College of Pharmacy, University of Minnesota, Minneapolis, Minnesota 55404, USA.
Curr Opin Nephrol Hypertens. 2011 Sep;20(5):498-503. doi: 10.1097/MNH.0b013e32834902c8.
Inadequately controlled blood pressure is considered an important risk factor for both chronic kidney disease (CKD) progression and cardiovascular disease progression in CKD patients. Patients with CKD and hypertension are typically followed in primary care practice settings and blood pressure is not controlled in a sizeable proportion. This review will focus on the evidence which demonstrates the important role of the pharmacist in collaboration with physicians within primary care practices to improve blood pressure management in CKD patients.
Several lines of evidence show that pharmacists working in collaboration with primary care physicians can improve blood pressure management as compared with usual care with a physician alone. The major effects of pharmacist intervention are to intensify antihypertensive regimens and improve medication adherence.
Currently, hypertension is not well controlled in a significant proportion of individuals with CKD. Recent studies in the CKD population support evidence from the general population that pharmacists as part of the collaborative care team improves blood pressure management. Research is needed to demonstrate cost-effectiveness of collaborative care models in management of hypertension and other comorbid conditions in CKD patients.
未得到充分控制的血压被认为是慢性肾脏病（CKD）患者发生 CKD 进展和心血管疾病进展的一个重要危险因素。患有 CKD 和高血压的患者通常在初级保健实践环境中接受治疗，而相当大比例的患者血压并未得到控制。本综述将重点关注表明药师在初级保健实践中与医生合作改善 CKD 患者血压管理方面发挥重要作用的证据。
多项证据表明，与仅由医生提供的常规护理相比，药师与初级保健医生合作可以更好地管理血压。药师干预的主要效果是加强降压治疗方案并提高药物依从性。
目前，相当大比例的 CKD 患者的高血压并未得到很好的控制。CKD 人群中的最近研究支持来自一般人群的证据，即药师作为协作护理团队的一部分可改善血压管理。需要研究来证明协作护理模式在管理 CKD 患者的高血压和其他合并症方面的成本效益。
