Blood pressure control

TABLE 1

Risk factors for hypertension

Controllable Uncontrollable
Obesity Age
Salt intake Race
Alcohol intake Heredity
Physical inactivity
Stress

 

creasing blood pressure in individuals ages 40 to 89.

The good news is that clinical trials have shown that antihypertensive therapy can significantly reduce the risk of adverse events and complications. Therapy can reduce the risk of stroke by 35 percent to 40 percent, myocardial infarction by 20 percent to 25 percent and heart failure by more than 50 percent.

However, not all the news is good. A recent study found that only 53 percent of participants who were being treated for hypertension were controlled with a blood pressure of less than 140/90 mmHg. Another study found similar results with only 48 percent of participants achieving goal blood pressures. Less than 40 percent of participants over 75 years old were controlled.

A variety of reasons are possible for the lack of control in nearly half of individuals with hypertension. The technician can and should play an important role in helping patients whose blood pressure is not under control get counseling from the pharmacist.

Patient Case

Mrs. Smith, a 60-year-old patient who has been coming to XYZ Pharmacy for many years, approaches the pharmacy counter. She is well-known by the pharmacy staff because she fills her prescriptions for insulin, syringes and other medications on a monthly basis. Mrs. Smith informs the technician that she has just come from her physician’s office. This was the first time that she had an appointment with this physician, explaining that her previous physician retired. She comments to the technician that her new physician says she has hypertension and that she needs to be started on a medication to control her blood pressure. Her previous physician never said anything like that. She feels fine, so she does not understand why she needs to start taking more medication when nothing seems to have changed.

Case Discussion

Patients are often confused by the need for treatment of hypertension. Patients with elevated blood pressure typically do not feel ill, leading them to believe that “ nothing is wrong.” Unfortunately, this is not true. Hypertension, known as a silent killer, can cause significant illness and death despite the limited symptoms. Patients who also have some other health problems (Mrs. Smith has diabetes) are at an increased risk of cardiovascular complications due to hypertension. The technician should ask the pharmacist to talk with Mrs. Smith to help her get her questions answered and to educate her about hypertension.

 

to be part of patients’ lives every day, reminders and encouragement are necessary.

Dietary changes

Studies involving the DASH (Dietary Approaches to Stop Hypertension) diet have shown beneficial effects on reducing blood pressure. The DASH diet is rich in fruits, vegetables, fat-free or low-fat milk and milk products, whole grain foods, fish, poultry, beans, seeds and nuts. The diet also contains low amounts of salt and sodium, sweets, added sugars, sugar-containing beverages, fats and red meats.

Smoking

Smoking increases the risk of cardiovascular events, especially stroke and peripheral vascular disease. This is particularly true in individuals with hypertension, another risk factor for these conditions. All patients who have hypertension and smoke should be encouraged to decrease or eliminate smoking.

TREATMENT GUIDELINES

FOR HYPERTENSION

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7) provides guidelines on the classifications of high blood pressure. ¹ The guidelines classify blood pressure as normal, prehypertension, stage 1 hypertension and stage 2 hypertension (Table 2).

The guidelines recommend that all patients with stage 1 or stage 2 hypertension should be treated to reduce their blood pressure. The goal of treatment for these patients is a blood pressure less than 140/90 mmHg. The blood pressure goal for patients with diabetes or chronic kidney disease is less than 130/80 mmHg.

Weight loss and exercise

Obesity is a risk factor for hypertension. The loss of 20 pounds can reduce systolic blood pressure by as much as 20 mmHg.

Aerobic exercise is recommended for the reduction of blood pressure. On average, individuals will reduce systolic blood pressure by 8 mmHg to 9 mmHg with aerobic exercise.

THE IMPORTANCE OF HOME MONITORING

Unfortunately, many patients with hypertension do not consider regular blood pressure monitoring to be a routine part of controlling hypertension. However, studies show that home blood pressure monitoring can improve blood pressure control. In a study of 430 patients, the patients who performed self-monitoring were more likely to reach blood pressures that allowed them to stop their antihypertensive medications or that allowed treatment to remain stable. Those who performed home monitoring, on average, used one drug or one

TABLE 2

IMPORTANCE OF LIFESTYLE MODIFICATIONS

Lifestyle modifications play an important role in the prevention and treatment of hypertension. Because these changes need

Stages of hypertension

Systolic blood
pressure (mmHg)

<120

120-139

140-159

>160

Classification Normal Prehypertension Stage 1 Stage 2

Diastolic blood pressure (mmHg)

<80

80-89 90-99

>100

May/June 2008

www.cedrugstorenews.com/40100008203H01

Drug Store News