Uso do monitoramento domiciliar da pressão arterial para otimização do tratamento da hipertensão em idosos na Atenção Primária em um município do Sudoeste Baiano – ensaio clínico randomizado

Abstract

Introduction: Clinical decisions about antihypertensive therapy are directly related to the patient's blood pressure values. Blood pressure (BP) measurements taken in the clinic are less reliable than measurements taken by the patient at home, when a home blood pressure monitoring (HBPM) protocol is applied. The use of HBPM associated with the management of drug therapy for the treatment of hypertension in the elderly, performed by pharmacists, can improve outcomes in these patients. Objectives: To evaluate the effectiveness of HBPM combined with drug therapy management by pharmacists to optimize antihypertensive treatment in the elderly. Methods: Open randomized clinical trial with parallel groups. Hypertensive elderly people attended at a public pharmacy in a medium-sized city in the interior of Bahia were included. In the control group, the participant received a digital BP meter and instructions on how to perform HBPM. The primary care physician received a report with BP values to decide on changes in treatment. In the intervention group, the participant also underwent HBPM and the pharmacist applied a drug therapy management protocol. The phisician received suggestions for optimizing antihypertensive therapy, in addition to the report with BP values. The following outcomes were considered: the proportion of participants who had deprescribed antihypertensive drugs, other treatment adjustments, and the difference in mean BP between groups 45 days after HBPM. Results: 161 participants in each group completed the study. There was deprescription of antihypertensives in 31 (19.3%) participants in the intervention group versus 11 (6.8%) in the control group (p=0.01). 14 (8.7%) of the participants had the inclusion of antihypertensive drugs in the intervention group versus 11 (6.8%) in the control group (p=0.52). Mean clinic Systolic BP and Systolic HBPM were lower in the intervention group (p-value= 0.22 and 0.29, respectively). Conclusions: The use of HBPM accompanied by a drug therapy management protocol performed by pharmaceutical professionals was effective in optimizing antihypertensive therapy in elderly people treated in primary health care.