The Critical Role of Community Pharmacists in Blood Pressure Monitoring

Abstract

Arterial hypertension is the most important modifiable risk factor for cardiovascular morbidity and mortality. In some countries, pharmacists' patient-centered approach has become a common practice, and their role in supporting the management of cardiovascular disease has been successfully developed for years. In particular, recent findings have confirmed benefits of pharmacist-provided hypertension care. Current guidelines emphasize the need for regular BP measurements in subjects age 40 years and older, who are at increased risk of hypertension. A panel of experts in cardiology, hypertensiology, family medicine, and pharmacy presented a narrative review of implementing community pharmacy blood pressure (CPBP) measurements into Polish pharmacy practice to assist pharmacists in CPBP readings. The paper focuses on basic aspects of management of untreated patients with elevated blood pressure levels, as well as management of individuals diagnosed with hypertension, who should follow their primary care physicians' recommendations for anti-hypertensive therapy. The article also includes a few important aspects related to CPBP measurement, such as equipment and techniques. Development of ready-made schemes of procedures for patients with different results of blood pressure measurement could ensure a uniform standard of services provided by pharmacists. This gives an opportunity to provide such patients with medical care and initiate treatment, and facilitates effective maintenance of BP in hypertensive subjects. This article reviews the role of pharmacists in Poland in screening for hypertension by taking blood pressure measurements.

Figure 1

The blood pressure measurement in community pharmacy. SBP – systolic blood pressure (Canva Pro).

Figure 2

Detection of increased blood pressure in patients without diagnosed hypertension (A); in all patients (B) during community pharmacy blood pressure (CPBP) measurement – based on Waszyk-Nowaczyk et al (2020) [14]. SC – standard counseling session*; IC – intensive counseling session**; HRC – high-risk consultation***; HE – education in hypertension****. * It involves patient education about proper lifestyle and HTN prevention (eg, diet, physical activity). ** It might be expanded to include more detailed information considering the identified risk factors and lifestyle modification. Such advice should be tailored to the individual patient. For example, smokers should be informed that tobacco smoking is the single largest preventable cause of death, and is a significant risk factor of cardiovascular disease; they should also be encouraged and counseled regarding smoking cessation. *** If the average reading obtained from the measurements is at least 140 mmHg (systolic blood pressure, SBP) and/or 90 mmHg (diastolic blood pressure, DBP), the pharmacist can qualify the patient for a HRC with IC, bearing in mind possible development of HTN, as well as discussing risk factors for the disease. **** It would be valuable to tailor the pharmacist-led education to an individual patient with diagnosed hypertension and include information on whether the therapeutic targets set by the attending physician have been met. Education about healthy lifestyle, adherence to the doctor’s recommendations, or proper techniques of taking BP measurement could be also provided if needed.