Community Pharmacy and Blood Pressure Control.

W idespread, effective identification and management of uncontrolled hypertension remains elusive, undermining our ability to reduce the impact of stroke and heart disease. The statistics are widely appreciated: ≈30% of North Americans have hypertension, and almost half of this hyper-tension is uncontrolled. Nearly 1000 people a day die of complications attributed to hypertension, and direct and indirect costs amount to $46 billion a year in the United States alone. 1 Effective management of blood pressure for the 70 million adults in the United States who currently have hypertension would clearly overwhelm our existing primary care system. There are already ≈39 million physician office visits for essential hypertension per year. 2 Article see p 93 Fortunately, help is available. Community pharmacies are one of the most widely available healthcare resources in North America. 3 A substantial body of research has been emerged over the past 20 years documenting the effectiveness of team-based approaches that incorporate pharmacists. Indeed, these approaches have been summarized in several systematic reviews and meta-analyses including the recent Community Guide prepared for the US Preventive Services Task Force. 4–6 Across the variety of interventions tested, the results have generated a rather consistent and compelling pattern of significant reductions in systolic and diastolic blood pressures when pharmacists are deployed to help manage blood pressure. The vast majority of these randomized clinical trials, however, were designed and conducted in medical clinics, including academic medical centers , as opposed to community pharmacies. The question of how transportable these interventions are into the community where the majority of pharmacists and people with hypertension interact is less well described and evaluated. The Community Guide noted 3 community pharmacy–based interventions, 2 of which were conducted in Canada and the third was conducted in the United States. 7–9 Internationally, there have been ≈16 random-ized, controlled trials of community pharmacist interventions, and their results are consistent with the clinic-based approaches. 5 Our group more recently demonstrated that community pharmacists can indeed improve blood pressure control, and adherence, as well, in the United States. 10 These results were particularly significant because the patient population consisted exclusively of blacks with uncontrolled hypertension. Another chain pharmacy–based program also reported positive effects on blood pressure control and adherence, 11 and the Asheville Project, a community collaboration between insurance plans, hospitals, and community pharmacists, likewise demonstrated reductions in blood pressure, although that was not their only targeted outcome. 12 In this …