Pharmacy Implementation Trial: Adherence to Antihypertensive Therapy

Implementation of a Pharmacy-Intervention to Establish and if Necessary Improve Adherence to Antihypertensive Therapy. A Cluster Randomized Trial.

The purpose of this study is to determine the effectiveness of maximal support of community pharmacies to implement a pharmaceutical care model for establishing and - if necessary - improving adherence to antihypertensive medication in patients with medication-resistant hypertension.

Cardiovascular disease is the main cause of death in large parts of the world. Hypertension is an important risk factor for cardiovascular disease. Although hypertension treatment has improved in the last decade, the effectiveness of antihypertensive therapy still needs attention. Adherence to medication appears to play an important role in that.

Pharmacists can support the general practitioners in their efforts to optimize antihypertensive therapy, by establishing adherence to medication of patients with hypertension in spite of the use of one or more antihypertensive drugs. This is performed with the electronic Medication Event Monitoring System (MEMS®). Registered adherence and accompanying blood pressure are discussed with the patient by the GP.

Implementation of the above-mentioned intervention is studied in two randomized groups of pharmacies. One group receives minimal support in the intervention, the other group also receives interactive educational meetings, reminders and feedback, and support of multiprofessional cooperation.

Inclusion Criteria:

• pharmacies: resident in the south of the Netherlands

• patients:

  • 18 years or older
  • diagnosis of hypertension
  • systolic blood pressure between 150 and 180 mm Hg despite the use of antihypertensive drug(s)
  • indication for treatment escalation

Exclusion Criteria:

• patients:

  • impossibility to establish blood pressure properly
  • patient treated by medical specialist
  • change of antihypertensive therapy because of adverse effects of current medication
  • insisting on using dose organisers
  • not managing their drug intake themselves
  • not able to come to the pharmacy