It’s Time for Pharmacy to Serve as the Front Door to Heart Care

May is American Stroke and High Blood Pressure Education Month, as promoted by the American Heart Association, and May 17 is World Hypertension Day. Yet we are not at a celebratory period, as hypertension affects nearly 1 in 2 US adults and is a major preventable risk factor for heart disease and stroke.¹

Despite the common nature of this condition, only 1 in 4 adults has their blood pressure (BP) under control. An individual’s risk for heart disease is greatly influenced by their blood pressure and low-density lipoprotein cholesterol levels. The No. 1 risk factor for heart disease is hypertension (BP > 130/80 mm Hg), and research informs us that the BP target for most individuals should be below 130/80 mm Hg.² Recently published research suggests this target is essential for individuals with type 2 diabetes as well.³

In 2025, the American Heart Association and American College of Cardiology released their Guideline for the Management of High Blood Pressure in Adults, providing the first major update since 2017.⁴ Among other items, this guideline emphasizes team‑based, multidisciplinary care, bringing together physicians, nurses, pharmacists, dietitians, and community health workers to achieve sustained BP control. In essence, effective hypertension management relies on coordinated systems rather than isolated clinical visits. Thus, pharmacies and pharmacists can play a critical role in the identification, treatment, and management of hypertension.

The US Surgeon General’s Call to Action to Control Hypertension from 2020 made this a priority.⁵ BP interventions led by pharmacists and community health workers effectively improve BP control and address disparities. Sadly, our health systems, government agencies, and communities underutilize these key players. What is understood is that community-based pharmacies are a critical access point to health care. Although we are the “front door to health care,” in this context we are also the front door to heart care.

There is an economic reality to leveraging the pharmacist beyond assessing BP alone that is not fully embraced. Study results published in JAMA in 2023 found that implementing a pharmacist‑prescribing intervention for BP management could yield substantial economic and clinical benefits.⁶ In a simulated cost‑effectiveness model, 50% adoption of this intervention was projected to generate $1.137 trillion in cost savings and add approximately 30.2 million life‑years over 30 years. In addition to the clinical impact, these results indicate that pharmacist‑prescribing approaches offer significantly greater economic value than usual care.

Over the past 20 years in my own state of Wisconsin, heart disease has been the leading cause of death among Black, White, Asian, Pacific Islander, and multiracial populations and the second leading cause of death among Hispanic or Latino and American Indian populations.¹ Patients can also play an essential role with their care providers in managing their hypertension.

Self-measured BP (SMBP) measurements at home (when done correctly and with a device validated for accuracy) better predict heart attacks and strokes than readings conducted in a clinical examination room.^7-9 BP interventions led by pharmacists and community health workers effectively improve BP control and address disparities, but our health systems and communities underutilize these interventions and care providers.^10-13

At the Medical College of Wisconsin (MCW), we are taking on an ambitious project built on a collaborative model between physicians and pharmacists, as well as community health workers. The bedrock of this project comes from a published work, led by one of our pharmacist faculty in the MCW School of Pharmacy, in which BP dropped significantly over the 12-month treatment course among 653 enrolled patients with a mean systolic BP difference of 19.97 mm Hg (P < .001) and a mean diastolic BP difference of 12.34 mm Hg (P < .001), demonstrating that a pharmacist-driven remote patient monitoring protocol utilizing SMBP readings is an effective management strategy to reduce BP in patients with uncontrolled hypertension.¹¹ Patient enrollment continues and has nearly doubled since publication.

The MCW project is to be accomplished by scaling an evidence-supported, team-based system through an asynchronous, digital care model scaled by each partnering health care organization in 6 contiguous Wisconsin counties, all reflecting diverse communities. It is hoped that the model of an evidence-based approach deploying a physician-pharmacist collaborative practice agreement and SMBP devices at home, with the relaying of readings to the clinical team (with a pharmacist titrating medications), could be replicated across the US.

Beyond such population health-based research, pharmacy schools play a critical role in preparing future pharmacist practitioners to perform BP measurements accurately. The new Accreditation Council for Pharmacy Education (ACPE) 2025 Standards for the PharmD require skills in diagnosing and prescribing.

I was part of a multidisciplinary workgroup led by physicians that resulted in the 2021 Academic Medicine publication “A Call to Action: Next Steps to Advance Diagnosis Education in the Health Professions,” in which we assessed the current state of diagnosis among 3 of the largest health professions (eg, medicine, nursing, and pharmacy). The conclusion was that stakeholders in each profession, representing education, certification, accreditation, and licensure, must take action in their own areas to encourage, promote, and enable improved diagnosis and move forward with such recommendations. This work, along with our academic pharmacist colleagues, helped inform ACPE of the need for diagnosis to be included in the New 2025 Standards adopted.¹¹

In this same interdisciplinary approach, several academic pharmacy programs, including our own at MCW, have utilized the American Medical Association (AMA) Student BP Measurement eLearning Series, an evidence-based resource designed to standardize BP measurement training across health care disciplines. Recognizing the need for further collaboration and feedback, we conducted a key stakeholder meeting at the American Association of Colleges of Pharmacy annual meeting in July 2025, inviting faculty involved in patient care laboratories to discuss how they use this resource and explore strategies to increase its adoption and effectiveness in their respective PharmD programs. Our uniform goal is to ensure our PharmD students are confident and competent in performing accurate BP measurements. Using a widely accepted AMA educational tool provides a systematic approach to ensuring a foundational clinical skill essential to effective hypertension management across all disciplines, including pharmacists. Imagine the value of having 10,000 PharmD graduates a year entering practice with a uniform approach to measuring blood pressure (and ultimately managing it) across the US.

We have alignment within the profession, support across multidisciplinary groups, clinical guidelines, published research, and now accreditation standards, so pharmacists can and should play a vital role in the diagnosis, treatment, and management of hypertension. It’s time for our profession to serve as the front door to heart care.

REFERENCES

1. Environmental public health tracking: heart disease and stroke data. Wisconsin Department of Health Services. Updated February 24, 2026. Accessed April 13, 2026. https://www.dhs.wisconsin.gov/epht/heart-attack.htm

2. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation. 2018;138(17):e484-e594. doi:10.1161/CIR.0000000000000596

3. Bi Y, Li M, Liu Y, et al. Intensive blood-pressure control in patients with type 2 diabetes. N Engl J Med. 2025;392:1155-1167. doi:10.1056/NEJMoa2412006

4. Writing Committee members; Jones DW, Ferdinand KC, Taler SJ, et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2025;152(11);e114-e218. doi:10.1161/CIR.0000000000001356

5. The surgeon general’s call to action to control hypertension. US Department of Health and Human Services. 2020. Accessed April 13, 2026. https://www.hhs.gov/sites/default/files/call-to-action-to-control-hypertension.pdf

6. Dixon DL, Johnston K, Patterson J, Marra CA, Tsuyuki RT. Cost-effectiveness of pharmacist prescribing for managing hypertension in the United States. JAMA Netw Open. 2023;6(11):e2341408. doi:10.1001/jamanetworkopen.2023.41408

7. Acharya S, Neupane G, Seals A, et al. Self-measured blood pressure-guided pharmacotherapy: a systematic review and meta-analysis of United States-based telemedicine trials. Hypertension. 2024;81(3):648-657. doi:10.1161/HYPERTENSIONAHA.123.22109

8. Mengden T, Weisser B, Vetter W. Ambulatory 24-hour blood pressure versus self-measured blood pressure in pharmacologic trials. J Cardiovasc Pharmacol. 1994;24(suppl 2):S20-S25.

9. Shimbo D, Artinian NT, Basile JN, et al. Self-measured blood pressure monitoring at home: a joint policy statement from the American Heart Association and American Medical Association. Circulation. 2020;142(4):e42-e63. doi:10.1161/CIR.0000000000000803

10. Baral N, Volgman AS, Seri A, et al. Adding pharmacist-led home blood pressure telemonitoring to usual care for blood pressure control: a systematic review and meta-analysis. Am J Cardiol. 2023;203:161-168. doi:10.1016/j.ajmcard.2023.06.109

11. Hovis Z, Hanson R, DeJarlais E. Clinical impact of a tiered, pharmacist-driven remote patient monitoring protocol utilizing self-measured blood pressure readings. J Am Coll Clin Pharm. 2024;8(1):6-11. doi:10.1002/jac5.2059

12. Margolis KL, Asche SE, Dehmer SP, et al. Long-term outcomes of the effects of home blood pressure telemonitoring and pharmacist management on blood pressure among adults with uncontrolled hypertension. JAMA Netw Open. 2018;1(5):e181617. doi:10.1001/jamanetworkopen.2018.1617

13. Omboni S, Sala E. The pharmacist and the management of arterial hypertension: the role of blood pressure monitoring and telemonitoring. Expert Rev Cardiovasc Ther. 2015;13(2):209-221. doi:10.1586/14779072.2015.1001368

14. Graber ML, Holmboe E, Stanley J, Danielson J, Schoenbaum S, Olson APJ. A call to action: next steps to advance diagnosis education in the health professions. Diagnosis (Berl). 2021;9(2):166-175. doi:10.1515/dx.2021.0103