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Background

Hypertension is a leading global health issue and a major modifiable risk factor for cardiovascular disease, stroke, and chronic kidney disease. Despite numerous treatment options, blood pressure control remains suboptimal in the United States. According to the Centers for Disease Control (CDC), high blood pressure contributed to 664,470 deaths in the United States in 2023. They also report that only about 22.5% of Americans with hypertension have their blood pressure under control. This is a staggering statistic considering nearly half of U.S. adults have high blood pressure.

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Why is Blood Pressure Control So Difficult?

Many patients struggle to manage their blood pressure due to several key barriers. Particularly, poor medication adherence and limited support between clinic visits are two of the biggest challenges. The American College of Cardiology (ACC)/American Heart Association (AHA) 2023 hypertension guidelines recommend regular home blood pressure monitoring along with frequent follow-up by a multidisciplinary team of healthcare providers. Home monitoring of blood pressure often falls flat if not done correctly or if it is not combined with health coaching and professional interventions. If patients aren’t being seen on a regular basis by healthcare professionals, they are not getting regular blood pressure interventions. In addition, overwhelmed healthcare providers may not have the time to properly adjust medications or offer meaningful education during brief clinic visits.

Enter Pharmacists

Optimal blood pressure management requires a multidisciplinary team and interprofessional collaboration. Pharmacists should be part of this team to improve medication adherence and provide patient education. Pharmacist-led interventions have been shown to make a positive impact on blood pressure control and the management of cardiovascular disease. This is because pharmacists understand antihypertensive medications and can help with adherence issues.

Can Pharmacist Intervention Really Help?

A meta-analysis published by Circulation: Cardiovascular Quality and Outcomes in 2024 looked at interventions made by various healthcare providers and their impact on blood pressure lowering. The study wanted to determine which healthcare providers were most effective at making interventions to reduce blood pressure in patients with hypertension. The meta-analysis included 100 articles reporting 116 comparisons and included 90,474 patients. The study assessed the mean net change in systolic and diastolic blood pressure between baseline and follow-up.

The greatest reductions in systolic and diastolic blood pressure were seen with pharmacist-led interventions.

The study concluded that pharmacists are effective at titrating medications, providing medication support, and educating patients. Pharmacists boost patient compliance by identifying and resolving adherence issues and adverse effects, which are major reasons why patients don’t take their medications.

The authors of the study emphasized that team-based care consistently outperforms physician-only care. A team-based approach is most efficacious at lowering blood pressure when someone other than the physician can optimize medications. Physicians often don’t have time during short clinic visits to provide education and titrate medications. A team that includes pharmacists, nurses, and other providers in hypertension management yields stronger blood pressure reductions and better overall control. All healthcare professionals can take on some of the responsibilities in managing blood pressure while supporting and supplementing the care of physicians.

Need More Evidence?

In 2024, Scientific Reports published a systematic review and meta-analysis of randomized controlled trials looking at whether remote follow-up by pharmacists was effective at reducing blood pressure in patients with hypertension. Pharmacist-led remote monitoring combined patient self-monitoring with pharmacist follow-up through telephone, text, internet communication, and other telemonitoring tools.

The meta-analysis included 13 studies and 3969 participants located in seven countries. The study compared an intervention group to a control group. The intervention period varied between studies and ranged from 8 weeks to 12 months.

Combined data from the 13 studies showed that remote follow-up by pharmacists improved systolic blood pressure in patients with hypertension as compared to those who underwent usual care.

• The mean difference in systolic blood pressure between the intervention and control groups was −7.35 mmHg (95% Confidence Interval [CI] − 9.10 to − 5.59 mmHg, P < 0.0001).

Subgroup analysis was performed comparing systolic blood pressure reduction in patients who had regularly scheduled follow-up to those who had as needed follow-up. The results show that regular follow-up is an important factor in reducing systolic blood pressure.

• Mean difference in systolic blood pressure between intervention and control groups:
  • Regularly scheduled follow-up: −8.89 mmHg (95% CI − 10.11 to − 7.66 mmHg, P < 0.0001)
  • As needed follow-up: −3.23 mmHg (95% CI − 5.72 to − 0.74 mmHg, P = 0.01)

Additional subgroup analysis compared groups where pharmacists reported follow-up information to physicians versus pharmacist-only follow-up. Interestingly, this analysis showed that pharmacists can independently achieve significant outcomes.

• Mean difference in systolic blood pressure between intervention and control groups:
  • Physician communication group: −6.56 mmHg (95% CI −8.84 to −4.28 mmHg, P < 0.0001)
  • Pharmacist only group: −8.96 mmHg (95% CI −11.50 to −6.42 mmHg, P < 0.0001)

This study shows the importance of regular follow-up in blood pressure control. Successful follow-up can be done remotely allowing fewer in-person clinic visits. This is more convenient for patients. Utilizing pharmacists for follow-up is effective at reducing systolic blood pressure and alleviates physician workload.

Why does it Matter?

When it comes to hypertension, even small blood pressure reductions translate to a reduction in cardiovascular risk. The evidence is clear, pharmacist-led interventions, whether in-person or remote, significantly improve blood pressure outcomes. It leads to enhanced medication adherence and reduced cardiovascular risk. Pharmacists are trained, accessible, and positioned within the community to offer consistent, high-quality care. With the right support and regular follow-up, controlling blood pressure is possible.

Terese H., APPE Student

References

1. Matsumoto N, Nakai T, Sakakibara M, Aimiya Y, Sugiura S, Lee JK, Yamada S, Mizuno T. Remote follow-up by pharmacists for blood pressure control in patients with hypertension: a systematic review and a meta-analysis of randomized controlled trials. Scientific Reports. 2024 Jan 30;14(1):2535. doi: 10.1038/s41598-024-52894-8. PMID: 38291114; PMCID: PMC10827741.
2. Mills KT, O’Connell SS, Pan M, Obst KM, He H, He J. Role of Health Care Professionals in the Success of Blood Pressure Control Interventions in Patients With Hypertension: A Meta-Analysis. Circulation: Cardiovascular Quality Outcomes. 2024 Aug;17(8):e010396. doi: 10.1161/CIRCOUTCOMES.123.010396. Epub 2024 Jul 19. PMID: 39027934; PMCID: PMC11338746.
3. Jones, Daniel W., et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Hypertension, 14 Aug. 2025, Online ahead of print, American Heart Association, doi:10.1161/HYP.0000000000000249. Accessed 27 Aug. 2025.
4. Centers for Disease Control and Prevention. High Blood Pressure Facts. 28 Jan. 2025, www.cdc.gov/high‑blood‑pressure/data‑research/facts‑stats/index.html. Accessed 27 Aug. 2025.
5. Waszyk-Nowaczyk M, Jasińska-Stroschein M, Dymek J, Drozd M, Sierpniowska O, Stankiewicz A, Jędra A, Banach M, Gierlotka M, Jankowski P, Windak A, Osadnik T, Tomasik T, Wolf J, Guzenda W, Stryczyński Ł, Jóźwiak J. The Critical Role of Community Pharmacists in Blood Pressure Monitoring. Medical Science Monitoring. 2024 Aug 15;30:e944657. doi: 10.12659/MSM.944657. PMID: 39143725; PMCID: PMC11334671.