Effective detection and management of hypertension through community pharmacy in England

Abstract

Hypertension is the leading risk factor for cardiovascular events globally and affects around a third of adults in the UK. Literature related to the role of pharmacists in hypertension is vast, and encompasses hypertension screening and management in community pharmacy, as well as general practice and secondary care settings. To date, the role of pharmacists in community practice does not routinely involve formally structured hypertension management or screening programmes. Several high blood pressure (BP) screening studies have been conducted in pharmacies, recording previously unidentified patients with hypertension. However, evidence relating to subsequent follow-up appears scarce, meaning that clinical outcomes for these patients compared with those not attending screening is unknown. The strongest evidence related to pharmacists in hypertension care is from research in to the management of hypertension rather than detection. Findings from systematic reviews and meta-analyses show that community pharmacist-led management of hypertension significantly changes systolic BP over usual GP care by between –6.1mmHg (95% confidence interval [CI] –8.4 to –3.8) and –7.2mmHg (95% CI –5.8 to –8.7). In addition, similar reductions can be achieved when pharmacists provide support to patients who self-monitor their BP from home. However, several factors require addressing before such services can be developed and sustained in pharmacies, including: the impact of delivering extra services on the pharmacist’s time; ensuring adequate training and legal approvals; improving communication with GPs and access to clinical records; the current policy and funding landscape; and pharmacy’s identity as a healthcare setting versus its commercial identity. This article summarises the findings of existing systematic reviews and meta-analyses related to both hypertension screening and management in community pharmacies. Factors for consideration prior to implementing hypertension-related services in pharmacies are also discussed.