Pharmacist Impact on First-Line Antihypertensives in African American Patients

Mia Y. Reid, Jamie E. Coates, Naomi Y. Yates, Bennett McDonald
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Abstract

Introduction Current guidelines recommend thiazide/thiazide-type diuretics and dihydropyridine calcium channel blockers as first-line agents in treating African Americans with hypertension. The purpose of this study is to examine the impact that ambulatory care clinical pharmacy specialists (CPSs) had on initiation of first-line antihypertensives in the African American population within an integrated healthcare system. Methods This retrospective, matched, observational cohort analysis included African American patients with hypertension not receiving a first-line antihypertensive as of September 1, 2021. Patients followed by CPSs were matched up to 1:4 on age and sex to patients not followed by CPSs. The primary outcome was the percentage of patients started on first-line antihypertensive(s) after working with CPSs. Conditional logistic regression was used to analyze outcomes. Results A total of 865 patients followed by CPSs were matched to 3,192 patients not followed by CPSs. Patients followed by CPSs were initiated on first-line antihypertensives at a significantly higher rate (adjusted OR 1.98, 95% CI 1.63-2.41), and a clinically significant improvement in blood pressure was observed with systolic improving an average of 22 points and diastolic 13 points. 283 patients managed by CPSs achieved blood pressure less than 135/85 mmHg. Conclusion The initiation of first-line antihypertensives in African American patients by CPSs led to clinically significant reductions in systolic and diastolic blood pressure which supports CPS involvement in hypertension management. The assessment of study outcomes provides guidance to clinical decision-making and contributes to the development of key practice standards across both physician and clinical pharmacy specialist services.
药剂师对非裔美国患者一线抗高血压药物的影响
导言:现行指南推荐将噻嗪/噻嗪类利尿剂和二氢吡啶类钙通道阻滞剂作为治疗非裔美国人高血压的一线药物。本研究旨在探讨非住院医疗临床药学专家(CPSs)对综合医疗系统中非裔美国人一线降压药使用的影响。方法 这项回顾性、匹配、观察性队列分析包括截至 2021 年 9 月 1 日未接受一线降压药治疗的非裔美国高血压患者。接受 CPS 随访的患者与未接受 CPS 随访的患者在年龄和性别上的配对比例为 1:4。主要结果是与 CPS 合作后开始接受一线降压治疗的患者比例。条件逻辑回归用于分析结果。结果 共有 865 名接受 CPS 随访的患者与 3192 名未接受 CPS 随访的患者进行了配对。接受 CPS 随访的患者开始服用一线降压药的比例明显更高(调整后 OR 1.98,95% CI 1.63-2.41),血压也有明显的临床改善,收缩压平均改善了 22 点,舒张压平均改善了 13 点。283 名接受 CPS 管理的患者血压低于 135/85 mmHg。结论CPS对非裔美国人患者使用一线降压药后,收缩压和舒张压均有显著降低,支持CPS参与高血压管理。对研究结果的评估为临床决策提供了指导,并有助于制定医生和临床药学专家服务的关键实践标准。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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