Pharmacist care in hypertension management: systematic review of randomized controlled trials

BACKGROUND: Hypertension management remains a major public health challenge in primary care. Recent hypertension guidelines recommend the involvement of pharmacists for team-based care management. Our objective was to systematically review the evidence of the impact of pharmacist care alone, or in collaboration, on blood pressure (BP) amongst hypertensive outpatients compared with usual care. One major focus was to assess the heterogeneity in the effects of these interventions to identify which ones work best in a given healthcare setting. METHODS: A systematic literature search was conducted for any article published up to 05.12.2022 in MEDLINE, EMBASE, CENTRAL, CINAHL, Web of Science, and Trip databases. Randomized controlled trials assessing the effect of pharmacist interventions on BP among outpatients were included. Results were synthesized descriptively and, where appropriate, pooled across studies to perform meta-analysis. We have previously published the study protocol in BMJ Open and registered in PROSPERO (CRD42021279751). RESULTS: 2048 study records were identified by electronic database searching. After removal of duplicates, 2006 were independently screened based on title and abstract by two authors (VG, ST), and 253 full texts were evaluated. A total of 90 studies with 33425 patients were included for data extraction. These studies were published between 1973 and 2022 and conducted in different regions (North America: n = 45, Europe: n = 17, other: n = 28). The preliminary random-effects summary estimate of the effect of pharmacist intervention is -6.6 mmHg (95% CI: -8.0 to -5.2) for systolic BP and -3.2 mmHG (95% CI: -4.1 to -2.2) for diastolic BP. Further results on the heterogeneity in the effects are in preparation. CONCLUSIONS: This systematic review provides updated evidence on the effect of pharmacist intervention on hypertension management. Pharmacist-directed or -collaborative interventions improve hypertension management. KEY MESSAGES: • Pharmacist-directed or -collaborative interventions improve hypertension management. • This systematic review provides updated evidence on the effect of pharmacist interventions on hypertension management.