University of Iowa News Release

April 23, 2009

NIH funds UI blood pressure study for $8.5 million

Only about half the people with high blood pressure who see a doctor keep their pressure under control. To study whether physician-pharmacist collaboration can improve control rates, particularly among minorities, the University of Iowa College of Pharmacy and College of Public Health have received a total of $8.5 million through two grants from the National Heart, Lung and Blood Institute of the National institutes of Health.

The five-year grants, which were effective April 15, include $4.8 million awarded to the College of Pharmacy and $3.7 million to the College of Public Health. The project also involves investigators in the Carver College of Medicine. The $4.8 million grant awarded to pharmacy is the largest award ever received by a principal investigator in that college.

The study will focus on people with high blood pressure who receive clinical care through a doctor's office, yet, for various reasons, have not achieved control of their condition, said Barry Carter, Pharm.D., UI professor of pharmacy practice and science, who as a principal investigator will manage study clinical interventions and personnel.

"Research shows that among people who already see a doctor, blood pressure control rates vary from about 45 to 60 percent. Our intention is to see if using a collaborative model that involves a clinical pharmacist working with each patient and the physician will make a difference in helping patients control their high blood pressure," said Carter, who also is professor and associate head for research of family medicine.

The study's second principal investigator, William Clarke, Ph.D., UI professor of biostatistics, will lead the collection, review and analysis of data.

Approximately 1,200 study participants will take part in the investigation at 27 physician offices nationwide, including several in Iowa. The participating medical offices are members of the National Interdisciplinary Primary Care Practice-Based Research Network that Carter directs. Many of the sites care for large numbers of minority populations, Carter said.

"While there have been blood pressure control studies using a clinical pharmacist intervention, we do not know if this approach is effective across populations," he said. "Minorities typically have had more difficulty with blood pressure control, with lower rates of successful control. This investigation should help us determine if minority groups can be assisted by the collaborative approach."

Study participants will be seen by their regular doctors and be assigned to one of three groups: regular care, nine months of collaborative care involving a clinical pharmacist, or the collaborative model for two years. The collaborative model involves the pharmacist employed in the doctor's office who will identify patients' problems and work with the physician to optimize therapy.

Carter said that lack of blood pressure control among patients being seen by doctors can be attributed primarily to these situations: forgetting to take medication, taking medications incorrectly, not being prescribed the proper medication or not being prescribed medication in sufficiently high dosages.

"Patients don't necessarily take their medications properly and at the same time, some doctors are not prescribing enough medications needed to achieve control," he said. "In defense of physicians, given our nation's care and payment systems, doctors are lucky to have 10 or 15 minute with a patient who may have multiple chronic problems. So it's a huge challenge for physicians to address blood pressure control issues in this context."

Nationwide, approximately 60 million people, regardless of whether they have regular care, have high blood pressure. Guidelines for controlled blood pressure are 140/90 for people without other conditions and 130/80 for people with other conditions such as diabetes or kidney disease.

The top number in a blood pressure reading -- the systolic pressure -- is the highest pressure that occurs in the bloodstream during a heartbeat. The bottom number -- the diastolic pressure -- is the lowest pressure that occurs in the bloodstream during a heartbeat.

"We're fortunate at the UI to be able to put together interdisciplinary teams and serve as leaders in interventional research on blood pressure, especially efforts involving team-based care provided by physicians, pharmacists and public health specialists," Carter said.

STORY SOURCE: University of Iowa Health Care Media Relations, 5137 Westlawn, Iowa City, Iowa 52242-1178