Fifty million Americans have hypertension, yet only half are treating it. While that fact may be enough to make any pharmacist's blood boil, it also is offering supermarket pharmacists an opportunity to increase awareness.
New programs designed to help patients keep their blood pressure in check have been introduced by several grocery chains:
Fred Meyer Inc., Portland, Ore., recently added more stores to the schedule of its HealthVan, a mobile health screening and education service being run in conjunction with a local hospital.
Dillon Stores, Hutchinson, Kan., is testing a computer software program designed to document and monitor patients with high blood pressure.
Price Chopper Supermarkets, Schenectady, N.Y., recently expanded a program in which a registered nurse is available on certain days to provide free blood pressure screenings.
Along with other disease states, such as diabetes and asthma, hypertension is increasingly being targeted by supermarket pharmacies. The greatest concern pharmacists have about the disease is its high noncompliance rate. Since hypertension is asymptomatic, patients tend not to treat it until they experience a serious end-organ effect, such as stroke, heart failure, coronary artery disease or renal problems.
"It's a silent disease," said John Beckner, pharmacy director at Ukrop's Super Markets, Richmond, Va. "Most of the time there won't be any symptoms until a stroke occurs."
Therefore, it's up to pharmacists to increase awareness, some said. Ukrop's plans to launch a hypertension disease state program for its employees within the next five months. Workers who have been diagnosed with the disease will be monitored by a Ukrop's pharmacist and placed on a nutritional program. It eventually may be extended to the general public.
"We'll be working with their insurance companies to have their blood pressure monitored by our pharmacists on a regular basis," Beckner said.
About $8 billion to $10 billion is spent on the disease annually, John Pieper, professor and chairman of pharmacy practice at the University of North Carolina, Chapel Hill, N.C., said in a presentation at last month's American Pharmaceutical Association convention in Nashville, Tenn.
Nearly 50 million Americans, or 20% of the population, have the disease (using a reading of 140 over 90 as the criteria for the upper end of normal). Of this, about two-thirds are aware of it, and about half are receiving treatment. Additionally, only 20% of patients are successfully controlling hypertension, Pieper said.
Concerned about statistics like these, several pharmacists interviewed said the main objective of their hypertension programs is to increase compliance.
"Most people taking medication don't feel any better; sometimes they feel worse. That's where noncompliance comes in," said Jane Siebert, pharmacy director at Dillon Stores.
Hypertension medications sometimes produce side effects, including hyperglycemia, diarrhea, fatigue, impotence, headache and nausea. But they reduce the risk of cardiovascular morbidity and mortality.
"Many people don't realize how important treatment is," Siebert added.
Dillon Stores this month began a three-month test of the DynaPulse 200M by Pulse Metric, San Diego. The program, launched at one of its Topeka, Kan., stores, is a computer-based blood pressure monitoring and tracking system.
The software can help plot out blood pressure monitoring programs, giving patients feedback on a monthly or a quarterly basis to help them determine if they're adequately controlling the disease. A blood pressure cuff is hooked up to the computer, enabling blood pressure readings to get entered into a computer file immediately. Assessments can be printed out so that patients can take them to a doctor. The program may be rolled out to other stores if it's proven to be successful.
Although Dillon offers self-serve blood pressure monitors and occasional in-store blood pressure screenings by a registered nurse, it decided more assistance was necessary.
"We had machines where people can monitor their own blood pressure. But there were still a lot questions that went unanswered, such as whether people were taking their medication and keeping on top of their problem," Siebert said. "We felt this system might help track cases better."
According to Pieper's APhA presentation, though the number of cases in the United States is decreasing, hypertension remains the most frequent reason people go into pharmacies for prescription drugs. It also is the most common diagnosis in the United States, Pieper said.
Statistics also show that 50% of the population 65 years or older has hypertension; 50% of all black males by age of 44 to 55. About 90% of all cases are mild, while 95% have primary hypertension, which means neither physical nor laboratory findings can explain their condition.
Fred Meyer early this year expanded a mobile health program that it runs with the Portland Adventist Medical Center. The service operates out of the HealthVan, a converted Greyhound bus operated by the Adventist Medical Center and staffed by a registered nurse. The HealthVan travels to one of 10 different Fred Meyer units for about four hours a day, according to Mark Smith, regional director of pharmacy.
Along with complimentary blood pressure screenings, HealthVan visitors can get fat analysis, cholesterol and blood sugar tests. Patients are charged $2 for cholesterol readings.
The program also operates runs in cooperation with Boehringer Mannheim, Rockville, Md., which sends a representative to each store the van visits. Visitors are told that if they purchase a set of Boehringer Mannheim blood glucose monitoring strips at Fred Meyer, a Boehringer representative will give them a free glucose monitor. The program is slated to run throughout the year.
Smith described the program as a win-win situation for all parties involved. "It helps get people back into the store," said Smith.
Though programs like Fred Meyer's are ideal ways to strengthen hypertension services, smaller efforts also can make a difference.
Price Chopper, for example, recently expanded the number of stores that have a registered nurse available on certain days to perform free blood pressure screenings.
Although the chain has electronic blood pressure machines available to all of its customers, some have been reluctant to use them, according to Bill Marth, pharmacy director. Five years ago, the retailer introduced a program in which a registered nurse was brought into one of its in-store pharmacies to perform free blood pressure screenings. It was so successful that it recently was implemented at another five stores. The program attracts nearly 40 people per store, according to Marth.
"It provides a great deal of interaction. The older people like it a lot. They enjoy being able to talk to someone," Marth said.
Price Chopper also is looking to launch an electronic program that will help track patient compliance.
The biggest hurdle is making people aware that they have high blood pressure, said Joseph Lanfer, pharmacy coordinator of the Fort Worth, Texas, division of Winn-Dixie Stores, Jacksonville, Fla.
"You can't just hand them a bottle and let them walk. You have to counsel them as well," he said.
To increase awareness about the disease, Winn-Dixie frequently promotes its free blood pressure monitors in its pharmacy ads.
"When we first put them in several years ago, we would go two or three months without people asking us a question. But now people want to discuss their readings with our pharmacists," he said.
Beckner of Ukrop's said hypertension programs can help supermarkets promote not only the pharmacy, but also other areas of the supermarket.
"Supermarket pharmacies have a big advantage because they can tie in [hypertension programs] with nutrition programs available in the grocery section of the store," he said.
Detecting hypertension often begins with a manual blood pressure check. But readings can be inaccurate if certain procedures are not followed. At last month's annual American Pharmaceutical Association convention, John Pieper, professor and chairman of pharmacy practice at the University of North Carolina, described the correct way to check blood pressure: