Canadian Pharmacists Journal - May/June 2019 - 184

PRaCtiCeReView
Table 2

(continued)
Pharmacists'
interventions shown
effective in systematic
reviews8,9

Responsibilities of a team
as recommended in the
aCC/aHa guidelines 201713

Tasks of a team as recommended
in Hypertension Canada's 2017
guidelines14

Education and
counselling of
patient

Medication adherence
support and appropriate
education about
hypertension medication.
Engage patients in their
care by shared decisionmaking. Use of evidencebased tools and resources
designed to maximize selfmanagement (including
health behavior change,
lifestyle modification, etc.).

Increasing patient involvement in
their treatment by encouraging
greater patient responsibility/
autonomy in monitoring their BP
and adjusting their prescriptions.
Educating patients and their families
about their disease and treatment
regimens. Being involved in weight
loss strategies, including dietary
education, counseling on physical
activity and performing behavioral
interventions.

Patient education and
counselling about
lifestyle, medication and
medication adherence.

Education of health
care professional

No recommendation.

Health care professional
education (including
training program).

level in hypertension
management

ACC/AHA, American College of Cardiology Foundation and American Heart Association; BP, blood pressure.

roles are defined for each specific member of the
team. Teams can be also informal and virtual
(online network).

The pharmacist's role in the team

The ACC/AHA guidelines give examples of the
roles of each team member, particularly pharmacists. The responsibilities of pharmacists
include "comprehensive medication management, which involves identification and documentation of medication-related problems,
initiating, modifying and discontinuing medication to address identified problems and educating patients on their medication regimen."13
The scope of pharmacists can be broadened
to almost every step of hypertension management, at the patient as well as the team organization levels. Indeed, recent systematic reviews
by Santschi et al.8,9 have found that pharmacists'
interventions that reach beyond the scope of
medication management are more effective in
reducing BP compared to standard of care. Table

2 compares the responsibilities and tasks of the
hypertension management team as stated in
the ACC/AHA and Canadian guidelines, with
pharmacists' interventions shown to be effective. Overall, pharmacists can be involved at the
patient level-from diagnosis to BP monitoring
and medication management-and at the team
level, for the education of patient and health care
providers and communication and organization
within the team.

Conclusion

For the first time, American guidelines strongly
recommend using TBC in hypertension management,13 in line with European and Canadian guidelines. Pharmacists are highly valuable
members in team care,6 with strong evidence that
their involvement in hypertension management
improves hypertension control as compared to
standard of care.7,8 Shared care through TBC
with the involvement of pharmacists should be
the standard of care for hypertension. ■

From the Institute of Primary Health Care (BIHAM) (Anker, Chiolero), University of Bern, Switzerland; EPICORE Centre
(Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta; the Department of Epidemiology,
Biostatistics and Occupational Health (Paradis, Chiolero), McGill University, Montreal, Canada; and La Source, School of Nursing
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