News|Articles|September 5, 2024

Pharmacist-Led Interventions Improve Hypertension Outcomes in Remote Program

Findings were presented at the American Heart Association's Hypertension Scientific Sessions in Chicago, Illinois.

A new study found that a program combining remote blood pressure monitoring with pharmacist interventions was successful in helping 74% of adults with treatment-resistant high blood pressure achieve a blood pressure reading below 140/90 mm HG within 1 year. Additionally, the study found that pharmacist interactions were linked with an average decline of 1.3 mm HG per month in systolic blood pressure over time.

Results were presented in an abstract at the American Heart Association’s 2024 Hypertension Scientific Sessions in Chicago, Illinois, held from September 5 to September 8.¹

Key Takeaways

A combined program of remote blood pressure monitoring and pharmacist interventions was highly successful in helping adults with treatment-resistant high blood pressure achieve blood pressure control.

Pharmacists' interactions with patients were associated with a notable decline in systolic blood pressure.

The study's findings suggest that this approach could be a feasible and effective solution for managing high blood pressure, particularly in rural areas or for patients with limited access to health care.

“This is an important program that allows for more efficient management of a high-risk patient group,” said Wanpen Vongpatanasin, MD, FAHA, professor in the department of internal medicine at UT Southwestern Medical Center, director of UT Southwestern Medical Center’s Hypertension Section in the division of cardiology and clinical chair of the Hypertension Scientific Sessions 2024 Executive Committee, in a news release.² “This program’s team-based care approach including a pharmacist remotely makes it a feasible option to increase access.”

The study targeted patients in a largely rural health system with blood pressure higher than 140/90 mm HG, defined by the American Heart Association 2017 clinical guidelines as stage 2 hypertension,³ and who were receiving care in clinics specializing in kidney conditions.

Participants were identified and enrolled through a program called ConnectedCare365 Hypertension Management. The program provides people in central and northeast Pennsylvania with remote blood pressure monitoring devices and other tools to track their health data. Collected health data is then transmitted to a centralized monitoring center and used by doctors and pharmacists to co-manage patient care and adjust medications accordingly.

In total, 205 adults were enrolled, 53% of whom had a diagnosis of chronic kidney disease at the time of enrollment. Participants’ blood pressure was tracked for up to 6 to 12 months between March 2022 and May 2024.

During the initial 6 months of the program, at-home blood pressure readings were transmitted from patients’ devices to doctors who collaborated with pharmacists through a virtual platform. Based on these, doctors assessed blood pressure measurements, as well as prescribed and adjusted blood pressure medications as necessary.

During the following 6 months, readings were transmitted first to pharmacists, who collaborated with doctors through a telehealth practice agreement to co-manage patient care.

By virtue of the program, 67% of patients were able to achieve blood pressure control of 140/90 mm HG or less at 6 months, and 74% of patients were able to achieve blood pressure control by 12 months.

Moreover, systolic blood pressure was reduced by an average of 3.3 mm HG per month (95% CI: -3.5, -3.1) for those with initial blood pressure readings greater than 150/90 mm HG; reduced by 2.4 mm HG per month (95% CI: -2.6, -2.1) for those with initial readings in the range of 140-149/90-99 mm HG; and reduced by 0.6 mm HG per month (95% CI: -0.9, -0.4) for those with initial readings lower than 140/90 mm HG.

Patients spoke directly with pharmacists about hypertension management in 65% of cases, and pharmacist interactions were associated with a reduction of 1.3 mm HG per month (95% CI: -1.6, -1.1) in systolic blood pressure over time.

In collaboration with physicians, pharmacists also played a key role in adjusting medication and prescribing new medications for 46% and 37% of patients, respectively.

Although there was no different in the number of reported emergency department visits, patients experienced fewer hospitalizations during the study period compared to the previous 12 months.

“We know that home blood pressure monitoring can be done by patients accurately and can really help engage patients in their own health. However, we also know that these self-measured blood pressure readings often do not make it back to patients’ health care team, therefore, delays in adjusting medications are very common,” said Alexander Chang, MD, MS, a nephrologist and associate professor in the department of nephrology and the department of population health sciences as Geisinger Health in Danville, Pennsylvania, in the same release.² “This type of physician-pharmacist collaborative model with home blood pressure monitoring that is centrally received and monitored by the care team can help address these issues.”

The clinical benefits of pharmacists and telemonitoring, both separately and together, have been demonstrated in abundance when it comes to promoting better health outcomes. The necessity of these interventions is underscored by the prevalence of high blood pressure: nearly half of adults in the US—equating to a staggering 1119.9 million—have hypertension, yet only 1 in 4 adults with high blood pressure have it under control.⁴

Investigators hope that the current data can “help provide more justification in expanding these types of programs.”²

References

1. Remote monitoring and pharmacist helped improve hard-to-control blood pressure. News release. EurekAlert. September 5, 2024. Accessed September 5, 2024. https://www.eurekalert.org/news-releases/1056848

2. Bitton N, Krumich C, Webster LK, et al. Evaluation of a remote patient monitoring hypertension program with telehealth pharmacist management in nephrology clinic patients. Presented at: American Heart Association’s Hypertension Scientific Sessions; September 5-8, 2024; Chicago, IL. Abstract MP-11. https://htn.apprisor.org/epsAbstractHTN.cfm?id=2

3. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in Hypertension. 2018 Jun;71(6):e136-e139. doi: 10.1161/HYP.0000000000000075] [published correction appears in Hypertension. 2018 Sep;72(3):e33. doi: 10.1161/HYP.0000000000000080]. Hypertension. 2018;71(6):1269-1324. doi:10.1161/HYP.0000000000000066

4. Hypertension cascade: hypertension prevalence, treatment and control estimates among US adults aged 18 years and older applying the criteria from the American College of Cardiology and American Heart Association’s 2017 hypertension guideline—NHANES 2017 NHANES 2017–March 2020. Report. Million Hearts. Published 2023. Accessed September 5, 2024. https://millionhearts.hhs.gov/data-reports/hypertension-prevalence.html

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