PHARMACEUTICAL CARE FOR PATIENTS WITH HYPERTENSIVE DISEASE: INTEGRATION OF THE CLINICAL PHARMACIST INTO PRIMARY HEALTH CARE
DOI:
https://doi.org/10.32689/2663-0672-2026-1-11Keywords:
pharmaceutical care, clinical pharmacist, hypertensive disease, arterial hypertension, primary health care, pharmacotherapy management, clinical and pharmaceutical counseling, interdisciplinary collaboration, patient routingAbstract
Background. One of the most prevalent non communicable diseases worldwide, including in Ukraine, and a leading risk factor for the development of cardiovascular complications associated with high mortality and disability, is hypertensive disease (arterial hypertension), which remains a major global public health problem. Aim. The aim of this study was to substantiate the feasibility of involving a clinical pharmacist in the management of pharmacotherapy for hypertensive disease (arterial hypertension), to improve patient routing at the primary health care level, and to develop practical recommendations for the integration of pharmaceutical care. Materials and Methods. The study materials included information sources as well as the regulatory and legal framework of the medical and pharmaceutical sectors related to pharmaceutical care for patients with arterial hypertension. The study was carried out using a complex of general scientific and special methods. Results. The feasibility of integrating a clinical pharmacist into the pharmacotherapy management of hypertensive disease (arterial hypertension) was substantiated, and the key roles and functions of the clinical pharmacist at the primary health care level were systematized. Based on a questionnaire survey of patients with arterial hypertension, the impact of clinical and pharmaceutical counseling provided by a clinical pharmacist on patients’ awareness of antihypertensive pharmacotherapy, treatment adherence, and blood pressure self-monitoring practices was assessed. The irregular use of self-monitoring data for pharmacotherapy adjustment indicates the need to strengthen the role of the clinical pharmacist in the long-term follow-up and support of patients with arterial hypertension. A comparative analysis of organizational models for managing patients with arterial hypertension at the primary health care level was conducted, and their advantages and limitations were identified. The most promising direction for the development of patient management at the primary health care level involves a combination of a team-based approach, telemedicine and telepharmacy tools, and patient self-management, which is consistent with current public health strategies and the principles of sustainable health care system development. A clinical pathway for patients with arterial hypertension at the primary health care level and practical recommendations for the integration of pharmaceutical care are proposed. Conclusions. The integration of a clinical pharmacist into primary health care for patients with hypertensive disease (arterial hypertension) may contribute to more efficient use of national health care system resources, promote a culture of patient responsibility for personal health, and strengthen the sustainability of the socioeconomic determinants of Ukraine’s public health system.
References
Aleksandruk, N. (2023). Rekomendatsii ESH-2023 shchodo vedennia patsiientiv z arterialnoiu hipertenziieiu. Chastyna 1. Patofiziolohiia, klasyfikatsiia ta diahnostyka [ESH-2023 recommendations for the management of patients with arterial hypertension. Part 1. Pathophysiology, classification and diagnosis]. Medychna hazeta “Zdorovia Ukrainy 21 storichchia”, 15(551), 10–11.
Bilousova, N. (2024). Obgruntuvannia rozshyrennia funktsii farmatsevta pry profilaktytsi ishemichnoi khvoroby sertsia na vtorynnomu ta tretynnomu rivniakh medychnoi dopomohy [Justification for expanding pharmacists’ functions in the prevention of coronary heart disease at the secondary and tertiary levels of medical care]. Suchasna medytsyna, farmatsiia ta psykholohichne zdorovia, 3(17), 41–50.
Babak, O. Ya., Vizir, M. O., Panchenko, H. Yu. et al. (Comp.). (2019). Vedennia khvoroho z arterialnoiu hipertenziieiu (suchasna praktyka vnutrishnoi medytsyny z nevidkladnymy stanamy): metod. vkaz. dlia studentiv ta likariv-interniv [Management of patients with arterial hypertension (modern practice of internal medicine with emergency conditions): methodological guidelines for students and medical interns]. Kharkiv: KhNMU.
WHO Regional Office for Europe. (2023). HEARTS: tekhnichnyi paket zakhodiv dlia vedennia patsiientiv iz sertsevo-sudynnymy zakhvoriuvanniamy na rivni pervynnoi medychnoi dopomohy: komandnyi pidkhid do vedennia patsiientiv [HEARTS: Technical package for cardiovascular disease management in primary health care: team-based care]. URL: https://surl.li/prnbkn
WHO Regional Office for Europe. (2023). HEARTS: tekhnichnyi paket zakhodiv dlia vedennia patsiientiv iz sertsevo-sudynnymy zakhvoriuvanniamy na rivni pervynnoi medychnoi dopomohy: posibnyk iz realizatsii [HEARTS: Technical package for cardiovascular disease management in primary health care: implementation guide]. URL: https://surl.li/iseqqg.
WHO Regional Office for Europe. (2023). HEARTS: tekhnichnyi paket zakhodiv dlia vedennia patsiientiv iz sertsevo-sudynnymy zakhvoriuvanniamy na rivni pervynnoi medychnoi dopomohy: systemy monitorynhu [HEARTS: Technical package for cardiovascular disease management in primary health care: monitoring systems]. URL: https://surl.li/cgreth.
Huz, V. S. (2023). Vyvchennia poinformovanosti ta uchasti farmatsevtiv v uriadovii prohrami “Dostupni Liky” [Study of pharmacists’ awareness and participation in the government program “Affordable Medicines”]. Sotsialna farmatsiia v okhoroni zdorovia, 9(3), 50–56. DOI https://doi.org/10.24959/sphhcj.23.296.
Datsenko, I. S., Kabachna, A. V., & Hulpa, V. S. (2022). Orhanizatsiia farmatsevtychnoho zabezpechennia khvorykh na lehenevu hipertenziiu v Ukraini na prykladi m. Kyieva [Organization of pharmaceutical provision for patients with pulmonary hypertension in Ukraine on the example of Kyiv]. Farmatsevtychnyi zhurnal, 2, 3–14. DOI http://doi.org/10.32352/0367-3057.2.22.01.
Kireiev, I. V., & Zhabotynska, N. V. (2022). Vyvchennia vplyvu dotrymannia suchasnykh rekomendatsii shchodo antyhipertenzyvnoi terapii na komplans patsiientiv z arterialnoiu hipertenziieiu [Study of the influence of adherence to modern antihypertensive therapy recommendations on compliance of patients with arterial hypertension]. Sotsialna farmatsiia v okhoroni zdorovia, 8(1), 27–33. DOI http://doi.org/10.24959/sphhcj.22.248.
Kireiev, I. V., Zhabotynska, N. V., Tsemenko, K. V., Bakumenko, M. H., & Olishchuk, I. A. (2023). Rol klinichnoho farmatsevta v realizatsii suchasnykh rekomendatsii z farmakoterapii arterialnoi hipertenzii [The role of the clinical pharmacist in implementing modern recommendations for pharmacotherapy of arterial hypertension]. Sotsialna farmatsiia v okhoroni zdorovia, 9(4), 31–38. DOI https://doi.org/10.24959/sphhcj.23.303
Maksymovych, N. M., & Zaliska, O. M. (2024). Analiz asortymentu likarskykh zasobiv dlia terapii arterialnoi hipertenzii pid chas vahitnosti [Analysis of the assortment of medicines for the treatment of arterial hypertension during pregnancy]. Farmatsevtychnyi zhurnal, 1, 3–12. DOI https://doi.org/10.32352/0367-3057.1.24.01
Mararash, H. H., & Boreiko, L. D. (2021). Otsinka efektyvnosti navchannia khvorykh na arterialnu hipertenziiu [Evaluation of the effectiveness of education for patients with arterial hypertension]. Visnyk medychnykh i biolohichnykh doslidzhen, 1, 21–28. DOI https://doi.org/10.11603/bmbr.2706-6290.2021.1.11918.
Ministry of Health of Ukraine. (2024). Arterialna hipertenziia: Klinichna nastanova, zasnovana na dokazakh [Arterial hypertension: Evidence-based clinical guideline]. State Expert Center of the Ministry of Health of Ukraine. URL: https://surli.cc/ltbudx
Ministry of Health of Ukraine. (2024). Unifikovanyi klinichnyi protokol pervynnoi ta spetsializovanoi medychnoi dopomohy “Hipertonichna khvoroba (arterialna hipertenziia)” [Unified clinical protocol of primary and specialized medical care “Hypertensive disease (arterial hypertension)”]. URL: https://surl.li/dscqwv
Nemchenko, A. S., Popova, I. A., & Demchenko, N. V. (2024). Doslidzhennia farmatsevtychnoho zabezpechennia khvorykh na sertsevo-sudynni zakhvoriuvannia v ramkakh prohramy “Dostupni liky” [Study of pharmaceutical provision for patients with cardiovascular diseases within the framework of the “Affordable Medicines” program]. Health & Education, 1, 121–130. DOI https://doi.org/10.32782/health-2024.1.16.
Ustinov, O. V. (2022). MOZ naholoshuie na neobkhidnosti pravylnoi marshrutyzatsii patsiientiv z insultom [The Ministry of Health emphasizes the need for proper routing of stroke patients]. Ukrainskyi medychnyi chasopys. URL: https://surl.lu/ovwqio.
Public Health Center of the Ministry of Health of Ukraine. (2021). Sertsevo-sudynni zakhvoriuvannia – holovna prychyna smerti ukraintsiv. Vysnovky z doslidzhennia Hlobalnoho tiaharia khvorob u 2019 rotsi [Cardiovascular diseases are the leading cause of death among Ukrainians. Findings from the Global Burden of Disease Study 2019]. https://surl.li/dpuwww.
Alshahrani, A. M. et al. (2021). Hypertensive Patient Compliance with Pharmacist Intervention: A Systematic Review. Journal of Pharmaceutical Research International. 33(39В), 85–97. https://doi.org/10.9734/jpri/2021/v33i39b32182.
Brouwers, S. et al. Arterial hypertension (2021). The Lancet, 398(10296), 249–261. https://doi.org/10.1016/s0140-6736(21)00221-x.
Burnier, M., Egan, B. M. (2019). Adherence in Hypertension. Circulation Research. 124(7), 1124–1140. https://doi.org/10.1161/circresaha.118.313220.
Carter B. L. et al. (2009). The Potency of Team-Based Care Interventions for Hypertension. Archives of Internal Medicine, 169(19). https://doi.org/10.1001/archinternmed.2009.316.
Gastens, V. et al. (2022). Pharmacist care in hypertension management: systematic review of randomized controlled trials. European Journal of Public Health, 32(3), 465-466. https://doi.org/10.1093/eurpub/ckac131.132.
Gastens, V. et al. (2022). Pharmacist interventions to improve hypertension management: protocol for a systematic review of randomised controlled trials. BMJ Open, 12(5), e059399. https://doi.org/10.1136/bmjopen-2021-059399.
Gastens, V. et al. (2025). Pharmacists delivering hypertension care services: a systematic review and meta-analysis of randomized controlled trials. Frontiers in Cardiovascular Medicine, 12. https://doi.org/10.3389/fcvm.2025.1477729.
Gonchar, A., Sholoiko, N., Kosyachenko, K., Komarida, O. (2025). Research on the consumption of two-component fixed combinations of medicines for the treatment of arterial hypertension in Ukraine in the period from 2020–2023 and the use of the results in the context of optimization of pharmaceutical assistance and the prospects of their inclusion in state reimbursement programs. ScienceRise: Pharmaceutical Science, 3(55), 4–19. http://doi.org/10.15587/2519-4852.2025.336898.
Khaira, M. et al. (2020). The Evolving Role and Impact of Integrating Pharmacists into Primary Care Teams: Experience from Ontario, Canada. Pharmacy, 8(4), P. 234. https://doi.org/10.3390/pharmacy8040234.
Olkhovska, A.B., Kupina, O.V., Tolmachova, I.M. (2025). The role of a clinical pharmacist in the routing of patients with arterial hypertension at the level of primary medical care. Актуальні питання клінічної фармакології та клінічної фармації (Topical issues of clinical pharmacology and clinical pharmacy): матеріали наук.-практ. Internet-конф. з міжнар. участю. м. Харків, 28 жовт. 2025 р. Харків: НФаУ, 2025. С. 69–70.
Santschi, V., Tsuyuki, R. T., Paradis, G. (2015). Evidence for pharmacist care in the management of hypertension. Canadian Pharmacists Journal / Revue des Pharmaciens du Canada, 148(1), 13–16. https://doi.org/10.1177/1715163514560564.
Sookaneknun, P. et al. (2004). Pharmacist involvement in primary care improves hypertensive patient clinical outcomes. Annals of Pharmacotherapy, 38(12), 2023–2028. https://doi.org/10.1345/aph.1d605.
Strand, L. et al. (2004). The Impact of Pharmaceutical Care Practice on the Practitioner and the Patient in the Ambulatory Practice Setting: Twenty-five Years of Experience. Current Pharmaceutical Design, 10(31), 3987–4001. https://doi.org/10.2174/1381612043382576.
Sustainable Development Goals. World Health Organization (WHO). URL: https://surl.li/jcaexn.
The realities of hypertension management in Ukraine. (2022). BJGP Life. https://surl.li/rxyjlt.
Vrijens, B. et al. (2012). A new taxonomy for describing and defining adherence to medications. British Journal of Clinical Pharmacology, 73(5), 691–705. https://doi.org/10.1111/j.1365-2125.2012.04167.x.
WHO: Hypertension. (2025). World Health Organization fact sheets. https://www.who.int/news-room/fact-sheets/detail/hypertension.
Williams, B. et al. (2018). 2018 ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal, 39(33), 3021–3104. https://doi.org/10.1093/eurheartj/ehy339.
Zhou, B. et al. (2021). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. The Lancet, 398(10304), 957–980. https://doi.org/10.1016/s0140-6736(21)01330-1.
