Pharmacist Interventions in the Management of Blood Pressure Control and Adherence to Antihypertensive Medications: A Systematic Review of Randomized Controlled Trials

Abstract

Objective: Pharmacists are ideally positioned to promote optimal use and assess the adherence of prescription medications in patients with chronic diseases. This systematic review of randomized controlled trials (RCTs) ascertains the effectiveness of pharmacist interventions to improve blood pressure (BP) control and medication adherence in patients with hypertension. Data Sources: Electronic databases were searched for studies in English published between January 1, 1995, and January 31, 2018. Eligibility criteria included patients with a diagnosis of hypertension tested with RCT where pharmacist-led interventions occurred. The primary outcome was BP control and the secondary outcome was adherence to hypertensive medication. Quality of studies was assessed using the Cochrane Risk of Bias Tool. Data Synthesis: Thirty-five studies met the inclusion–exclusion criteria and were included in this study. Major themes included pharmacist-led interventions with medication counseling, patient education, distribution of interventions materials, individualized care plans, and check-in meetings. The vast majority of trials (n = 29) showed statistically significant improvement in BP in the intervention groups at follow-up. Of the 35 studies, most (n = 20) assessed medication adherence; several trials (n = 9) showed statistically significant improvement in medication adherence in patients receiving additional pharmaceutical care services. None of the RCTs was considered to have a high risk of bias. Conclusion: Pharmacist-led interventions improved BP control and medication adherence through education, counseling, or a combination of both. Future research is needed to determine the most effective pharmacists’ interventions in managing hypertension and to assess the cost-effectiveness of these interventions.