A collaborative cardiologist-pharmacist care model to improve hypertension management in patients with or at high risk for cardiovascular disease

  • Brian K. Irons
  • Gary Meyerrose
  • Sherry Laguardia
  • Kweku Hazel
  • Charles F. Seifert


Physician led collaborative drug therapy management utilizing clinical pharmacists to aid in the medication management of patients with hypertension has been shown to improve blood pressure control. With recommendations for lower blood pressures in patients with coronary artery disease, a cardiologist-pharmacist collaborative care model may be a novel way to achieve these more rigorous goals of therapy.

Objective: The purpose of this project was to evaluate this type of care model in a high cardiac risk patient population.

Methods: A retrospective cohort study determined the ability of a cardiologist-pharmacist care model (n=59) to lower blood pressure and achieve blood pressure goals (< 130/80 mmHg) in patients with or at high risk for coronary artery disease compared to usual cardiologist care (n=58) in the same clinical setting.

Results: The cardiologist-pharmacist care model showed a higher percentage of patients obtaining their goal blood pressure compared to cardiologist care alone, 49.2% versus 31.0% respectively, p=0.0456. Greater reductions in systolic blood pressure (-22 mmHg versus -12 mmHg, p=0.0077) and pulse pressure (-15 mmHg versus -7 mmHg, p=0.0153) were noted in the cardiologist-pharmacist care model. No differences in diastolic blood pressure were found. There was a shorter duration of clinic follow-up (7.0 versus 13.2 months, p=0.0013) but a higher frequency of clinic visits (10.7 versus 3.45, p<0.0001) in the cardiologist-pharmacist care model compared to usual care. The number of antihypertensive agents used did not change over the time period evaluated.

Conclusion: This study suggests a team-based approach to hypertensive care using a collaborative cardiologist-pharmacist care model improves blood pressure from baseline in a high cardiac risk patient population and was more likely to obtain more stringent blood pressure goals than usual care.


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1. American Heart Association. Heart disease and stroke statistics – 2010 Update. Circulation. 2010;121:e46-e215.

2. Wong N, Lopez V, L’Italien G, Chen R, Kline S, Franklin S. Inadequate4 control of hypertension in US adults with cardiovascular disease comorbidities in 2003-2004. Arch Intern Med. 2007;167(22):2431-2436.

3. Egan B, Zhao Y, Axon R. US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008. JAMA. 2010;303(20):2043-2050.

4. Law M, Morris J, Wald N. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ. 2009;338:b1665.

5. Rosendorff C, Black H, Cannon C, Gersh B, Gore J, Izzo J, Kaplan N, O’Connor C, O’Gara P, Oparil S. Treatment of hypertension in the prevention and management of ischemic heart disease. Circulation. 2007;115(21):2761-2788.

6. Chobanian A, Bakris G, Black H, Cushman W, Green L, Izzo J, Jones D, Materson B, Oparil S, Wright J, Roccella E. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. JAMA. 2003;289(19):2560-2572.

7. Williams B, Poulter N, Brown M, Davis M, McInnes G, Potter J, Sever P, Thom S. British Hypertension Society Guidelines for hypertension management. BMJ. 2004;328:634-640.

8. World Health Organization (WHO) / International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens. 2002;21:1983-1992.

9. The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). 2007 Guidelines for the management of arterial hypertension. European Heart Journal. 2007;28:1462-1536.

10. Lipton H. Home is where the health is: Advancing team-based care in chronic disease management. Arch Intern Med. 2009;169(21):1945-1948.

11. Walsh J, McDonald K, Shojania, Sundaram V, Nayak S, Lewis R, Owens D, Goldstein M. Quality improvement strategies for hypertension management. Med Care. 2006;44(7):646-657.

12. Robinson J, Segal R, Lopez L, Doty R. Impact of a pharmaceutical care intervention on blood pressure control in a chain pharmacy practice. Ann Pharmacother. 2010;44:88-96.

13. Carter B, Elliott W. The role of pharmacists in the detection, management, and control of hypertension: A national call to action. Pharmacotherapy. 2000;20(2):119-122.

14. Green B, Cook A, Ralston J, Fishman P, Catz S, Carlson J, Carrell D, Tyll L, Larson E, Thompson R. Effectiveness of home blood pressure monitoring, web communication, and pharmacist care in hypertension control. JAMA. 2008;299(24):2857-2867.

15. Mehos B, Saseen J, MacLaughlin E. Effect of pharmacist intervention and initiation of home blood pressure monitoring in patients with uncontrolled hypertension. Pharmacotherapy. 2000;20(11):1384-1389.

16. Carter B, Ardery G, Dawson J, James P, Bergus G, Doucette W, Chrischilles E, Franciscus C, Xu Y. Physician and pharmacist collaboration to improve blood pressure control. Arch Intern Med. 2009;169(21):1996-2002.

17. Vivian E. Improving blood pressure control in a pharmacist-managed hypertension clinic. Pharmacotherapy. 2002:22(12):1533-1540.

18. Okamoto M, Nakahiro R. Pharmacoeconomic evaluation of a pharmacist-managed hypertension clinic. Pharmacotherapy. 2001;21(11):1337-1344.

19. Bogden P, Abbott R, Williamson P, Onopa J, Koontz L. Comparing standard care with a physician and pharmacist team approach for uncontrolled hypertension. J Gen Intern Med. 1998;13:740-745.

20. Borenstein J, Graber G, Saltiel E, Wallace J, Ryu S, Jackson A, Deutsch S, Weingarten S. Physician-pharmacist comanagement of hypertension: A randomized, comparative trial. Pharmacotherapy. 2003;23(2):209-216.

21. McConnell K, Zadvorny E, Hardy A, Delate T, Rasmussen J, Merenich J. Coronary artery disease and hypertension: Outcomes of a pharmacist-managed blood pressure program. Pharmacotherapy. 2006;26(9):1333-1341.

22. Turchin A, Goldberg S, Shubina M, Einbinder J, Conlin P. Encounter frequency and blood pressure in hypertensive patients with diabetes mellitus. Hypertension. 2010;56(1):68-74.

23. Arguedas J, Perez M, Wright J. Treatment blood pressure targets for hypertension. Cochrane Database Syst Rev. 2009;(3):CD004349.

24. Cooper-DeHoff R, Gong Y, Handberg E, Bavry A, Denardo S, Bakris G, Pepine C. Tight blood pressure control and cardiovascular outcomes among hypertensive patients with diabetes and coronary artery disease. JAMA. 2010;304(1):61-68.

25. The ACCORD Study Group. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362(17):1575-1585.

26. Mancia G, Laurent S, Agabiti-Rosei, E, Ambrosioni E, Burnier M, Caulfield M, Cifkova R, Clement D, Coca A, Dominiczak A, Erdine S, Fagard R, Farsang C, Grassi G, Haller H, Heaferty A, Kjeldsen S, Kiowski W, Mallion J, Manolis A, Narkiewicz K, Nilsson P, Olsen M, Rahn K, Redon J, Rodicio J, Ruilope L, Schmeider R, Struijker-Boudier H, va Zwieten P, Viigimaa M, Zanchetti A. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hyperten. 2009;27:2121-2158.

27. Carter B, Ogers M, Daly J, Zheng S, James P. The potency of team-based care interventions for hypertension. Arch Intern Med. 2009;169(19):1748-1755.

28. The European trial on reduction of cardiac events with perindopril in stable coronary artery disease investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomized, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet. 2003;362:782-788.

29. Vaccarino V, Holford T, Krumholz H. Pulse pressure and risk for myocardial infarction and heart failure in the elderly. J Am Coll Cardiol. 2000;36:130-138.
Original Research