Department of Pharmacology and Therapeutics, State University of Maringá, Maringá, PR, Brazil.
J Pharm Pharm Sci. 2011;14(2):249-63. doi: 10.18433/j3259q.
To examine the effect of a pharmaceutical care program on the coronary heart disease risk in elderly diabetic and hypertensive patients.
A total of 200 elderly (> 60 years) diabetic and/or hypertensive patients were recruited into a randomized, controlled, prospective clinical trial with a 36-month follow-up, developed in a public primary health care unit in a municipality in the Brazilian State of Sao Paulo. A range of clinical measurements were evaluated at the baseline and up to 36 months afterwards. The intervention group patients received pharmaceutical care from a clinical pharmacist, whereas the control group patients received their usual care from the medical and nursing staff. The Framingham scoring method was used to estimate changes in the 10-year coronary heart disease risk scores of all the patients.
A total of 194 patients completed the study. Significant reductions (p < 0.05) in the mean values (baseline vs. 36 months) for the systolic blood pressure [156.7 mmHg vs 133.7 mmHg; P < 0.001), diastolic blood pressure (106.6 mmHg vs. 91.6 mmHg; P < 0.001),fasting glucose (135.1 mg/dL vs. 107.9 mg/dL; P < 0.001), hemoglobin A1C (7.7% vs. 7.0%; P <0.001), triglycerides (206.0 mg/dL vs. 152.5 mg/dL; P < 0.001), low-density lipoprotein (LDL)cholesterol (112.4 mg/dL vs. 102.0 mg/dL; P < 0.001), high-density lipoprotein cholesterol (55.5 mg/dL vs. 65.5 mg/dL; P < 0.001), total cholesterol (202.5 mg/dL vs. 185.9 mg/dL; P < 0.001), body mass index (26.2 kg/m2 vs. 26.1 kg/m2; P < 0.001), and abdominal circumference (103.2 cm vs. 102.5 cm; P= 0.001) were observed in the intervention group, whereas no significant changes were verified in the control group. The mean Framingham risk prediction score in the intervention group was 6.8% at baseline and decreased to 4.5%; P < 0.001) after 36 months, but remained unchanged in the control group.
The pharmaceutical care program resulted in better clinical measurements and reduced the cardiovascular risk scores in elderly diabetic and hypertensive patients over a 36-month period.
研究药物治疗方案对老年糖尿病和高血压合并冠心病患者的冠心病风险的影响。
在巴西圣保罗州一个市级的公立基层医疗单位，开展了一项为期 36 个月的随机、对照、前瞻性临床试验，共招募了 200 名年龄大于 60 岁的糖尿病和/或高血压老年患者。在基线和之后的 36 个月内评估了一系列临床指标。干预组患者由临床药师提供药物治疗，而对照组患者则由医护人员提供常规护理。采用 Framingham 评分法评估所有患者 10 年内冠心病风险评分的变化。
共有 194 名患者完成了研究。干预组的收缩压[156.7mmHg 与 133.7mmHg；P＜0.001]、舒张压[106.6mmHg 与 91.6mmHg；P＜0.001]、空腹血糖[135.1mg/dL 与 107.9mg/dL；P＜0.001]、糖化血红蛋白[7.7%与 7.0%；P＜0.001]、三酰甘油[206.0mg/dL 与 152.5mg/dL；P＜0.001]、低密度脂蛋白胆固醇[112.4mg/dL 与 102.0mg/dL；P＜0.001]、高密度脂蛋白胆固醇[55.5mg/dL 与 65.5mg/dL；P＜0.001]、总胆固醇[202.5mg/dL 与 185.9mg/dL；P＜0.001]、体重指数[26.2kg/m2 与 26.1kg/m2；P＜0.001]和腰围[103.2cm 与 102.5cm；P=0.001]等临床指标均有显著降低（P＜0.05），而对照组则无显著变化。干预组 Framingham 风险预测评分在基线时为 6.8%，36 个月后降至 4.5%（P＜0.001），而对照组则保持不变。
在 36 个月的时间内，药物治疗方案改善了老年糖尿病和高血压合并冠心病患者的临床指标，并降低了心血管风险评分。
