Pharmacist-Directed Hypertension and Diabetes Mellitus Medication Management in Sleeve Gastrectomy Patients

Purpose: There are little published data on hypertension (HTN) and diabetes mellitus (DM) medication adjustments in patients undergoing bariatric surgery and more specifically sleeve gastrectomy (SG).  These patients are at risk for hypoglycemia and hypotension in the early postoperative period.  This study sought to document the impact of a pharmacist-directed HTN and DM medication management program in patients undergoing SG.

Methods: All patients undergoing SG at a single center who were on at least one HTN or DM medication from November 2010-November 2011 were concurrently assessed. Medications were reconciled via patient interview by the pharmacist on postoperative day one. Recommendations were approved by the bariatric surgeon and implemented immediately postoperatively. Patients were encouraged to document home blood pressure/glucose readings and bring to first postoperative visit to aid medication adjustments. Patients were seen two weeks postoperatively and followed-up as needed by phone until seen by their primary care physician by week 6. Preoperative and 2-week postoperative blood pressures were documented.  Readmissions and emergency department visits for medication-related hypoglycemia/hypotension were documented. 

Results: Fifty patients (78% female) were evaluated. All recommendations were accepted including HTN medication discontinuation (n=46), DM medication discontinuation (n=21), HTN medication dosage decrease (n=13), and insulin dosage decrease (n=11).  Patients required a mean decrease of 1 DM and HTN medication immediately postoperatively which persisted through week 6 (p<0.01).  Postoperative 2-week mean systolic blood pressure readings were decreased significantly compared to preoperative readings (122mm Hg vs 132mm Hg, p<0.01). No patients were readmitted for medication-related hypoglycemia/hypotension.

Conclusion: A pharmacist-directed program in the SG patient requiring immediate postoperative HTN/DM medication decreases and frequent monitoring was both safe and effective. Perioperative and long-term management of HTN/DM medications represents an excellent opportunity for pharmacist intervention and research.