Physician–pharmacist collaborative practice and telehealth may transform hypertension management


Community pharmacists play a crucial role in hypertension management and their intervention, mainly including education, medication monitoring, and reviewing, blood pressure (BP) measurement and cardiovascular risk factors tracking, have proved to enhance BP control and adherence to antihypertensive treatment. A multidisciplinary collaborative approach with the referring physician and a patient-centered model of care have been proved to be particularly effective for improving control of hypertension and promoting patients’ health. The inclusion of telehealth in such model (the so-called telepharmacy) may expand the reach of the pharmacist’s intervention and provide pharmacy operations and patient care at a distance with further benefits for hypertensive patients and their managing physicians. Very few randomized controlled studies have evaluated the clinical efficacy of the implementation of telepharmacy services in the management of hypertension, with the strongest evidence limited to physician–pharmacist collaborative interventions based on home BP telemonitoring plus patient education on lifestyle, drug therapy, and cardiovascular risk factors control. The results of these trials documented a benefit of telehealth mainly in terms of improvement of BP control consequent to antihypertensive medication intensification and optimization. Although promising, these results need to be corroborated through larger, prospective, and long-term studies, which should also evaluate additional long-term benefits of telepharmacy services in hypertension management.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Fig. 1
Fig. 2
Fig. 3
Fig. 4


  1. 1.

    Di Palo KE, Kish T. The role of the pharmacist in hypertension management. Curr Opin Cardiol. 2018;33:382–7.

  2. 2.

    Proia KK, Thota AB, Njie GJ, Finnie RK, Hopkins DP, Mukhtar Q, et al. Community Preventive Services Task Force. Team-based care and improved blood pressure control: a community guide systematic review. Am J Prev Med. 2014;47:86–99.

  3. 3.

    Carter BL, Rogers M, Daly J, Zheng S, James PA. The potency of team-based care interventions for hypertension: a meta-analysis. Arch Intern Med. 2009;169:1748–55.

  4. 4.

    Omboni S, Sala E. The pharmacist and the management of arterial hypertension: the role of blood pressure monitoring and telemonitoring. Expert Rev Cardiovasc Ther. 2015;13:209–21.

  5. 5.

    World Health Organization (WHO). Pharmacy-based hypertension management model: protocol and guidelines. A joint CINDI/EuroPharm Forum Project. 2005. Available at (last accessed 3 October2018).

  6. 6.

    Albasri A, Prinjha S, McManus RJ, Sheppard JP. Hypertension referrals from community pharmacy to general practice: multivariate logistic regression analysis of 131 419 patients. Br J Gen Pract. 2018;68:e541–e550.

  7. 7.

    O’Brien E, Atkins N, Stergiou G, Karpettas N, Parati G, Asmar R, et al. Working Group on Blood Pressure Monitoring of the European Society of Hypertension. European Society of Hypertension International Protocol revision 2010 for the validation of blood pressure measuring devices in adults. Blood Press Monit. 2010;15:23–38.

  8. 8.

    Non-invasive sphygmomanometers - Part 2: Clinical investigation of automated measurement type. American National Standards. ANSI/AAMI/ISO 81060-2:2013. Available at (last accessed 3 October 2018).

  9. 9.

    Erdem DG, Erdem E, Dilek M, Aydogdu T, Selim N, Demiray F, et al. Accuracy of sphygmomanometers at pharmacies. Kidney Blood Press Res. 2009;32:231–4.

  10. 10.

    Gonzalvo J, Zillich A. Accuracy of automated community pharmacy-based blood pressure devices. J Am Pharm Assoc. 2003;2011:408–11.

  11. 11.

    Ross KL, Bhasin S, Wilson MP, Stewart SA, Wilson TW. Accuracy of drug store blood pressure monitors: an observational study. Blood Press Monit. 2013;18:339–41.

  12. 12.

    Hodgkinson J, Koshiaris C, Martin U, Mant J, Heneghan C, Hobbs FR, et al. Accuracy of monitors used for blood pressure checks in English retail pharmacies: a cross-sectional observational study. Br J Gen Pract. 2016;66:e309–314.

  13. 13.

    Sabater-Hernández D, de la Sierra A, Sánchez-Villegas P, Baena MI, Amariles P, Faus MJ, MEPAFAR study workgroup. Magnitude of the white-coat effect in the community pharmacy setting: the MEPAFAR study. Am J Hypertens. 2011;24:887–92.

  14. 14.

    Sabater-Hernández D, De La Sierra A, Sánchez-Villegas P, Santana-Pérez FM, Merino-Barber L, Faus MJ, MEPAFAR Study Workgroup. Agreement between community pharmacy and ambulatory and home blood pressure measurement methods to assess the effectiveness of antihypertensive treatment: the MEPAFAR study. J Clin Hypertens (Greenwich). 2012;14:236–44.

  15. 15.

    Sendra-Lillo J, Sabater-Hernández D, Sendra-Ortolá Á, Martínez-Martínez F. Agreement between community pharmacy, physician’s office, and home blood pressure measurement methods: the PALMERA Study. Am J Hypertens. 2012;25:290–6.

  16. 16.

    Albasri A, OʼSullivan JW, Roberts NW, Prinjha S, McManus RJ, Sheppard JP. A comparison of blood pressure in community pharmacies with ambulatory, home and general practitioner office readings: systematic review and meta-analysis. J Hypertens. 2017;35:1919–28.

  17. 17.

    Machado M, Bajcar J, Guzzo GC, Einarson TR. Sensitivity of patient outcomes to pharmacist interventions. Part II: systematic review and meta-analysis in hypertension management. Ann Pharmacother. 2007;41:1770–81.

  18. 18.

    Morgado MP, Morgado SR, Mendes LC, Pereira LJ, Castelo-Branco M. Pharmacist interventions to enhance blood pressure control and adherence to antihypertensive therapy: Review and meta-analysis. Am J Health Syst Pharm. 2011;68:241–53.

  19. 19.

    Santschi V, Chiolero A, Colosimo AL, Platt RW, Taffé P, Burnier M, et al. Improving blood pressure control through pharmacist interventions: a meta-analysis of randomized controlled trials. J Am Heart Assoc. 2014;3:e000718.

  20. 20.

    Cheema E, Sutcliffe P, Singer DR. The impact of interventions by pharmacists in community pharmacies on control of hypertension: a systematic review and meta-analysis of randomized controlled trials. Br J Clin Pharmacol. 2014;78:1238–47.

  21. 21.

    Rotta I, Souza TT, Salgado TM, Correr CJ, Fernandez-Llimos F. Characterization of published randomized controlled trials assessing clinical pharmacy services around the world. Res Soc Adm Pharm. 2017;13:201–8.

  22. 22.

    Kennelty KA, Polgreen LA, Carter BL. Team-based care with pharmacists to improve blood pressure: a review of recent literature. Curr Hypertens Rep. 2018;20:1.

  23. 23.

    Kulchaitanaroaj P, Brooks JM, Chaiyakunapruk N, Goedken AM, Chrischilles EA, Carter BL. Cost-utility analysis of physician-pharmacist collaborative intervention for treating hypertension compared with usual care. J Hypertens. 2017;35:178–87.

  24. 24.

    Schell SF, Luke DA, Schooley MW, Elliott MB, Herbers SH, Mueller NB, et al. Public health program capacity for sustainability: a new framework. Implement Sci. 2013;8:15.

  25. 25.

    Dunn SP, Birtcher KK, Beavers CJ, Baker WL, Brouse SD, Page RL 2nd, et al. The role of the clinical pharmacist in the care of patients with cardiovascular disease. J Am Coll Cardiol. 2015;66:2129–39.

  26. 26.

    Al Hamarneh YN, Houle SK, Padwal R, Tsuyuki RT. Hypertension Canada’s 2016 Canadian Hypertension Education Program guidelines for pharmacists: an update. Can Pharm J. 2016;149:337–44.

  27. 27.

    Haines SL, DeHart RM, Hess KM, Marciniak MW, Mount JK, Phillips BB, et al. Report of the 2009-2010 Professional Affairs Committee: pharmacist integration in primary care and the role of academic pharmacy. Am J Pharm Educ. 2010;74:S5.

  28. 28.

    Sabater-Hernández D, de la Sierra A, Bellver-Monzó O, Divisón JA, Gorostidi M, Perseguer-Torregosa Z, et al. Guía de actuación para el farmacéutico comunitario en pacientes con hipertensión arterial y riesgo cardiovascular. Documento de consenso (versión resumida). Hypertensión. 2011;28:169–81.

  29. 29.

    Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in adults. Executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:1269–324.

  30. 30.

    Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018;36:1953–2041.

  31. 31.

    Omboni S, Tenti M. Telepharmacy for the management of cardiovascular patients in the community. Trends Cardiovasc Med 2018;pii: S1050-1738:30131-2.

  32. 32.

    Abughosh S, Wang X, Serna O, Esse T, Mann A, Masilamani S, et al. A motivational interviewing intervention by pharmacy students to improve medication adherence. J Manag Care Spec Pharm. 2017;23:549–60.

  33. 33.

    Milani RV, Lavie CJ, Bober RM, Milani AR, Ventura HO. Improving hypertension control and patient engagement using digital tools. Am J Med. 2017;130:14–20.

  34. 34.

    Magid DJ, Ho PM, Olson KL, Brand DW, Welch LK, Snow KE, et al. A multimodal blood pressure control intervention in 3 healthcare systems. Am J Manag Care. 2011;17:e96–103.

  35. 35.

    Margolis KL, Asche SE, Bergdall AR, Dehmer SP, Groen SE, Kadrmas HM, et al. Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: a cluster randomized clinical trial. JAMA. 2013;310:46–56.

  36. 36.

    Magid DJ, Olson KL, Billups SJ, Wagner NM, Lyons EE, Kroner BA. A pharmacist-led, American Heart Association Heart360 Web-enabled home blood pressure monitoring program. Circ Cardiovasc Qual Outcomes. 2013;6:157–63.

  37. 37.

    Green BB, Cook AJ, Ralston JD, Fishman PA, Catz SL, Carlson J, et al. Effectiveness of home blood pressure monitoring, web communication, and pharmacist care on hypertension control: a randomized controlled trial. JAMA. 2008;299:2857–67.

  38. 38.

    Welch LK, Olson KL, Snow KE, Pointer L, Lambert-Kerzner A, Havranek EP, et al. Systolic blood pressure control after participation in a hypertension intervention study. Am J Manag Care. 2011;17:473–8.

  39. 39.

    Margolis KL, Asche SE, Dehmer SP, Bergdall AR, Green BB, Sperl-Hillen JM, et al. Long-hypertension control and patient engagement using digital term outcomes of the effects of home blood pressure telemonitoring and pharmacist management on blood pressure among adults with uncontrolled hypertension. follow-up of a cluster randomized clinical trial. JAMA Netw Open. 2018;1:e181617.

  40. 40.

    Green BB, Anderson ML, Ralston JD, Catz SL, Cook AJ. Blood pressure 1 year after completion of web-based pharmacist care. JAMA Intern Med. 2013;173:1250–2.

  41. 41.

    Fishman PA, Cook AJ, Anderson ML, Ralston JD, Catz SL, Carrell D, et al. Improving BP control through electronic communications: an economic evaluation. Am J Manag Care. 2013;19:709–16.

  42. 42.

    Billups SJ, Moore LR, Olson KL, Magid DJ. Cost-effectiveness evaluation of a home blood pressure monitoring program. Am J Manag Care. 2014;20:e380–7.

  43. 43.

    Dehmer SP, Maciosek MV, Trower NK, Asche SE, Bergdall AR, Nyboer RA, et al. Economic evaluation of the home blood pressure telemonitoring and pharmacist case management to control hypertension (Hyperlink) trial. J Am Coll Clin Pharm. 2018;1:21–30.

  44. 44.

    Robins LS, Jackson JE, Green BB, Korngiebel D, Force RW, Baldwin LM. Barriers and facilitators to evidence-based blood pressure control in community practice. J Am Board Fam Med. 2013;26:539–57.

  45. 45.

    Kerby TJ, Asche SE, Maciosek MV, O’Connor PJ, Sperl-Hillen JM, Margolis KL. Adherence to blood pressure telemonitoring in a cluster-randomized clinical trial. J Clin Hypertens (Greenwich). 2012;14:668–74.

  46. 46.

    Asche SE, O’Connor PJ, Dehmer SP, Green BB, Bergdall AR, Maciosek MV, et al. Patient characteristics associated with greater blood pressure control in a randomized trial of home blood pressure telemonitoring and pharmacist management. J Am Soc Hypertens. 2016;10:873–80.

Download references


No funds or grants were received for the preparation of this manuscript.

Author information

SO devised the original idea of the work, made the search of the literature, and wrote the manuscript. MT and CC critically revised the manuscript. All authors met the ICMJE criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published.

Correspondence to Stefano Omboni.

Ethics declarations

Conflict of interest

SO is scientific consultant of Biotechmed Ltd, provider of telemedicine services. The remaining authors declare no conflicts of interest regarding the publication of this paper.

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Further reading