Lifestyle changes for prehypertension with other cardiovascular risk factors: Findings from Thailand
Juraporn Pongwecharak, PhD; Tarakamon Treeranurat, MPharm
J Am Pharm Assoc (2003) 2011;51:719-726. doi:10.1331/JAPhA.2011.10129


Objectives  To evaluate a model for community pharmacists to screen and recommend lifestyle changes for patients with prehypertension/hypertension and other elevated modifiable cardiovascular risk factors.

Design  Descriptive, exploratory, nonexperimental study.

Setting  One accredited community pharmacy in Hat Yai, Thailand, between October 2008 and January 2009.

Participants  Individuals 35 years or older without any previous diagnosis of hypertension and other cardiovascular disease.

Intervention  Measurement of blood pressure, blood glucose, total cholesterol, and body mass index; history taking for smoking and physical exercise; laboratory referral; assessment of readiness to adopt lifestyle changes; and provision of verbal advice and an education pamphlet on cardiovascular risk factors and recommended lifestyle modifications.

Main outcome measures  Number of prehypertensive/hypertensive participants, patient return rate at 3-month follow-up, rate of laboratory referral uptake, confirmed glucose intolerance and dyslipidemia, and changes from baseline in blood pressure level.

Results  263 of 400 people eligible for screening were found to have prehypertension or hypertension. Of these patients, 57% returned at 3-month follow-up. Mean (±SE) systolic (6.5 ± 0.89 mm Hg [95% CI 4.7–8.2], P < 0.001) and diastolic (2.2 ± 0.82 [0.54–3.77], P = 0.009) blood pressure were lowered. Compared with baseline (39.3%), the percentage of normotensive participants increased significantly at 3-month follow-up (51.8%; P < 0.001). The overall laboratory referral uptake was 36% (50 of 138). Glucose intolerance was confirmed in 2 of 21 participants. Of the 42 patients accepting laboratory confirmation, total and low-density lipoprotein cholesterol were confirmed to be above the normal range in 100% and 78.6%, respectively. Among these participants, those who returned at follow-up were rescreened for blood glucose and total cholesterol. Both values were found to be in the normal range. Although more participants reported lifestyle changes at 3 months, the smoking rate and amount of physical exercise were not changed.

Conclusion  Community pharmacists, through the use of point-of-care testing and referrals for laboratory testing, can detect patients who are at risk of developing or already have hypertension, diabetes, and/or dyslipidemia. Lifestyle advice from pharmacists can have a positive effect on these risk factors.

Sign In
APhA Members 
Welcome to JAPhA.org! Please log in below using your APhA username and password. Update your APhA profile.
Not a Subscriber
New to JAPhA? Become an APhA member to receive a full subscription to both the print and online editions.


Register for a FREE limited account to benefit from personalization features such as alerts.


Thailand Ministry of Public Health.  Health status and health problems of Thai people. In: Thailand health profile report 2005-2007. Accessed at www.moph.go.th/ops/thp/index.php, November 30,  2009.
Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.  Hypertension.  2003;42:1206–52.[PubMed][CrossRef]
Aekplakorn W, Abbott-Klafter J, Khonputsa P, et al. Prevalence and management of prehypertension and hypertension by geographic regions of Thailand: the Third National Health Examination Survey, 2004.  J Hypertens.  2008;26:191–8.[PubMed]
Greenlund KJ, Croft JB, Mensah GA.  Prevalence of heart disease and stroke risk factors in persons with prehypertension in the United States, 1999-2000.  Arch Intern Med.  2004;164:2113–8.[PubMed]
Kshisagar AV, Carpenter M, Bang H, et al. Blood pressure usually considered normal is associated with an elevated risk of cardiovascular disease.  Am J Med.  2006;119:133–41.[PubMed]
Conen D, Ridker PM, Buring JE, Glynn RJ.  Risk of cardiovascular events among women with high normal blood pressure or blood pressure progression: prospective cohort study.  BMJ.  2007;335:432.
Lawes CM, Rodgers A, Bennett DA, et al. Blood pressure and cardiovascular disease in the Asia Pacific region.  J Hypertens.  2003;21:707–16.[PubMed]
Gu D, Kelly TN, Wu X, et al. Blood pressure and risk of cardiovascular disease in Chinese men and women.  Am J Hypertens.  2008;21:265–72.[PubMed]
Ikeda A, Iso H, Yamagishi K, et al. Blood pressure and the risk of stroke, cardiovascular disease, and all-cause mortality among Japanese: the JPHC study.  Am J Hypertens.  2009;22:273–80.[PubMed]
Jackson R, Lawes CM, Bennett DA, et al. Treatment with drugs to lower blood pressure and blood cholesterol based on an individual's absolute cardiovascular risk.  Lancet.  2005;365:434–41.[PubMed]
Nash IS.  Reassessing normal blood pressure.  BMJ.  2007;335:408–9.[PubMed]
Lee J, Ma S, Heng D, et al. Hypertension, concurrent cardiovascular risk factors and mortality: the Singapore Cardiovascular Cohort Study.  J Hum Hypertens.  2008;22:468–74.[PubMed]
Pongwecharak J, Treeranurat T.  Screening for pre-hypertension and elevated cardiovascular risk factors in a Thai community pharmacy.  Pharm World Sci.  2010; 32:329–33.[PubMed]
Zimmerman GL, Olsen CG, Bosworth MF.  A ‘stages of change’ approach to helping patients change behavior.  Am Fam Physician.  2000;61:1409–16.[PubMed]
American Diabetes Association.  Diagnosis and classification of diabetes mellitus.  Diabetes Care.  2008;31(suppl 1):S55–60.
Parati G, Stergiou GS, Asmar R, et al. European Society of Hypertension guidelines for blood pressure monitoring at home: a summary report of the Second International Consensus Conference on Home Blood Pressure Monitoring.  J Hypertens.  2008;26:1505–30.[PubMed]
Karwalajtys T, Kaczorowski J, Hutchison B, et al. Blood pressure variability and prevalence of hypertension using automated readings from multiple visits to a pharmacy-based community-wide programme.  J Hum Hypertens.  2009;23:585–9.[PubMed]
International Diabetes Federation.  Global guideline for type 2 diabetes. Accessed at www.idf.org/webdata/docs/IDF%20GGT2D.pdf, November 19,  2009.
Krass I, Mitchell B, Clarke P, et al. Pharmacy diabetes care program: analysis of two screening methods for undiagnosed type 2 diabetes in Australian community pharmacy.  Diabetes Res Clin Pract.  2007;75:339–47.[PubMed]
Hoerger TJ, Harris R, Hicks KA, et al. Screening for type 2 diabetes mellitus: a cost-effectiveness analysis.  Ann Intern Med.  2004;140:689–99.[PubMed]
Waugh N, Scotland G, McNamee P, et al. Screening for type 2 diabetes: literature review and economic modeling. Accessed at www.hta.ac.uk/execsumm/summ1117.shtml, November 1,  2009.
Snella KA, Canales AE, Irons BK, et al. Pharmacy- and community-based screenings for diabetes and cardiovascular conditions in high-risk individuals.  J Am Pharm Assoc.  2006;46:370–7.
Liu Y, McDonough RP, Carruthers KM, Doucette WR.  Identifying patients at risk of cardiovascular disease: a pharmacist-managed screening event for union workers and their dependents.  J Am Pharm Assoc.  2009;49:549–53.
Horgan JM, Blenkinsopp A, McManus RJ.  Evaluation of a cardiovascular disease opportunities risk assessment pilot (‘Heart MOT’ service) in community pharmacies.  J Public Health (Oxf).  2010;32:110–6.[PubMed]
Peterson GM, Fitzmaurice KD, Kruup H, et al. Cardiovascular risk screening program in Australian community pharmacies.  Pharm World Sci.  2010;32:373–80.
Blenkinsopp A, Anderson C, Armstrong M.  Systematic review of the effectiveness of community pharmacy-based interventions to reduce risk behaviors and risk factors for coronary heart disease J Public Health Med.  2003;25:144–53.[PubMed]
Yamada C, Johnson JA, Robertson P, et al. Long term impact of a community pharmacist intervention on cholesterol levels in patients at high risk for cardiovascular events: extended follow-up of the Second Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP-plus).  Pharmacotherapy.  2005;25:110–5.[PubMed]
Chiang CE, Chen CH.  Hypertension in the Asia-Pacific region.  J Hum Hypertens.  2008;22:441–3.[PubMed]
National Statistical Office of Thailand.  The 2007 cigarette smoking and alcoholic drinking behaviour survey. Accessed at http://web.nso.go.th/survey/smoke/smoke07.htm, November 19,  2009.
Botomino A, Bruppacher R, Krähenbühl S, Hersberger KE.  Change of body weight and lifestyle of persons at risk for diabetes after screening and counseling in pharmacies.  Pharm World Sci.  2008;30:222–6.[PubMed]
Olenak JL, Calpin M.  Establishing a cardiovascular health and wellness program in a community pharmacy: screening for metabolic syndrome.  J Am Pharm Assoc.  2010;50:32–6.
Lloyd-Jones D, Adams RJ, Brown TM, et al. Heart disease and stroke statistics–2010 update: a report from the American Heart Association.  Circulation.  2010;121:948–54.[PubMed]
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Please read the other comments before you post yours. Comments are moderated and will appear on the site at the discertion of the editorial staff.
* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe

Related Content

Customize your page view by dragging & repositioning the boxes below.

JAPhA Articles
Topic Collections
PubMed Articles
  • Print
  • PDF Download
  • Email
  • Share
  • Get Citation
  • Submit Comment
  • Article Alerts
    Please Wait... Processing your request... Please Wait.
    You must sign in to sign-up for alerts.

    Please confirm that your email address is correct, so you can successfully receive this alert.

  • Letters To Editor
  • Reprints