Minneapolis, MN—
Pharmacists can make a significant difference in helping patients manage uncontrolled hypertension and lower their risk for cardiovascular disease.

An article
in Hypertension describes a cluster-randomized trial in 16 primary care clinics that showed that 12 months of home blood pressure telemonitoring and pharmacist management lowered blood pressure more than usual care (UC) for 24 months. 

HealthPartners Institute–led researchers report the incidence of cardiovascular events—nonfatal myocardial infarction, nonfatal stroke, hospitalized heart failure, coronary revascularization, and cardiovascular death—and costs over 5 years of follow-up.

The telemonitoring intervention, which was overseen by pharmacists, involved 228 patients, compared with 222 in the UC group.

Results indicate that 15 cardiovascular events—five myocardial infarction, four stroke, five heart failure, one cardiovascular death—occurred among 10 patients in the telemonitoring intervention group, while 26 events—11 myocardial infarction, 12 stroke, three heart failure—occurred among 19 patients in the UC group.

Researchers calculate that the cardiovascular composite end point incidence was 4.4% in the telemarketing intervention group versus 8.6% in the usual-care group (odds ratio, 0.49 [95% CI, 0.21-1.13], P = .09). When including two coronary revascularizations in the TI group and 10 in the UC group, the authors report that the secondary cardiovascular composite end point incidence was 5.3% in the TI group versus 10.4% in the UC group (odds ratio, 0.48 [95% CI, 0.22–1.08], P = .08). 

The authors explain that microsimulation modeling showed the difference in events far exceeded predictions based on observed blood pressure.

The pharmacist-led intervention also was cost-effective, according to the study.  Intervention costs (in 2017 US dollars) were $1,511 per patient. “Over 5 years, estimated event costs were $758, 000 in the TI group and $1,538,000 in the UC group for a return on investment of 126% and a net cost savings of about $1,900 per patient,” the authors note.

“Telemonitoring with pharmacist management lowered blood pressure and may have reduced costs by avoiding cardiovascular events over 5 years,” researchers conclude.

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