Canadian Pharmacists Journal - May/June 2019 - 180

839675
research-article2019

CPHXXX10.1177/1715163519839675C P J / R P CC P J / R P C

Practice review  PeeR-ReViewed

Practice review * Peer-reviewed

Pharmacists to improve hypertension
management: Guideline concordance
from North America to Europe
Daniela Anker, MSc; Ross T. Tsuyuki, BSc(Pharm), PharmD, MSc; Gilles Paradis, MD, MSc;
Arnaud Chiolero, MD, PhD; Valérie Santschi, PharmD, PhD

Introduction

© The Author(s) 2019
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DOI:10.1177/1715163519839675
180



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 expertise.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 recommendations 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.

Recommendations from guidelines

The 2017 ACC/AHA guidelines for hypertension management strongly recommend TBC.
These guidelines give a formal definition of TBC,
identify members of the team-based care, specify patient circumstances where TBC is recommended and define roles and responsibilities of
the team at every level of hypertension management.13 Table 1 compares the 2017 ACC/AHA
guidelines with recommendations from the 2018
guidelines from the Task Force for the Management of Arterial Hypertension of the European
Society of Cardiology and the European Society of Hypertension (ESC/ESH) and Hypertension Canada's 2017 Guidelines for Diagnosis,
Risk Assessment, Prevention and Treatment of
Hypertension in Adults.14,15 The American ACC/
AHA guidelines emphasize TBC more than the
European ESC/ESH and Hypertension Canada's
2017 guidelines by providing a more exhaustive
definition of TBC, including the composition
of the team. The 3 guidelines assign roles and
responsibilities in hypertension management
on the level of the team as an entity, but no firm
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Canadian Pharmacists Journal - May/June 2019

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