Morgado Manuel P, Morgado Sandra R, Mendes Liliana C, Pereira Luísa J, Castelo-Branco Miguel
Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.
Am J Health Syst Pharm. 2011 Feb 1;68(3):241-53. doi: 10.2146/ajhp090656.
Pharmacist interventions to enhance blood pressure (BP) control and adherence to antihypertensive therapy in adults with essential hypertension were reviewed.
A literature search was conducted to identify relevant articles describing pharmacist interventions intended to improve adherence to antihypertensive medications. Studies were included if they described a pharmacist intervention to improve medication adherence and analyzed adherence to therapy and BP control as outcomes. A fixed-effects model was used to combine data from randomized controlled trials.
A total of 15 studies were identified, testing 16 different interventions and containing data on 3280 enrolled patients. Although 87.5% of the interventions resulted in significant improvements in treatment outcomes, only 43.8% of the interventions were associated with significant increases in medication adherence. All interventions that increased antihypertensive medication adherence also significantly reduced BP. Almost all the interventions that were effective in increasing adherence to medication were complex, including combinations of different strategies. Meta-analysis of 2619 patients in 8 studies found that pharmacist interventions significantly reduced systolic blood pressure (SBP) (p < 0.001) and diastolic blood pressure (DBP) (p = 0.002) and that the meta-analytic differences in SBP and DBP changes from baseline to endpoint in intervention and control groups were -4.9 ± 0.9 mm Hg (p < 0.001) and -2.6 ± 0.9 mm Hg (p < 0.001), respectively.
A literature review and meta-analysis showed that pharmacist interventions can significantly improve medication adherence, SBP, DBP, and BP control in patients with essential hypertension. Interventions were complex and multifaceted and included medication management in all analyzed studies.
对药剂师干预措施进行综述，以提高原发性高血压成人患者的血压（BP）控制水平及抗高血压治疗依从性。
进行文献检索，以识别描述旨在提高抗高血压药物依从性的药剂师干预措施的相关文章。若研究描述了药剂师干预措施以改善药物依从性，并将治疗依从性和血压控制作为结果进行分析，则纳入该研究。采用固定效应模型合并随机对照试验的数据。
共识别出15项研究，测试了16种不同的干预措施，纳入患者3280例。虽然87.5%的干预措施使治疗结果有显著改善，但只有43.8%的干预措施与药物依从性显著提高相关。所有提高抗高血压药物依从性的干预措施也显著降低了血压。几乎所有有效提高药物依从性的干预措施都很复杂，包括不同策略的组合。对8项研究中的2619例患者进行的荟萃分析发现，药剂师干预措施显著降低了收缩压（SBP）（p<0.001）和舒张压（DBP）（p = 0.002），干预组和对照组从基线到终点的SBP和DBP变化的荟萃分析差异分别为-4.9±0.9 mmHg（p<0.001）和-2.6±0.9 mmHg（p<0.001）。
文献综述和荟萃分析表明，药剂师干预措施可显著提高原发性高血压患者的药物依从性、SBP、DBP及血压控制水平。干预措施复杂且多方面，所有分析研究均包括药物管理。
