Joseph J. Saseen

Effect of pharmacist intervention and initiation of home blood pressure monitoring in patients with uncontrolled hypertension.

This prospective, randomized, controlled study evaluated the impact of pharmacist‐initiated home blood pressure monitoring and intervention on blood pressure control, therapy compliance, and quality of life (QOL). Subjects were 36 patients with uncontrolled stage 1 or 2 hypertension. Eighteen subjects received home blood pressure monitors, a diary, and instructions to measure blood pressure twice every morning. Home measurements were evaluated by a clinical pharmacist by telephone, and the patients family physician was contacted with recommendations if mean monthly values were 140/90 mm Hg or higher. Eighteen control patients did not receive home monitors or pharmacist intervention. Office blood pressure measurements and QOL surveys (SF‐36) were obtained at baseline and after 6 months. Mean absolute reductions in systolic and diastolic pressures were significantly reduced from baseline in intervention subjects (17.0 and 10.5 mm Hg, both p<0.0001) but not in controls (7.0 and 3.8 mm Hg, p=0.12 and p=0.09). More intervention subjects (8) had blood pressure values below 140/90 at 6 months compared with controls (4). During the study 83.3% (15) of intervention subjects had drug therapy changes versus 33% (6) of controls (p<0.01). Compliance and QOL were not significantly affected. Our data suggest that the combination of pharmacist intervention with home monitoring can improve blood pressure control in patients with uncontrolled hypertension. This may be related to increased modifications of drug regimens.

A Comparison of the Direct Costs and Cost Effectiveness of Serotonin Reuptake Inhibitors and Associated Adverse Drug Reactions

AbstractBackground: The economic burden of depression is known to be high and was estimated to be

Comparison of Nifedipine Alone and With Diltiazem or Verapamil in Hypertension

US83.1 billion in 2000. Serotonin reuptake inhibitors (SRIs), including both selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs), have a superior adverse effect and safety profile relative to traditional agents (e.g. TCAs), and as a result have demonstrated superior cost effectiveness. Although efficacy across the SRIs is similar, the incidence of adverse drug reactions (ADRs) within SRIs remains significant and varies by agent. Patients who experience ADRs from SRIs may seek medical care, require additional treatment, and even discontinue treatment altogether, leading to increased utilisation and cost of therapy.n Objective: This study estimates the direct cost and cost effectiveness, taking into account the impact of treatment-related ADRs, of eight currently marketed SRIs (citalopram, escitalopram, generic fluoxetine, paroxetine, paroxetine controlled release [CR], sertraline, venlafaxine and venlafaxine extended release [XR]) used as initial treatment for depression.n Methods: A decision analytic model with a 6-month treatment goal was used to estimate the direct cost and cost effectiveness of treatment from the managed care/ payer perspective. Estimates of SRI-related ADRs, associated treatments and costs were derived from the US FDA-approved prescribing information and published literature. Efficacy was assumed to be similar across all SRIs. Effectiveness was measured using quality-adjusted life years (QALY) based on EuroQol EQ-5D scores derived from the 2000 Medical Expenditure Panel Survey (MEPS). Censored least absolute deviations (CLAD) regression analysis was used to derive age-adjusted estimates of utility for all health states. Univariate and Bayesian second-order multivariate probabilistic sensitivity analyses were conducted to examine the impact of uncertainty in the parameter estimates.n Results: The expected direct cost and cost effectiveness of treatment from least to most expensive were: escitalopram (

Impact of the Women's Health Initiative Trial Results on Hormone Replacement Therapy

US3891; 0.341), citalopram (

A retrospective cohort study of correlates of response to pharmacologic therapy for hyperlipidemia in members of a managed care organization.

US3938; 0.340), generic fluoxetine (

β-Blockers A Review of Their Pharmacological and Physiological Diversity in Hypertension

US4034; 0.335), venlafaxine XR (

Update on the use of PCSK9 inhibitors in adults: Recommendations from an Expert Panel of the National Lipid Association

US4226; 0.336), sertraline (

Postabsorption Concentration Peaks with Brand‐Name and Generic Verapamil: A Double‐Blind, Crossover Study in Elderly Hypertensive Patients

US4250; 0.335), generic paroxetine (

Clinical and economic consequences of statin intolerance in the United States: Results from an integrated health system

US4385; 0.332), paroxetine CR (

Simvastatin Prescribing Patterns Before and After FDA Dosing Restrictions: A Retrospective Analysis of a Large Healthcare Claims Database

US4440; 0.332) and venlafaxine (