Charles George VA Medical Center, Asheville, NC 28805.
J Manag Care Spec Pharm. 2014 Sep;20(9):905-11. doi: 10.18553/jmcp.2014.20.9.905.
Two-thirds of Americans who are prescribed antihypertensive medications are not at a blood pressure (BP) goal of <140/90 mmHg, and low adherence is identified as a primary cause of inadequate control. Improved adherence to antihypertensive medications has been shown to enhance BP control and reduce the risk of cardiovascular complications. This study investigated the effectiveness of a pill box clinic to improve BP in veterans with uncontrolled hypertension taking 3 or more antihypertensive medications.
To (a) investigate the reduction of systolic BP by 10 mmHg from pre-intervention to post-intervention (primary outcome) and (b) investigate the percentage of patients meeting goal blood pressure--as defined by The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7)--and percentage of patient adherence to antihypertensive medications (secondary outcomes).
Patients with uncontrolled hypertension currently taking at least 3 antihypertensive medications were enrolled in this prospective pre/post study. Under the supervision of a pharmacist, each patient was provided two 7-day pill boxes to organize all antihypertensive medications. In addition, baseline BP and previous history of nonadherence were documented. Following the initial encounter, patients attended 2 follow-up appointments, at 2 and 4 weeks, for refill of pill boxes, BP measurement, and adherence assessment. A chi-square test was used for categorical outcomes and logistic regression for nominal outcomes as well as descriptive statistics, as appropriate.
Sixty patients were enrolled, with 50 completing appointments 1 and 2, and 45 completing all 3 appointments. Of those, 24% and 31% achieved at least a 10 mmHg reduction in systolic BP from baseline to appointments 2 and 3, respectively (P = 0.438). Systolic BP readings for appointments 1, 2, and 3 were not statistically significant (mean [SD]: 134.1 [11.8], 131.9 [9.4], and 130.6 [11.4], respectively). Goal BP per JNC7 was achieved by 44% and 51% of patients at appointments 2 and 3, respectively, compared with baseline (P = 0.201). All patients had ≥ 80% adherence to antihypertensive medications, assessed via pill counts at the second and third appointments.
Although results were not statistically significant, the pill box clinic resulted in clinically significant reductions in systolic BP by 10 mmHg, as well as an increased number of patients meeting prescribed BP goals.
三分之二服用抗高血压药物的美国人血压未达到<140/90mmHg 的目标值，而低依从性被认为是控制不佳的主要原因。提高抗高血压药物的依从性已被证明可增强血压控制并降低心血管并发症的风险。本研究调查了药丸盒诊所对改善服用 3 种或更多种抗高血压药物的未控制高血压退伍军人的血压的有效性。
(a) 从干预前到干预后收缩压降低 10mmHg（主要结局），(b) 调查符合第七次联合国家委员会预防、检测、评估和治疗高血压报告（JNC7）规定的目标血压的患者百分比以及抗高血压药物患者依从性的百分比（次要结局）。
本前瞻性预/后研究纳入了目前服用至少 3 种抗高血压药物且血压未得到控制的患者。在药剂师的监督下，每位患者均提供了两个 7 天的药丸盒来整理所有的抗高血压药物。此外，记录了基线血压和之前的不依从史。初次就诊后，患者在 2 周和 4 周时进行 2 次随访，以补充药丸盒、测量血压和评估依从性。对于分类结果，使用卡方检验，对于名义结果，使用逻辑回归以及适当的描述性统计。
共纳入 60 例患者，其中 50 例完成了第 1 次和第 2 次就诊，45 例完成了所有 3 次就诊。其中，从基线到第 2 次和第 3 次就诊，分别有 24%和 31%的患者收缩压至少降低了 10mmHg（P=0.438）。第 1、2 和 3 次就诊的收缩压读数无统计学意义（平均值[标准差]：134.1[11.8]、131.9[9.4]和 130.6[11.4]）。根据 JNC7，第 2 次和第 3 次就诊时分别有 44%和 51%的患者达到了规定的血压目标值，与基线相比（P=0.201）。通过第二次和第三次就诊时的药丸计数评估，所有患者的抗高血压药物依从性均≥80%。
尽管结果无统计学意义，但药丸盒诊所可使收缩压降低 10mmHg，达到临床显著水平，并且有更多的患者符合规定的血压目标值。
