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Beyond Blood Pressure: The Clinical and Economic Value of Pharmacist-Led Care for Hypertension

Dave Dixon, PharmD, BCACP, CLS, FACC, FAHA, FCCP, FNLA

Chair, Department of Pharmacotherapy & Outcomes Science

Nancy and Ronald McFarlane Professor of Pharmacy | School of Pharmacy

Professor of Internal Medicine, Division of Cardiology | School of Medicine

Virginia Commonwealth University

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Disclosures

Funding/Support: The Mercatus Center at George Mason University commissioned this work with authors Dave Dixon and Julie Patterson.

Role of the Sponsor: The sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Generative AI: used to assist with slide formatting, layout, and visual presentation. All scientific content, interpretations, and conclusions were developed and reviewed by the presenter, who assumes full responsibility for the accuracy and integrity of the material.

OpenAI. (2026). ChatGPT [Large language model]. https://chatgpt.com/

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Scope of the Problem

World Heart Federation Roadmap for Hypertension - A 2021 Update. Glob Heart. 2021 Sep 10;16(1):63.

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Prevalence, Control, and Treatment of HTN Among US Adults

https://www.cdc.gov/bloodpressure/CTAtoolkit.htm

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Health Problems Caused by Hypertension

https://www.cdc.gov/bloodpressure/CTAtoolkit.htm

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We Know What Works…

Factors Favoring BP Control
Availability of inexpensive, generic, fixed-dose combination medications
Robust evidence base that lowering BP reduces the risk of adverse outcomes
General public understanding of hypertension is higher than with other conditions
BP is easily measured and various technologies and tools exist to support patients and clinicians

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…So Why Aren’t We Winning?

Factors Against BP Control
Asymptomatic disease leading to low perceived urgency to manage BP
Most individuals will require multiple medications to control their BP (i.e., polypharmacy)
Social determinants of health (e.g., food insecurity, safe space for exercise)
Therapeutic inertia (i.e., lack of therapy intensification when BP is uncontrolled)

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Team-Based Care for Hypertension�

J Am Coll Cardiol. 2018 May 15;71(19):e127-e248.

Hypertension. 2023 Oct;80(10):e143-e157.

Centers for Disease Control and Prevention. Using the Pharmacists’ Patient Care Process to Manage High Blood Pressure: A Resource Guide for Pharmacists. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2016

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Systematic Review of Pharmacists Delivering HTN Care Services

95 RCTs with 31,168 participants

75% were pharmacist-led interventions

SBP: -5.3 mm Hg (95% CI -6.3 to -4.4; I² = 86%)

BP reduction was larger if the intervention was collaborative

Gastens V, et al. Front Cardiovasc Med. 12:1477729.

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Effectiveness of Implementation Strategies on Reducing Systolic BP

Implementation Strategy	Net Change in SBP (95% CI), mm Hg	Studies, n
Team-based care with titration by nonphysician	-7.1 (-8.9 to -5.2)	10
Team-based care with titration by physician	-6.2 (-8.1 to -4.2)	19
Multilevel strategy without team-based care	-5.0 (-8.0 to -2.0)	8
Health coaching	-3.9 (-5.4 to -2.3)	38
Electronic decision-support systems	-3.7 (-5.2 to -2.2)	4
Home blood pressure monitoring	-2.7 (-3.6 to -1.7)	26
Provider training	-1.4 (-3.6 to 0.7)	5
Audit and feedback	-0.8 (-2.1 to 0.5)	2

Mills KT, et al. Ann Intern Med. 2018;168(2):110-120.

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LA Barbershop BP Study (LABBPS)

Victor RG, et al. N Engl J Med. 2018;378:1291-1301.

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Value of HTN Treatment by Pharmacists in Black Barbershops

Bryant KB, et al. Circulation. 2021;143(24):2384-2394.

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Better BP is Only Part of the Value Proposition

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What would be the cost-effectiveness of implementing a pharmacist-prescribing intervention to improve blood pressure control in the �United States?

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Cost-Effectiveness of Pharmacist Prescribing for Managing HTN in the US