The Influence of Pharmaceutical Care on the Cardiovascular Risk Rate of Hypertensives from Health Care Unit of CearÃ

A HipertensÃo Arterial SistÃmica à uma das doenÃas de maior importÃncia epidemio-lÃgica no Brasil. Dentre as principais causas de morte decorrentes da hipertensÃo, as complicaÃÃes cardiovasculares apresentam grande relevÃncia devido à sua fre-qÃÃncia e gravidade. Estudos anteriormente realizados em vÃrios paÃses demonstra-ram que a prestaÃÃo da AtenÃÃo FarmacÃutica (AF) proporcionou reduÃÃo da taxa de risco cardiovascular (%RCV) em pacientes hipertensos. Tendo em vista esse fa-to, foi decidido averiguar e demonstrar, atravÃs de um ensaio clÃnico randomizado, a influÃncia da prestaÃÃo da AF na %RCV de pacientes hipertensos atendidos pela farmÃcia da Unidade BÃsica de SaÃde Dr. AnastÃcio MagalhÃes. Com esse intuito, foram formados dois grupos de estudo, um Grupo IntervenÃÃo (GI), no qual os parti-cipantes foram submetidos a um Acompanhamento FarmacoterapÃutico (AFT) de nove meses de duraÃÃo segundo o MÃtodo DÃder, e um Grupo Controle (GC), no qual os participantes receberam a assistÃncia tradicional e foram monitorados duran-te o mesmo perÃodo. Ao inÃcio, meio e fim do estudo, foram registrados exames labo-ratoriais e nÃveis pressÃricos dos participantes, indicadores necessÃrios para o cÃl-culo da %RCV, realizado posteriormente atravÃs da Escala de Framingham. Foram incluÃdos 68 pacientes, com 56 deles tendo completado o estudo. No fim, foram ana-lisadas as diferenÃas entre os resultados obtidos, para cada grupo, durante o estu-do. ApÃs anÃlise estatÃstica, observou-se que houve reduÃÃo estatisticamente signi-ficante nas %RCV e nos nÃveis de pressÃo arterial sistÃlica (PAS) de 26,9% e de 4,5% do valor inicial, respectivamente no GI, enquanto que no GC nÃo houve mu-danÃa significante. AlÃm disso, observou-se tendÃncia à resultados positivos nos demais indicadores clÃnicos dos participantes da pesquisa, sendo mais acentuado no GI. TambÃm foi analisada, durante o estudo, a incidÃncia de Problemas Relaciona-dos a Medicamentos (PRM), tendo sido identificados e classificados 151 casos, ha-vendo predominÃncia do PRM 04, 03 e 05, com freqÃÃncia de 31,8, 28,5 e 21,2%, respectivamente. A maioria foi considerada real (65,6%), sendo 28,3% deles classifi-cados como PRM 04, tambÃm sendo o mais freqÃente dentre os considerados po-tenciais (34,4%), com freqÃÃncia de 38,5% dos potenciais. Foram realizadas 124 intervenÃÃes farmacÃuticas a fim de resolver ou prevenir os PRM, sendo, a mais fre-qÃente, o aprazamento das tomadas dos medicamentos (52,4%). ApÃs a realizaÃÃo das intervenÃÃes, 89,2% das que tiveram seu desfecho avaliado resultaram em so-luÃÃo/prevenÃÃo dos problemas. Ao fim do trabalho, pÃde-se inferir que a inclusÃo do serviÃo de AF na assistÃncia ao paciente hipertenso foi mais eficaz na reduÃÃo da %RCV e nÃveis de PAS, principalmente, em comparaÃÃo à assistÃncia tradicional oferecida. Por fim, enfatiza-se a importÃncia da prestaÃÃo da AF a pacientes hiper-tensos em relaÃÃo à melhora do quadro de saÃde atual e da prevenÃÃo de compli-caÃÃes cardiovasculares futuras, bem como de problemas relacionados à terapia normalmente nÃo detectados ou negligenciados.The Systemic Arterial Hypertension is one of the most important diseases in Brazil regarding epidemiology. Among the major causes for death in individuals with hyper-tension the cardiovascular complications show great relevance due to their severity and frequency. Prior studies from several countries demonstrated that, through the Pharmaceutical Care (PC) practice, there was a decrease in the cardiovascular risk rate (%CVR) of patients with hypertension. Up to that, it was decided to investigate and demonstrate, by means of a randomized clinical assay, the influence of the PC practice on the %CVR from hypertensive patients attended by the pharmacy service from the Primary Care Unit Dr. AnastÃcio MagalhÃes. Aiming this, two study groups were formed, an Intervention Group (IG), in which the participants went through a 9 month Pharmacotherapeutic Follow-up (PTF) according to the DÃder Method, and a Control Group (CG), in which the participants received traditional care and were mo-nitored during the same period of time. At the beginning, middle and end of the study, laboratorial exams and blood pressure levels from the participants were registered. These were necessary for the %CVR assessment which was performed after using the Framingham Scale. Were included 68 patients and 56 of them completed the study. At the end, the differences between results from each group were analyzed. After the statistical analysis, it was observed a statistically significant decrease on the %CVR and systolic blood pressure level from the IG patients, equivalent to 26.9% and 4.5% from the baseline, respectively. The CG didnât show any significant differ-ence. Beside this, it was observed a tendency for positive results on the other clinic indicators from the participants, which was greater on the IG. The incidence of the Drug Related Problems (DRP) was determined, and 151 DRP were identified and classified. The DRP 04, 03 and 05 were the most predominant with frequency of 31.8% 28.5% and 21.2%, respectively. The majority of the DRP was considered the real type (65.6%), with 28.3% of them classified as DRP 04. Among the potential type (34.4%) the most common was also the DRP 04, representing 38.5% of this group. Several pharmaceutical interventions were taken in order to solve or prevent the identified DRP (124 total). The most common intervention made was the teaching about the right time to take the drugs (52.4%). After the developing of the interven-tions, 89.2% of the problems were solved/prevented. At the end, we were able to conclude that the inclusion of the PC service on the hypertensive patient health care was more effective at decreasing %CVR and SBP level, especially, in comparison to the traditional health care offered. Finally, we emphasize the importance of the PC practice oriented to patients with hypertension as a good strategy to improve current health status and the future cardiovascular complications prevention as well as the prevention of the therapy related problems which are normally undetected or ne-glected