A hyper-opportunity for pharmacy

At the Canadian Pharmacists Journal-Revue des pharmaciens du Canada, we pride ourselves on being leaders in the advancement of pharmacy practice. One thing that leaders do is keep an eye open for opportunities. Merriam Webster (https://www.merriam-webster.com/dictionary/opportunity) defines opportunity as “a favourable juncture of circumstances; a good chance for advancement or progress”—indeed, these definitions are highly applicable to modern pharmacy practice.

That opportunity is hypertension. Yes, you may have heard us talk about hypertension as the ultimate opportunity to advance both public health and the practice of pharmacy. ¹ Those circumstances are now overwhelmingly “ripe” and the chance for advancement is also very high. Here we outline the reasons:

• 1. Hypertension is the leading risk factor for premature death and disability in the world. It impacts more people than lack of clean water, dyslipidemia, diabetes, alcohol misuse, etc. So, it is of enormous public health importance. ² Over a billion people worldwide have hypertension—a billion people! And less than half of them have their blood pressure (BP) under control. To make matters worse, many people don’t know their BP is high (cue the phrase “silent killer”) and don’t seek treatment. Identifying undiagnosed hypertension and making the right interventions to manage and keep it under control can save millions of lives worldwide.

• 2. Pharmacists are in the ideal position to identify and manage hypertension. People with undiagnosed hypertension can be easily identified and managed in a community setting. Pharmacists are the most accessible providers of primary care and see their patients up to 10 times more frequently in a year than other primary care providers. ³

  BP is easily measured (more on that later) and is easily managed and controlled with medications. Indeed, hypertension might be the ideal condition for pharmacists to tackle (see inset box 1).

• 3. There is outstanding evidence for pharmacist care in hypertension. Recently, Gastens et al. ⁴ published a systematic review of 95 randomized trials (yes, 95 trials!!) of pharmacist care in hypertension and showed a mean reduction of 5.3/2.3 mmHg in over 31,000 patients. How many therapies do you know that have 95 randomized trials of evidence? But wait, another systematic review by Mills et al. ⁵ showed that of all health professionals, pharmacists have the greatest impact on BP lowering, significantly greater than nurses or physicians. Indeed, there might be no other intervention with a stronger evidence base than pharmacists and hypertension.

• 4. BP screening in pharmacies is feasible. Better management of hypertension starts with measurement. BP measurement is one of those things where the scope of practice across Canada for pharmacists and registered pharmacy technicians is unified; everyone can measure BP.

  We have recently published some of our experience with BP screening in Canadian pharmacies. Lee et al. ⁶ reported on community pharmacy-based BP screening in 460 subjects recruited from 32 pharmacies in Newfoundland and Labrador (NL) on World Hypertension Day 2022. They found elevated BP in 27% of subjects, with 41% of those having no history of diagnosed hypertension. Gysel et al. ⁷ reported on BP screening in 52 pharmacies in British Columbia, Alberta, and NL as part of the 2023 May Measurement Month (MMM, see below) program. Of the 736 participants, 20.7% had elevated BP, and in the subgroup with diabetes, 51.5% had elevated BP. Moreover, in a survey of the participating pharmacies in British Columbia and Alberta, pharmacy personnel cited a positive influence on their professional satisfaction, and that BP screening was not a burden on their workload. ⁸

Box 1.

Hypertension as the “sentinel condition” for pharmacy practice

In the safety world, a sentinel event is a patient safety event which leads to a disastrous outcome and signals a need for an immediate corrective action. Perhaps, hypertension is a “sentinel condition” for pharmacy practice: • The outcomes of untreated hypertension are devastating. • Traditional family physician-based treatment of hypertension is not sufficient. Change is necessary. Let’s empower Canadians to understand their blood pressure through pharmacy-based screening. Regardless of differences in our scope of practice across Canada or access to physicians, patients need access to services that improve their health and promote self-advocacy. • What interventions (pharmacist or otherwise) have the evidence of 95 randomized controlled trials behind them? Folks, the evidence base is not going to get any better than this. • What are the consequences of not acting, when we know we can do it? What is the role of our professional advocacy organizations? What is your individual role to advocate? • A change to pharmacists’ scope of practice for hypertension management might just be the “thin edge of the wedge” towards a full scope of pharmacist practice.

None of this is new. In Spain, Rodilla et al. ⁹ have been using community pharmacists for BP screening as part of May Measurement Month since 2017. In their report on May Measurement Month 2018, 891 community pharmacists participated in BP screening, enrolling over three-quarters of the 7646 participants. They found that 40% of those screened were hypertensive. ⁹

• 5.  Pharmacist care for hypertension has broad support. The World Health Organization’s Guideline for the Pharmacological Treatment of Hypertension in Adults Recommendation #8 states that “. . . pharmacological treatment of hypertension can be provided by non-physician professionals such as pharmacists. . . .” Professor Bryan Williams, then-President of the International Society of Hypertension, discussed how “Traditional paradigms fail: Primary care clinic-based management is not sufficient” when referring to the need for other health care professionals to step up to address the hypertension epidemic. The Heart and Stroke Foundation released a report from Canadian health professionals advocating for routine BP screening in the community by including pharmacists and community paramedicine as the way forward in Canada (https://www.heartandstroke.ca/what-we-do/media-centre/news-releases/health-professionals-concerned-about-blood-pressure-in-canada). Hypertension Canada has published a call to action to implement pharmacist prescribing authority for hypertension management. ¹⁰

• 6. This could become a paid pharmacy service. The National Health Service (NHS) in England launched the Community Pharmacy Blood Pressure Check Service in 2021 where eligible members of the public can have their BP assessed at a pharmacy at no direct cost to them. Pharmacy contractors are paid a fee for each BP screening and follow-up 24-hour ambulatory BP assessment. In a recent abstract, Tsuyuki et al. ¹¹ reported on over 4.1 million BP measurements conducted in community pharmacies in England as part of this program. In this cohort, over 30% (>1.2 million people!) had elevated BP, indicating the success of this case-finding program. ¹¹

Hypertension Canada is planning to use the data from Canadian May Measurement Month screenings in pharmacies to advocate for a remunerated BP check program similar to the NHS program. Similar actions are taking place in European countries such as Spain by scientific societies (Spanish Society of Family and Community Pharmacists, SEFAC).

• 7. New guidelines, new opportunities. On May 26, 2025, Hypertension Canada released their new guidelines for primary care, simultaneously published in the Canadian Medical Association Journal, Canadian Family Physician, Canadian Nurse, and CPJ (in this issue). These much-simplified guidelines are aimed squarely at primary care professionals—again an opportunity for pharmacists.

In addition, 2 recently published international hypertension guidelines by the European Society of Hypertension (ESH) ¹² and the European Society of Cardiology (ESC) ¹³ explicitly recommend involving community pharmacies in hypertension management.

How to take advantage of this opportunity

As we stated above, it all starts with measurement. So why not join our national effort to screen BP in pharmacies as part of the 2025 May Measurement Month campaign.

May Measurement Month is a global BP screening and awareness campaign, launched in 2017 by the International Society of Hypertension. This volunteer-run campaign runs from May 1 to July 31 every year. During May Measurement Month, well over 7 million people have been screened in 120 countries. See www.maymeasure.org for more information on the global campaign.

To join the Canadian May Measurement Month, here’s what you will need to do:

1. Go to: https://bloodpressurescreening.ca/may-measurement-month. This website has all the necessary information and links for you to join this initiative.

2. Take a short (20-minute) online certificate course on BP measurement technique.

3. Attend or watch a short training session on the procedures and data collection.

4. Locate your pharmacy’s BP device; it must be a Hypertension Canada-recommended device (see https://hypertension.ca/healthcare-professionals/recommended-devices).

5. Email mmmcanadapharmacy@gmail.com when you have completed the above steps with your pharmacy name and contact information. You will then be provided with access to the May Measurement Month 2025 database and study drive. ■