When it comes to helping high blood pressure patients manage their hypertension, a new study from Tulane University finds that pharmacists and community health workers have the best success rates.
The study, published in Circulation: quality and cardiovascular outcomesThey analyzed data from 100 hypertension trials around the world and compared blood pressure reductions according to the type of health professionals leading the interventions.
While interventions led by nurses, physicians, and multiple health professionals still significantly reduced patients’ blood pressure, pharmacists achieved the greatest improvements, followed by community health workers.
Interventions in both clinical and community settings can effectively treat hypertension – the leading preventable cause of premature death worldwide – particularly in communities where economic and geographic barriers allow the disease to remain prevalent. The study results suggest that the disease is best managed by healthcare professionals who have more time available.
“Blood pressure may require more time to monitor than is typically available in primary care visits,” said senior author Katherine Mills, an associate professor and vice chair of epidemiology at the Tulane University School of Public Health and Tropical Medicine. “Having someone leading the effort who doesn’t have the same time constraints may be the most effective approach.”
On average, pharmacist-led interventions reduced systolic blood pressure by 7.3 mmHg and community health workers saw a drop of 7.1 mmHg. Nurse- and pharmacist-led interventions saw a reduction of between 2 and 3 mmHg in systolic blood pressure. Pharmacist- and community health worker-led interventions also saw the largest decreases in diastolic blood pressure. According to current guidelines, hypertension is diagnosed at 130/80 mmHg and above in adults.
Mills said she was not surprised by the results and that “the good news is that all health care professionals were effective in delivering interventions.” But when it comes to addressing the different individual medical needs of hypertensive patients, pharmacists may be best suited to that role.
“One of the big challenges is getting the right combinations and doses of antihypertensive medications, and that can be difficult for some patients who require repeat visits,” Mills said. “Pharmacists are perfect for that.”
“This study underscores the importance of a team-based approach to care to help keep blood pressure under control,” said Lawrence J. Fine, MD, senior advisor in the Prevention and Clinical Applications Branch in the Division of Cardiovascular Sciences at the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health (NIH). “In addition to traditional health care providers, such as physicians, other team members, such as pharmacists and community health care workers, can be effective in helping people achieve their treatment goals, particularly as blood pressure control has declined nationwide in recent years,” Fine said.
Community health workers are also likely to be highly effective in their interventions because of cultural ties to the community that can help build trust and foster acceptance. In addition, the use of community health workers is often more cost-effective compared to interventions led by other health professionals.
“Hypertension often has no symptoms, so it is not usually the first concern of patients during brief primary care visits if they have multiple health problems. The goal is to determine who should lead these interventions and what is the best strategy to address this important health problem,” Mills said.
This study was supported by grants from the NIH, including the NHLBI (UH3HL151309, UH3HL152373, R01HL133790), the National Institute of General Medical Sciences (P20GM109036), the National Institute on Aging (R33AG068481), and the National Institute of Minority Health and Health Disparities (R01MD018193).