Improving blood pressure control through pharmacist interventions: a meta-analysis of randomized controlled trials

Abstract

Background: Control of blood pressure (BP) remains a major challenge in primary care. Innovative interventions to improve BP control are therefore needed. By updating and combining data from 2 previous systematic reviews, we assess the effect of pharmacist interventions on BP and identify potential determinants of heterogeneity.

Methods and results: Randomized controlled trials (RCTs) assessing the effect of pharmacist interventions on BP among outpatients with or without diabetes were identified from MEDLINE, EMBASE, CINAHL, and CENTRAL databases. Weighted mean differences in BP were estimated using random effect models. Prediction intervals (PI) were computed to better express uncertainties in the effect estimates. Thirty-nine RCTs were included with 14 224 patients. Pharmacist interventions mainly included patient education, feedback to physician, and medication management. Compared with usual care, pharmacist interventions showed greater reduction in systolic BP (-7.6 mm Hg, 95% CI: -9.0 to -6.3; I(2)=67%) and diastolic BP (-3.9 mm Hg, 95% CI: -5.1 to -2.8; I(2)=83%). The 95% PI ranged from -13.9 to -1.4 mm Hg for systolic BP and from -9.9 to +2.0 mm Hg for diastolic BP. The effect tended to be larger if the intervention was led by the pharmacist and was done at least monthly.

Conclusions: Pharmacist interventions - alone or in collaboration with other healthcare professionals - improved BP management. Nevertheless, pharmacist interventions had differential effects on BP, from very large to modest or no effect; and determinants of heterogeneity could not be identified. Determining the most efficient, cost-effective, and least time-consuming intervention should be addressed with further research.

Keywords: hypertension; pharmacist; prediction interval; systematic review; team‐based care.

Figure 1.

Forest plot of the mean difference in (A) systolic and (B) diastolic blood pressure with pharmacist care compared with usual care group. n=number of participants.

Figure 2.

Forest plot of the mean difference in (A) systolic and (B) diastolic blood pressure with pharmacist care compared with usual care group according to type of care (pharmacist‐led care vs collaborative care). n=number of participants.

Figure 3.

Forest plot of the mean difference in (A) systolic and (B) diastolic blood pressure with pharmacist care compared with usual care group according to frequency of intervention (once a month or more frequently, less than once a month, irregularly/not specified). n=number of participants.