Programa de Pós-Graduação em Saúde Coletiva, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Candeias, Vitória da Conquista, Brazil.
Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Candeias, Vitória da Conquista, Brazil; Programa de Pós-Graduação em Assistência Farmacêutica em Rede e Associação de Instituições de Ensino Superior, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Brazil.
Clin Ther. 2023 Oct;45(10):941-946. doi: 10.1016/j.clinthera.2023.06.007. Epub 2023 Jun 24.
Incorporating technology such as home blood pressure monitoring (HBPM) into the clinical routine generates opportunities to improve BP monitoring and control in primary health care. It is also important to prevent overtreatment. However, the combination of HBPM with collaborative drug therapy management (CDTM) has not yet been studied. This study aimed to assess the efficacy of combining HBPM with CDTM to optimize hypertension treatment for older patients.
This open-label, parallel-group, randomized clinical trial was conducted between June 2021 and August 2022 in a Brazilian community pharmacy and included older patients (aged ≥60 years) with hypertension. Those who were classified as poorly adherent or nonadherent to the prescribed drug treatment or who were unable to perform HBPM were excluded. In the control group, participants received a BP monitor and instructions on how to perform HBPM. A general practitioner, who was provided a report with the obtained BP values, determined any changes to the treatment protocol. In the intervention group, a pharmacist enrolled participants in a drug therapy management protocol and provided the general practitioner with suggestions to optimize the antihypertensive drug therapy, in addition to the report with the BP values. The following outcomes were considered: the proportion of participants receiving deprescriptions of antihypertensive drugs, other treatment adjustments, and the difference in mean BP between the groups 45 days after performing HBPM. The study used a t test combined with Levene's test to calculate mean intergroup differences in BP, the paired t test to calculate mean intragroup differences in BP, and Pearson's χ test to determine intergroup differences in changes in drug therapy.
In each group, 161 participants completed the trial. Antihypertensive agents were deprescribed for 31 (19.3%) participants in the intervention group versus 11 (6.8%) in the control group (P = 0.01). In addition, 14 (8.7%) participants were prescribed antihypertensive drugs in the intervention group versus 11 (6.8%) in the control group (P = 0.52). The mean office systolic BP and HBPM values were lower in the intervention group (P = 0.22 and P = 0.29, respectively).
Combining HBPM with a CDTM protocol effectively optimized antihypertensive treatment for older patients in a primary health care setting.
gov identifier: NCT04861727.
将家庭血压监测（HBPM）等技术纳入临床常规，为改善初级保健中的血压监测和控制提供机会。防止过度治疗也很重要。然而，HBPM 与协作药物治疗管理（CDTM）的结合尚未得到研究。本研究旨在评估将 HBPM 与 CDTM 相结合以优化老年患者高血压治疗的疗效。
这是一项于 2021 年 6 月至 2022 年 8 月在巴西社区药房进行的开放标签、平行组、随机临床试验，纳入了患有高血压的老年患者（年龄≥60 岁）。那些被归类为不遵守或不遵守规定药物治疗或无法进行 HBPM 的患者被排除在外。在对照组中，参与者接受了血压监测仪和如何进行 HBPM 的说明。一名全科医生收到了获得的血压值报告，确定了治疗方案的任何更改。在干预组中，药剂师为药物治疗管理方案招募参与者，并向全科医生提供建议，以优化抗高血压药物治疗，除了血压值报告。考虑了以下结果：接受抗高血压药物减药的参与者比例、其他治疗调整以及进行 HBPM 后 45 天两组之间平均血压的差异。该研究使用 t 检验结合 Levene 检验计算 BP 组间差异的平均值，使用配对 t 检验计算 BP 组内差异的平均值，并使用 Pearson's χ 检验确定药物治疗变化的组间差异。
在每组中，有 161 名参与者完成了试验。在干预组中，有 31 名（19.3%）参与者接受了抗高血压药物减药，而对照组中为 11 名（6.8%）（P=0.01）。此外，干预组中有 14 名（8.7%）参与者被开了抗高血压药物，而对照组中有 11 名（6.8%）（P=0.52）。干预组的诊室收缩压和 HBPM 平均值较低（P=0.22 和 P=0.29）。
将 HBPM 与 CDTM 方案相结合，有效地优化了初级保健中老年患者的抗高血压治疗。
gov 标识符：NCT04861727。
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