Effect of a 36-month Pharmaceutical Care Program on the Coronary Heart Disease Risk in Elderly Diabetic and Hypertensive Patients

Abstract

Purpose. To examine the effect of a pharmaceutical care program on the coronary heart disease risk in elderly diabetic and hypertensive patients. Methods. A total of 200 elderly (> 60 years) diabetic and/or hypertensive patients were recruited into a randomized, controlled, prospective clinical trial with a 36-month follow-up, developed in a public primary health care unit in a municipality in the Brazilian State of Sao Paulo. A range of clinical measurements were evaluated at the baseline and up to 36 months afterwards. The intervention group patients received pharmaceutical care from a clinical pharmacist, whereas the control group patients received their usual care from the medical and nursing staff. The Framingham scoring method was used to estimate changes in the 10-year coronary heart disease risk scores of all the patients. Results. A total of 194 patients completed the study. Significant reductions (p < 0.05) in the mean values (baseline vs. 36 months) for the systolic blood pressure [156.7mmHg vs 133.7mmHg; p<0.001], diastolic blood pressure [106.6mmHg vs 91.6mmHg; p<0.001], fasting glucose [135.1mg/dL vs 107.9mg/dL; p<0.001], hemoglobin A1C [7.7% vs 7.0%; p<0.001], triglycerides [206.0mg/dL vs 152.5mg/dL; p<0.001], high-density lipoprotein cholesterol [55.5mg/dL vs 65.5mg/dL; p<0.001], total cholesterol [202.5mg/dL vs 185.9mg/dL; p<0.001], body mass index [26.2kg/m2 vs 26.1kg/m2; p<0.001] and abdominal circumference [103.2cm vs 102.5cm; p = 0.001] were observed in the intervention group, whereas no significant changes were verified in the control group. The mean Framingham risk prediction score in the intervention group was 6.8% (5.9:7.8) at baseline, and decreased to 4.5% (3.9:5.0) (p <0.001) after 36 months, but remained unchanged in the control group. Conclusion. The pharmaceutical care program resulted in better clinical measurements and reduced the cardiovascular risk scores in elderly diabetic and hypertensive patients over a 36-month period.