The importance of blood pressure is evident as it is measured at every visit to a physician’s office.

Hypertension or high blood pressure is a common chronic condition affecting 1 out of every 3 American adults. Hypertension can be defined based on a systolic blood pressure 140 mm Hg or a diastolic blood pressure 90 mmHg. Although we make a distinction between hypertension or its absence based on a blood pressure cut-off of 140/90 mmHg, there is increased risk for cardiovascular disease for patients with pre-hypertension (defined as systolic blood pressure 120–139 mmHg or diastolic blood pressure 80–89 mmHg.) Patients with pre-hypertension are at higher risk for cardiovascular disease than patients with normotension and should receive aggressive lifestyle management. For those patients with pre-hypertension and other cardiovascular risk factors, antihypertensive therapy may be warranted.

High blood pressure is a risk factor for stroke, myocardial infarction, heart failure and renal failure. Lowering blood pressure reduces the risk for these diseases. Both lifestyle management and antihypertensive therapy assist with achieving goal blood pressure. Goal blood pressure is < 140/90 mmHg, unless the patient has comorbid diabetes or renal dysfunction which warrants a more aggressive blood pressure goal of < 130/80 mmHg.

Lifestyle management is recommended for all patients with hypertension and includes cessation of smoking, reduction of excess weight, increased physical activity, moderate reduction of sodium intake, increased intake of potassium, moderate intake of alcohol and maintenance of adequate intake of calcium and magnesium.

The reality is that, over time, changes in lifestyle are often not sustained. This is why it is critical to teach our youth healthy habits so they do not have to make lifestyle change later on.

In 2003, the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VII) published the latest version of nationally accepted hypertension guidelines. Antihypertensives have been found to reduce the incidence of strokes by 35-40%, heart attacks by 20–25% and heart failure by 50% . Treatment should be individualized and most patients will require 2 or more antihypertensive agents to achieve goal blood pressure. Diuretics are recommended as first-line therapy by JNC-VII guidelines and supported by the landmark trial, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).

Since hypertension is a “silent” disease process, adherence to medication is particularly problematic. Cost has been found, especially in the elderly to impact medication adherence negatively. If a medication is not taken correctly, the intended benefit will not be gained. Therefore, it is essential to consider factors such as cost, ease of administration and patient tolerability when designing and monitoring drug therapy regimens for hypertension.

According to NHANES (National Health and Nutrition Examination Survey of 2005-2006), 64% of American adults have uncontrolled hypertension putting them at increased risk for heart attacks and strokes. Patients with hypertension need to be more aggressively managed using lifestyle management and antihypertensive therapy to reduce unwanted consequences of high blood pressure.

To learn more about hypertension, RxSchool is offering a 1.25 credit hour distance course entitled The Role of the Pharmacy Team in the Management of Hypertension. This course not only covers clinical issues about hypertension, but through its case-based approach, offers tools for the Pharmacist and Pharmacy Technician to counsel patients with questions about their blood pressure.

This program is supported by an educational grant from PharmaSmart.

Contributed by:
Catherine E. Cooke, PharmD, BCPS, PAHM

This home study web activity has been assigned a maximum of 1.25 credit hours and the
ACPE UPN: 372-000-09-001-H01-P
ACPE UPN: 372-000-09-001-H01-T

RxSchool is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education.

To receive CE credit for this course, please log onto RxSchool.com
URL: Course Information Page
Email: info@rxschool.com