Long-Term Outcomes of Pharmacist-Physician Collaborative Drug Therapy Management in Hypertensive Stroke Survivors: A Prospective Cohort Study in South South Nigeria

Hypertensive stroke survivors face a high risk of recurrent stroke, cardiovascular events, and functional decline, outcomes substantially influenced by the quality of long-term antihypertensive drug therapy management. Pharmacist-physician collaborative drug therapy management models have demonstrated effectiveness in controlled blood pressure populations, but evidence from stroke survivor cohorts in African settings is absent from the literature. This prospective cohort study investigated the long-term outcomes of pharmacist-physician collaborative drug therapy management in hypertensive stroke survivors at tertiary hospitals in South South Nigeria, with sites in Rivers, Delta, and Akwa Ibom States. Two hundred and twenty stroke survivors were enrolled and followed prospectively for 24 months in a collaborative management arm, with a matched historical control cohort drawn from pre-program stroke survivor records. The collaborative model involved joint pharmacist-physician clinic reviews at one, three, six, twelve, eighteen, and twenty-four months, with pharmacist-led medication reconciliation, drug-related problem resolution, adherence monitoring, and patient education between visits. Primary outcomes were recurrent stroke incidence, systolic blood pressure control, and antihypertensive adherence at 24 months. Recurrent stroke incidence was significantly lower in the collaborative arm at 9.1 percent versus 18.7 percent in controls. Systolic blood pressure was controlled to below 130 mmHg in 67 percent versus 42 percent. Adherence was high in 71 percent versus 39 percent. These landmark findings provide the first prospective cohort evidence for collaborative pharmacist-physician drug therapy management reducing stroke recurrence in Nigerian patients. Keywords: collaborative drug therapy management, stroke survivors, hypertension, South South Nigeria, secondary prevention