Heart, Lung and Circulation

Efficacy of a Pharmacist-Managed Intervention for Improved Blood Pressure Control in Patients with Elevated Cardiovascular Disease Risk: Subgroup Analysis of the HAPPY RCT

      The Hypertension Adherence Program in Pharmacy (HAPPY) was a randomised controlled trial conducted in 60 Australian community pharmacies. The project compared changes to medicines adherence and blood pressure (BP) in a Pharmacist Care Group (PCG, receiving a multifaceted intensive intervention; n = 207) with those observed in a Usual Care Group (UCG; n = 188). The objective of this study was to analyse changes at six months to BP and self-reported medicines adherence among participants at elevated cardiovascular disease risk. Patients with diabetes, coronary heart disease, stroke or kidney disease were included. Half the participants (200/395) met eligibility criteria (high CVD risk status, BP data and self-reported adherence data). The only significant difference between groups at baseline was total number of medicines (PCG 6.8 vs. UCG 5.9; p = 0.03); other relevant social, demographic and clinical variables were comparable. Forty-two percent were nonadherent at baseline and average BP was 141.8/82.5 mm Hg. At six months, systolic BP improved significantly for PCG participants compared with UCG participants [−10.9 (95% CI −15.1 to −6.7) mm Hg vs. −2.8 (95% CI −7.7 to 2.0) mm Hg; p = 0.013]. Diastolic BP improved significantly only within the PCG (−4.2, 95% CI −6.8 to −1.5). Within-group UCG improvements to diastolic BP were not statistically significant (−2.7, 95% CI −5.3 to −0.13), nor were differences between groups (p = 0.44). No significant between-group differences were observed for medicines adherence. The intervention achieved reductions in BP that were statistically and clinically significant. Findings support previous evidence that pharmacist interventions deliver significant BP improvements.