Hypertenion: Sensitivity of Patient Outcomes to Pharmacist Interventions. Part II: Systematic Review and Meta-Analysis in Hypertension Management

Abstract

Spanish

French

Background:

Hypertension is a major health concern worldwide due to its deleterio us impact. Few studies have quantitatively assessed pharmacists’ interventions in hypertensive patients.

Objectives:

To identify and quantify outcomes sensitive to pharmacists’ interventions.

Methods:

International Pharmaceutical Abstracts, MEDLINE, Cochrane Central, and EMBASE were searched from inception through December 2006. Two independent reviewers identified articles; results were compared and resolved through consensus. Data extracted included intervention type, patient numbers, demographics, study characteristics, instruments used, data compared, and outcomes reported. A random effects meta-analysis was used to combine data. Study quality was assessed using the Downs–Black scale.

Results:

Of 203 potential articles identified, 98 were selected and their abstracts were read. Nine of these were reviewed full-text and 19 more were identified from references, resulting in a total of 28 articles. Research designs included 18 randomized controlled trials, 6 single-arm clinical trials, 3 nonrandomized comparative trials, and 1 database study. Average quality score was 66% ± 12% (fair). Medication management (82%) and hypertension education (68%) were the interventions most used. Thirty-nine study results (57% of all outcomes evaluated) were sensitive to pharmacists’ interventions. Meta-analysis of 2246 patients in 13 studies found that pharmacists’ interventions significantly reduced systolic blood pressure (10.7 ± 11.6 mm Hg; p = 0.002), while controls remained unchanged (3.2 ± 12.1 mm Hg; p = 0.361). Pharmacists’ interventions further reduced systolic blood pressure (6.9 ± 12.1 mm Hg;p = 0.047) over controls. Nonsensitive results included further reduction in diastolic blood pressure (3.6 ± 3.7 mm Hg; p = 0.06), quality of life (1 of 8 significant), and adherence (5 of 13 significant).

Conclusions:

Systolic blood pressure is sensitive to pharmacists’ interventions. Other outcomes may also be sensitive; however, more high-quality studies are needed for a comprehensive quantitative assessment

Keywords

hypertension pharmaceutical care pharmacist intervention

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