62.6%, P<.001). Ambulatory BPs were significantly lower for the patients who had a diuretic added during the first month compared with those who never had a diuretic added (P<.01). Physician‐pharmacist co‐management significantly improved ambulatory BP compared with the control group. Antihypertensive drug therapy was intensified much more for patients in the co‐managed group.
Funding Information
  • National Heart, Lung, and Blood Institute (HL069801, HL070740)
  • Agency for Healthcare Research and Quality (#5U18HSO16094)
  • Comprehensive Access and Delivery Research and Evaluation

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