Pharmacists to improve hypertension management: Guideline concordance from North America to Europe

Hypertension is highly prevalent but remains poorly controlled in Canada, the United States and European countries.1-4 Reasons include clinical inertia, patients’ limited access to health care, lack of awareness or underestimation of the importance of lifestyle factors and nonadherence to blood pressure (BP)–lowering medication.1 Challenges exist at every level of hypertension management, and accordingly, solutions for improving hypertension control rates should be multilevel. One innovative solution for improving hypertension care is shared care through teambased care (TBC). TBC is a coordinated model of shared care involving different health care professionals, such as physicians, pharmacists, nurses or other health care professionals, working in collaborative partnership, each with their own expertise.5 An important member of the team is the pharmacist, who is a valuable asset to improve hypertension management given his or her accessibility and drug therapy xpertise.6 Several meta-analyses of randomized trials have shown significant reductions in BP when pharmacists were involved compared to usual care.7-9 In addition, pharmacist-led interventions appear to be cost-effective. Indeed, Marra et al.10 showed a net cost savings of $CDN 15.7 billion if only 50% of Canadians had their hypertension care provided by a prescribing pharmacist, compared to usual care.11,12 Recent guidelines on hypertension management, notably the 2017 guidelines from the American College of Cardiology Foundation and American Heart Association (ACC/AHA), recommend TBC for the first time.13 Moreover, the ACC/AHA recommendations are in line with recent commendations of Hypertension Canada and the European Society of Hypertension.14,15 In this brief review, we discuss the recommendations for TBC for hypertension management in recent American, Canadian and European guidelines and pinpoint roles and responsibilities that fall within the scope of care provided by a pharmacist.