Lifestyle changes for prehypertension with other cardiovascular risk factors: Findings from Thailand

Abstract

Objective: To evaluate a model for community pharmacists to screen and recommend lifestyle changes for patients with prehypertension/hypertension and other elevated modifiable cardiovascular risk factors. Design: Descriptive, exploratory, nonexperimental study. Setting: One accredited community pharmacy in Hat Yai, Thailand, between October 2008 and January 2009. Participants: Individuals 35 years or older without any previous diagnosis of hypertension and other cardiovascular disease. Intervention: Measurement of blood pressure, blood glucose, total cholesterol, and body mass index; history taking for smoking and physical exercise; laboratory referral; assessment of readiness to adopt lifestyle changes; and provision of verbal advice and an education pamphlet on cardiovascular risk factors and recommended lifestyle modifications. Main outcome measures: Number of prehypertensive/hypertensive participants, patient return rate at 3-month follow-up, rate of laboratory referral uptake, confirmed glucose intolerance and dyslipidemia, and changes from baseline in blood pressure level. Results: 263 of 400 people eligible for screening were found to have prehypertension or hypertension. Of these patients, 57% returned at 3-month follow-up. Mean (±SE) systolic (6.5 ± 0.89 mm Hg [95% CI 4.7-8.2], P < 0.001) and diastolic (2.2 ± 0.82 [0.54-3.77], P = 0.009) blood pressure were lowered. Compared with baseline (39.3%), the percentage of normotensive participants increased significantly at 3-month follow-up (51.8%; P < 0.001). The overall laboratory referral uptake was 36% (50 of 138). Glucose intolerance was confirmed in 2 of 21 participants. Of the 42 patients accepting laboratory confirmation, total and low-density lipoprotein cholesterol were confirmed to be above the normal range in 100% and 78.6%, respectively. Among these participants, those who returned at follow-up were rescreened for blood glucose and total cholesterol. Both values were found to be in the normal range. Although more participants reported lifestyle changes at 3 months, the smoking rate and amount of physical exercise were not changed. Conclusion: Community pharmacists, through the use of point-of-care testing and referrals for laboratory testing, can detect patients who are at risk of developing or already have hypertension, diabetes, and/or dyslipidemia. Lifestyle advice from pharmacists can have a positive effect on these risk factors.