Adding Pharmacist-Led Home Blood Pressure Telemonitoring to Usual Care for Blood Pressure Control: A Systematic Review and Meta-Analysis

Abstract

Health systems have been quickly adopting telemedicine throughout the United States, especially since the onset of the COVID-19 pandemic. However, there are limited data on whether adding pharmacist-led home blood pressure (BP) telemonitoring to office-based usual care improves BP. We searched PubMed/MEDLINE and Embase for randomized controlled trials from January 2000 until April 2022, comparing studies on pharmacist-led home BP telemonitoring with usual care. Six randomized controlled trials, including 1,550 participants, satisfied the inclusion criteria. There were 774 participants in the pharmacist-led telemonitoring group and 776 in the usual care group. The addition of pharmacist-led telemonitoring to usual care was associated with a significant decrease in systolic BP (mean difference −8.09, 95% confidence interval −11.15 to −5.04, p <0.001, I2 = 72%) and diastolic BP (mean difference −4.19, 95% confidence interval −5.58 to −2.81, p <0.001, I2 = 42%) compared with usual care. In conclusion, this meta-analysis showed that adding pharmacist-led home BP telemonitoring to usual care achieves better BP control than usual care alone. Health systems have been quickly adopting telemedicine throughout the United States, especially since the onset of the COVID-19 pandemic. However, there are limited data on whether adding pharmacist-led home blood pressure (BP) telemonitoring to office-based usual care improves BP. We searched PubMed/MEDLINE and Embase for randomized controlled trials from January 2000 until April 2022, comparing studies on pharmacist-led home BP telemonitoring with usual care. Six randomized controlled trials, including 1,550 participants, satisfied the inclusion criteria. There were 774 participants in the pharmacist-led telemonitoring group and 776 in the usual care group. The addition of pharmacist-led telemonitoring to usual care was associated with a significant decrease in systolic BP (mean difference −8.09, 95% confidence interval −11.15 to −5.04, p <0.001, I2 = 72%) and diastolic BP (mean difference −4.19, 95% confidence interval −5.58 to −2.81, p <0.001, I2 = 42%) compared with usual care. In conclusion, this meta-analysis showed that adding pharmacist-led home BP telemonitoring to usual care achieves better BP control than usual care alone. Hypertension, or high blood pressure (BP), is one of the most common chronic medical conditions managed in an outpatient setting in the United States and worldwide.1Margolis KL Crain AL Bergdall AR Beran M Anderson JP Solberg LI O'Connor PJ Sperl-Hillen JM Pawloski PA Ziegenfuss JY Rehrauer D Norton C Haugen P Green BB McKinney Z Kodet A Appana D Sharma R Trower NK Williams R Crabtree BF Design of a pragmatic cluster-randomized trial comparing telehealth care and best practice clinic-based care for uncontrolled high blood pressure.Contemp Clin Trials. 2020; 92105939Crossref PubMed Scopus (14) Google Scholar,2James PA Oparil S Carter BL Cushman WC Dennison-Himmelfarb C Handler J Lackland DT LeFevre ML MacKenzie TD Ogedegbe O Smith Jr, SC Svetkey LP Taler SJ Townsend RR Wright Jr, JT Narva AS Ortiz E 2014 Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the eighth joint national committee (JNC 8).JAMA. 2014; 311: 507-520Crossref PubMed Scopus (6092) Google Scholar Affecting approximately 30% of the US adult population,3Wright JT Jr Fine LJ Lackland DT Ogedegbe G Dennison Himmelfarb CREvidence supporting a systolic blood pressure goal of less than 150 mm Hg in patients aged 60 years or older: the minority view.Ann Intern Med. 2014; 160: 499-503Crossref PubMed Google Scholar,4Nwankwo T Yoon SS Burt V Gu Q. Hypertension among adults in the United States: National Health and Nutrition Examination Survey, 2011–2012.NCHS Data Brief. 2013; : 1-8PubMed Google Scholar it is a major risk factor for cardiovascular disease and accounts for about 35% of deaths.5Karamichalakis N Georgopoulos S Vlachos K Liatakis I Efremidis M Sideris A Letsas KP. Efficacy and safety of novel anticoagulants in the elderly.J Geriatr Cardiol. 2016; 13: 718-723PubMed Google Scholar,6Mozaffarian D Benjamin EJ Go AS Arnett DK Blaha MJ Cushman M Das SR de Ferranti S Després JP Fullerton HJ Howard VJ Huffman MD Isasi CR Jiménez MC Judd SE Kissela BM Lichtman JH Lisabeth LD Liu S Mackey RH Magid DJ McGuire DK Mohler ER Moy CS Muntner P Mussolino ME Nasir K Neumar RW Nichol G Palaniappan L Pandey DK Reeves MJ Rodriguez CJ Rosamond W Sorlie PD Stein J Towfighi A Turan TN Virani SS Woo D Yeh RW Turner MB Writing Group MembersAmerican Heart Association Statistics Committee, Stroke Statistics SubcommitteeExecutive summary: heart disease and stroke statistics–2016 update: a report from the American Heart Association.Circulation. 2016; 133: 447-454Crossref PubMed Scopus (2431) Google Scholar Unfortunately, medication adherence in hypertension remains relatively poor and complicates treatment.7Vrijens B Antoniou S Burnier M de la Sierra A Volpe M. Current situation of medication adherence in hypertension.Front Pharmacol. 2017; 8: 100Crossref PubMed Scopus (142) Google Scholar Additionally, the current and projected shortage of primary care providers (PCPs) in the coming years is expected to further limit patient access to care.8Zhang X Lin D Pforsich H Lin VW. Physician workforce in the United States of America: forecasting nationwide shortages.Hum Resour Health. 2020; 18: 8Crossref PubMed Scopus (93) Google Scholar These current and expected gaps in care may be minimized through the employment of telehealth and leveraging pharmacists as physician extenders. Telehealth has evolved rapidly to improve access to health care, especially after the onset of the COVID-19 pandemic, and provides a promising platform to help improve BP.9COVID-19 brings changes to NP scope of practice.Am J Nurs. 2020; 120: 14Crossref Scopus (9) Google Scholar, 10Kichloo A Albosta M Dettloff K Wani F El-Amir Z Singh J Aljadah M Chakinala RC Kanugula AK Solanki S Chugh S. Telemedicine, the current COVID-19 pandemic and the future: a narrative review and perspectives moving forward in the USA.Fam Med Community Health. 2020; 8PubMed Google Scholar, 11Tsuyuki RT Houle SK Charrois TL Kolber MR Rosenthal MM Lewanczuk R Campbell NR Cooney D McAlister FA RxACTION Investigators*Randomized trial of the effect of pharmacist prescribing on improving blood pressure in the community: the Alberta clinical trial in optimizing hypertension (RxACTION).Circulation. 2015; 132: 93-100Crossref PubMed Scopus (122) Google Scholar Indeed, telemedicine-based BP management has been found to reduce systolic BP (SBP) by 4 to 10 mm Hg compared with the usual office-based care.12Carter BL Bosworth HB Green BB. The hypertension team: the role of the pharmacist, nurse, and teamwork in hypertension therapy.J Clin Hypertens (Greenwich). 2012; 14: 51-65Crossref PubMed Scopus (113) Google Scholar,13Monaghesh E Hajizadeh A. The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence.BMC Public Health. 2020; 20: 1193Crossref PubMed Scopus (654) Google Scholar Notably, pharmacists play a crucial role in bridging the gap between patients and physicians, ensuring patient compliance, and initiating interventions in treatment in coordination with a physician.13Monaghesh E Hajizadeh A. The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence.BMC Public Health. 2020; 20: 1193Crossref PubMed Scopus (654) Google Scholar Maximizing pharmacists’ impact on BP control through telemonitoring has the potential to decrease the burden of hypertension, its complications and healthcare costs, and PCP workload.1Margolis KL Crain AL Bergdall AR Beran M Anderson JP Solberg LI O'Connor PJ Sperl-Hillen JM Pawloski PA Ziegenfuss JY Rehrauer D Norton C Haugen P Green BB McKinney Z Kodet A Appana D Sharma R Trower NK Williams R Crabtree BF Design of a pragmatic cluster-randomized trial comparing telehealth care and best practice clinic-based care for uncontrolled high blood pressure.Contemp Clin Trials. 2020; 92105939Crossref PubMed Scopus (14) Google Scholar,2James PA Oparil S Carter BL Cushman WC Dennison-Himmelfarb C Handler J Lackland DT LeFevre ML MacKenzie TD Ogedegbe O Smith Jr, SC Svetkey LP Taler SJ Townsend RR Wright Jr, JT Narva AS Ortiz E 2014 Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the eighth joint national committee (JNC 8).JAMA. 2014; 311: 507-520Crossref PubMed Scopus (6092) Google Scholar,12Carter BL Bosworth HB Green BB. The hypertension team: the role of the pharmacist, nurse, and teamwork in hypertension therapy.J Clin Hypertens (Greenwich). 2012; 14: 51-65Crossref PubMed Scopus (113) Google Scholar,13Monaghesh E Hajizadeh A. The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence.BMC Public Health. 2020; 20: 1193Crossref PubMed Scopus (654) Google Scholar We hypothesized that adding pharmacists’ telemonitoring to office visits would lead to better management of BP. In this systematic review and meta-analysis of randomized controlled trials (RCTs), we the in the and diastolic BP pharmacist-led home BP telemonitoring is to usual care in with usual care alone. We searched and Embase for studies from January 2000 until April with including pressure We on pharmacist-led telemonitoring home BP management in addition to usual care compared with usual care alone. adults with hypertension were PA Oparil S Carter BL Cushman WC Dennison-Himmelfarb C Handler J Lackland DT LeFevre ML MacKenzie TD Ogedegbe O Smith Jr, SC Svetkey LP Taler SJ Townsend RR Wright Jr, JT Narva AS Ortiz E 2014 Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the eighth joint national committee (JNC 8).JAMA. 2014; 311: 507-520Crossref PubMed Scopus (6092) Google Scholar in than and studies were with by a pharmacist through telehealth visits or in addition to usual care the were compared with usual care BP management in the office by physicians, physician The for and for systematic as by the United was D A J for and the Med. Scopus Google MJ I L JM SE R J JM A MM T E S J P The an guideline for systematic PubMed Scopus Google Scholar were in We data through a and the and were through a the The risk of was to the of a high risk of risk of or to in The of was the difference in and after to of telemedicine-based The of from to in the were with the We the and 95% confidence interval the effect The I2 was to We the difference in and between the pharmacist-led telemonitoring group and the usual care group. We from PubMed/MEDLINE and from In were after the based on of and inclusion criteria. and were with studies There were participants from of 774 participants were in the pharmacist-led group and 776 were in the usual care group. The studies were from to of the studies were in primary care in the United KL SE Bergdall AR SE O'Connor PJ Sperl-Hillen JM Trower NK of home blood pressure telemonitoring and pharmacist management on blood pressure a randomized clinical 2013; PubMed Scopus Google Scholar, BM of pharmacist and of home blood pressure in patients with uncontrolled 20: PubMed Google Scholar, BB PA J D L of home blood pressure and pharmacist care on hypertension a randomized controlled PubMed Scopus Google Scholar, DJ KL SJ A American Heart Association home blood pressure 2013; PubMed Scopus (113) Google Scholar was in a in and the was in a in N MJ F of a pharmacist in on blood pressure control in J Health 2012; PubMed Google S N H of blood pressure management in patients with a randomized control PubMed Scopus Google Scholar were including chronic and cardiovascular KL SE Bergdall AR SE O'Connor PJ Sperl-Hillen JM Trower NK of home blood pressure telemonitoring and pharmacist management on blood pressure a randomized clinical 2013; PubMed Scopus Google BM of pharmacist and of home blood pressure in patients with uncontrolled 20: PubMed Google DJ KL SJ A American Heart Association home blood pressure 2013; PubMed Scopus (113) Google Scholar, N MJ F of a pharmacist in on blood pressure control in J Health 2012; PubMed Google Scholar, S N H of blood pressure management in patients with a randomized control PubMed Scopus Google Scholar In the group home BP and pharmacist through telemonitoring in addition to usual KL SE Bergdall AR SE O'Connor PJ Sperl-Hillen JM Trower NK of home blood pressure telemonitoring and pharmacist management on blood pressure a randomized clinical 2013; PubMed Scopus Google Scholar, BM of pharmacist and of home blood pressure in patients with uncontrolled 20: PubMed Google Scholar, BB PA J D L of home blood pressure and pharmacist care on hypertension a randomized controlled PubMed Scopus Google Scholar, DJ KL SJ A American Heart Association home blood pressure 2013; PubMed Scopus (113) Google Scholar, N MJ F of a pharmacist in on blood pressure control in J Health 2012; PubMed Google Scholar, S N H of blood pressure management in patients with a randomized control PubMed Scopus Google Scholar The usual care group visits with PCP home BP and with the was through in In Green BB PA J D L of home blood pressure and pharmacist care on hypertension a randomized controlled PubMed Scopus Google Scholar a was in addition to in Magid DJ KL SJ A American Heart Association home blood pressure 2013; PubMed Scopus (113) Google Scholar the was through a The of the and usual care were and The the studies from to The of in the group was in the usual care of of BM of pharmacist and of home blood pressure in patients with uncontrolled 20: PubMed Google randomized controlled BB PA J D L of home blood pressure and pharmacist care on hypertension a randomized controlled PubMed Scopus Google randomized controlled medical an group practice in S N H of blood pressure management in patients with a randomized control PubMed Scopus Google controlled Heart in DJ KL SJ A American Heart Association home blood pressure 2013; PubMed Scopus (113) Google controlled primary care or KL SE Bergdall AR SE O'Connor PJ Sperl-Hillen JM Trower NK of home blood pressure telemonitoring and pharmacist management on blood pressure a randomized clinical 2013; PubMed Scopus Google group randomized controlled primary care in health in N MJ F of a pharmacist in on blood pressure control in J Health 2012; PubMed Google in = chronic = cardiovascular = in a of studies in pharmacist-led home blood pressure telemonitoring usual and and KL Crain AL Bergdall AR Beran M Anderson JP Solberg LI O'Connor PJ Sperl-Hillen JM Pawloski PA Ziegenfuss JY Rehrauer D Norton C Haugen P Green BB McKinney Z Kodet A Appana D Sharma R Trower NK Williams R Crabtree BF Design of a pragmatic cluster-randomized trial comparing telehealth care and best practice clinic-based care for uncontrolled high blood pressure.Contemp Clin Trials. 2020; 92105939Crossref PubMed Scopus (14) Google care with home BP home or pharmacist for was by data from significant difference in in usual care in pharmacist of participants in the group addition of medication in the control group years or current with one or to BP with a home and of an of hypertension, current to of and or PA Oparil S Carter BL Cushman WC Dennison-Himmelfarb C Handler J Lackland DT LeFevre ML MacKenzie TD Ogedegbe O Smith Jr, SC Svetkey LP Taler SJ Townsend RR Wright Jr, JT Narva AS Ortiz E 2014 Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the eighth joint national committee (JNC 8).JAMA. 2014; 311: 507-520Crossref PubMed Scopus (6092) Google BP and pharmacist and until BP controlled and less adherence was in the of in group from to after aged to with a and of disease or conditions were JT Jr Fine LJ Lackland DT Ogedegbe G Dennison Himmelfarb CREvidence supporting a systolic blood pressure goal of less than 150 mm Hg in patients aged 60 years or older: the minority view.Ann Intern Med. 2014; 160: 499-503Crossref PubMed Google of based usual care of by with as patients in as significant difference in in in BP mm and years of BP than or to mm and or patients and and and have the were T Yoon SS Burt V Gu Q. Hypertension among adults in the United States: National Health and Nutrition Examination Survey, 2011–2012.NCHS Data Brief. 2013; : 1-8PubMed Google home BP and pharmacist office-based adherence from a medication significant difference in adherence in pharmacist group usual of participants in the group addition of medication in the control group of and most BP were goal or or for with or or a PCP of the 10 access to years of or disease or were access to the N Georgopoulos S Vlachos K Liatakis I Efremidis M Sideris A Letsas KP. Efficacy and safety of novel anticoagulants in the elderly.J Geriatr Cardiol. 2016; 13: 718-723PubMed Google telemonitoring pharmacist for and until by D Benjamin EJ Go AS Arnett DK Blaha MJ Cushman M Das SR de Ferranti S Després JP Fullerton HJ Howard VJ Huffman MD Isasi CR Jiménez MC Judd SE Kissela BM Lichtman JH Lisabeth LD Liu S Mackey RH Magid DJ McGuire DK Mohler ER Moy CS Muntner P Mussolino ME Nasir K Neumar RW Nichol G Palaniappan L Pandey DK Reeves MJ Rodriguez CJ Rosamond W Sorlie PD Stein J Towfighi A Turan TN Virani SS Woo D Yeh RW Turner MB Writing Group MembersAmerican Heart Association Statistics Committee, Stroke Statistics SubcommitteeExecutive summary: heart disease and stroke statistics–2016 update: a report from the American Heart Association.Circulation. 2016; 133: 447-454Crossref PubMed Scopus (2431) Google adherence and in pharmacist group usual in of to and to BP BP or mm Hg most primary care and 4 or disease or or stroke of or 4 heart or less than patients with a B Antoniou S Burnier M de la Sierra A Volpe M. Current situation of medication adherence in hypertension.Front Pharmacol. 2017; 8: 100Crossref PubMed Scopus (142) Google home BP with physician visits during was adherence was between and significant in of patients in pharmacist group usual care significant in the medication in patients of with a BP the of to the were a a cardiovascular the changes in treatment during the were a for patients or = blood = = chronic = cardiovascular = diastolic blood = = home blood pressure = = = Heart PCP = primary care in a = chronic = cardiovascular = = blood = = chronic = cardiovascular = diastolic blood = = home blood pressure = = = Heart PCP = primary care The addition of pharmacist-led home BP telemonitoring to usual care was associated with a significant decrease in (mean difference −8.09, 95% −11.15 to −5.04, p <0.001, I2 = 72%) and (mean difference −4.19, 95% −5.58 to −2.81, p <0.001, I2 = 42%) compared with usual care These after studies in the was associated with an in the of BP compared with usual care by the in of the KL SE Bergdall AR SE O'Connor PJ Sperl-Hillen JM Trower NK of home blood pressure telemonitoring and pharmacist management on blood pressure a randomized clinical 2013; PubMed Scopus Google Scholar, BM of pharmacist and of home blood pressure in patients with uncontrolled 20: PubMed Google Scholar, BB PA J D L of home blood pressure and pharmacist care on hypertension a randomized controlled PubMed Scopus Google Scholar, DJ KL SJ A American Heart Association home blood pressure 2013; PubMed Scopus (113) Google Scholar, N MJ F of a pharmacist in on blood pressure control in J Health 2012; PubMed Google Scholar, S N H of blood pressure management in patients with a randomized control PubMed Scopus Google risk of in adherence was in of the the Green and of a of medication PubMed Google Scholar There was significant in adherence in 4 BM of pharmacist and of home blood pressure in patients with uncontrolled 20: PubMed Google DJ KL SJ A American Heart Association home blood pressure 2013; PubMed Scopus (113) Google Scholar, N MJ F of a pharmacist in on blood pressure control in J Health 2012; PubMed Google Scholar, S N H of blood pressure management in patients with a randomized control PubMed Scopus Google Scholar the showed adherence or KL SE Bergdall AR SE O'Connor PJ Sperl-Hillen JM Trower NK of home blood pressure telemonitoring and pharmacist management on blood pressure a randomized clinical 2013; PubMed Scopus Google Scholar a high risk of in and of participants and than 10 on be the difference in diastolic blood pressure comparing pharmacist-led home blood pressure telemonitoring usual care usual help the of the we the of patients that to in In of patients to in the by N MJ F of a pharmacist in on blood pressure control in J Health 2012; PubMed Google Scholar of to in Green BB PA J D L of home blood pressure and pharmacist care on hypertension a randomized controlled PubMed Scopus Google Scholar of to in Magid DJ KL SJ A American Heart Association home blood pressure 2013; PubMed Scopus (113) Google Scholar of to in KL SE Bergdall AR SE O'Connor PJ Sperl-Hillen JM Trower NK of home blood pressure telemonitoring and pharmacist management on blood pressure a randomized clinical 2013; PubMed Scopus Google Scholar and patients were as to in S N H of blood pressure management in patients with a randomized control PubMed Scopus Google Scholar or BM of pharmacist and of home blood pressure in patients with uncontrolled 20: PubMed Google Scholar of to there was patient studies was as to and that patient been randomized to the usual care group in the by Green BB PA J D L of home blood pressure and pharmacist care on hypertension a randomized controlled PubMed Scopus Google Scholar There was significant difference in to after between the the studies of in the group of in the usual care p = In this meta-analysis of adding pharmacist-led home BP telemonitoring in a better in the and to usual office-based care. that than to care to J C MR the to adult primary Intern Med. 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