Pharmacist Impact on First-Line Antihypertensives in African American Patients

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.