Pharmacist-physician comanagement of hypertension and reduction in 24-hour ambulatory blood pressures.
Pharmacist-physician comanagement of hypertension and reduction in 24-hour ambulatory blood pressures.
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DOI：
10.1001/archinternmed.2010.349
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发表时间：
2010-10-11
影响因子：
--
通讯作者：
Carter, Barry L.
中科院分区：
文献类型：
--
作者：
Weber, Cynthia A.;Ernst, Michael E.;Sezate, Genesis S.;Zheng, Shimin;Carter, Barry L.
药剂师-医师共同管理高血压已被证明可以改善办公室血压（BP）。我们试图描述这种模型对24小时动态血压的影响。我们对来自爱荷华州爱荷华州市五个初级保健诊所的179例未控制的高血压患者进行了前瞻性、随机分组对照临床试验。患者按门诊随机分为两组，一组接受药师-医师协作治疗高血压（干预），另一组接受常规治疗（对照），为期9个月。在干预组中，药剂师帮助患者识别血压控制的障碍，建议改变生活方式和饮食，并与患者的初级保健提供者合作调整抗高血压治疗。药剂师至少每2个月对患者进行一次检查。在基线和研究结束时获得动态BP。评价了175例患者的基线和研究结束时动态BP曲线。与对照组相比，干预组的动态血压降低程度更大（白天ΔSBP [SD] 15.2[11.5] vs 5.5[13.5]，p<0.001;夜间ΔSBP [SD] 12.2[14.8] vs 3.4[13.3]，p<0.001; 24小时ΔSBP [SD] 14.1[11.3] vs 5.5[12.5]，p<0.001）。通过24小时动态血压监测，干预组中更多患者在研究结束时血压得到控制（75% vs 50.7%，p<0.001）。药师-医师协作管理高血压实现了持续和显著的24小时血压降低和高血压控制率。
Pharmacist-physician co-management of hypertension has been shown to improve office blood pressures (BP). We sought to describe the effect of such a model on 24-hour ambulatory BPs. We performed a prospective, cluster-randomised controlled clinical trial in 179 patients with uncontrolled hypertension from five primary care clinics in Iowa City, Iowa. Patients were randomized by clinic to receive pharmacist-physician collaborative management of hypertension (intervention) or usual care (control) for a 9-month period. In the intervention group, pharmacists helped patients identify barriers to BP control, counselled on lifestyle and dietary modifications, and adjusted antihypertensive therapy in collaboration with the patient’s primary care provider. Patients were seen by pharmacists a minimum every 2 months. Ambulatory BP was obtained at baseline and study end. Baseline and end of study ambulatory BP profiles were evaluated for 175 patients. Ambulatory BPs were reduced to a greater extent in the intervention compared to control group (daytime ΔSBP [SD] 15.2[11.5] vs 5.5[13.5], p<0.001; nighttime ΔSBP [SD] 12.2[14.8] vs 3.4[13.3], p<0.001; 24-hour ΔSBP [SD] 14.1[11.3] vs 5.5[12.5], p<0.001). More patients in the intervention group had BP controlled at the end of the study (75% vs 50.7%, p<0.001) as defined by overall 24-hour ambulatory BP monitoring. Pharmacist-physician collaborative management of hypertension achieved consistent and significantly greater reduction in 24-hour BP and a high rate of BP control.
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影响因子：
120.7
作者：
Green, Beverly B.;Cook, Andrea J.;Thompson, Robert S.
通讯作者：
Thompson, Robert S.
影响因子：
--
作者：
Von Muenster, Shannon J.;Carter, Barry L.;Xu, Yinghui
通讯作者：
Xu, Yinghui
影响因子：
3.2
作者：
Finkielman, JD;Schwartz, GL;Turner, ST
通讯作者：
Turner, ST
影响因子：
8.3
作者：
Banegas, Jose R.;Segura, Julian;Ruilope, Luis M.
通讯作者：
Ruilope, Luis M.
影响因子：
158.5
作者：
Clement, DL;De Buyzere, ML;O'Brien, E
通讯作者：
O'Brien, E