Role of clinical pharmacist in the management of blood pressure in dialysis patients

Background Hypertension is highly prevalent yet undertreated condition in hemodialysis patients. Objective The objective of this study was to evaluate clinical pharmacist’s role in the management of blood pressure in hemodialysis patients guided by home blood pressure monitoring. Setting Outpatient hemodialysis units of Jordan University Hospital and Isra’a Hospital. Method This was a randomized controlled study. It lasted 6 months (September 2011 till the end of March 2012). All hypertensive patients receiving hemodialysis were invited to participate in the study. Out of 60 patients approached, 56 were actually included. Patients were randomly allocated to an intervention (29) or control group (27). In the intervention arm, patients received physician-pharmacist collaborative care. While in the control arm patients received standard medical care. Main outcome measure Percentage of patients achieving weekly average home blood pressure below or equal 135/85 mmHg. Other secondary measures that were assessed include absolute reduction in peridialysis blood pressure, interdialytic weight gain, adherence to medications and dialysis sessions. Results A total of 52 patients completed the study. Forty-six percent of patients in the intervention arm achieved BP target (mean home blood pressure ≤135/85 mmHg) compared to only 14.3 % of patients in the control arm (p = 0.02). Average decline in weekly mean home systolic blood pressure was 10.9 ± 17.7 mmHg in the intervention arm (p = 0.004), while weekly mean home systolic blood pressure increased by 3.5 ± 18.4 mmHg in the control arm (p = 0.396). No significant reduction was achieved in weekly home diastolic blood pressure, dialysis blood pressure readings, or interdialytic weight gain in either arm. Conclusions Clinical pharmacist-physicians’ collaboration improved rate of blood pressure control in hemodialysis patients. Using home blood pressure monitoring was found to be an efficient way to guide blood pressure therapy.