Lauren S. Schlesselman, PharmD, assistant clinical professor, University of Connecticut School of Pharmacy

Universal Program Number: 401-000-08-008-H01 Initial release date: June 1, 2008

Planned expiration date: June 1, 2011

This program is worth two contact hours (0.2 CEUs).

Target Audience

Pharmacists in community-based practice.

Program Goal

To enable pharmacists to provide patient interventions and increase the percentage of patients who meet hypertension goals.

Learning Objectives

Upon completion of this program, the pharmacist should be able to:

1. Identify reasons patients with HTN do not make goal.

2. List steps pharmacists can and should take to assist patients with HTN to meet goal.

3. Counsel patients to be an active partner in reaching blood pressure goals.

4. Teach patients what steps they can take, including lifestyle modifications and home monitoring, to improve outcomes.

5. Contact prescribers when necessary.

Pharmacists’ role in promoting
adequate blood pressure control

TABLE 1

Risk factors for hypertension

Controllable Uncontrollable Obesity Age

Salt intake Race

Alcohol Heredity intake

Physical inactivity Stress

TO LINK DIRECTLY TO THIS LESSON CLICK www.cedrugstorenews.com/40100008008H01 To obtain credit: Answer the questions at the end of this lesson on the answer sheet provided. If you are submitting your answers by mail or fax, completely fill in the circle corresponding to your answer with a black pen (no pencils or blue pens please). A statement of credit will be sent to participants achieving a minimum score of 70 percent correct responses. Statements of credit are issued within seven days of receipt, if submitted by mail or fax, and immediately, if submitted online.

pharmacist must first identify the underlying issue(s) and then, in a collaborative manner, work with the patient toward a solution.

Questions regarding statements of credit and other customer service issues should be directed to Angela Sims at (800) 933-9666. Include your seven-digit CEQ enrollment number on the answer sheet. (The seven-digit number immediately to the right of the letters CE on the first line of the label.) Fax to (813) 626-7203 or mail completed answer sheet to DrSN/Pharmacy Practice, P.O. Box 31180, Tampa, FL 33631-3180.Programs also may be completed online at www.cedrugstorenews.com.

If you are a paid enrollee, there is no cost to participate in this lesson. The fee for participants who are not enrolled is $10.95.

Promotion code for Kmart lesson: 021-08-0008

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ÅINTRODUCTION

Hypertension affects approximately 1 billion individuals worldwide, including 50 million in the United States. ¹ Hypertension is the most common primary diagnosis in the United States. ² As the population ages, the prevalence of hypertension will increase. More than half of all individuals ages 60 to 69 have hypertension, while approximately three-fourths of those ages 70 years and older have hypertension. ³ Data from the Framingham Heart Study suggest that individuals whose blood pressure is in the normal range at age 55 have a 90 percent lifetime risk of developing hypertension. ⁴ Non-Hispanic blacks are more likely to have hypertension than non-Hispanic whites. Of great concern, nearly 25 percent of individuals with hypertension are unaware of their condition.

According to the American Heart Association, nearly 55,000 people died from hypertension in the United States in 2004.⁵ The death rates per 100,000 individuals from hypertension were 15. 7 for white males, 5l for black males, 14. 5 for white females and 40.9 for black females. The higher the blood pressure, the greater are the risks. These risks include heart attack, heart failure, stroke and kidney disease. For individuals between the ages of 40 and 70, the risk of cardiovascular disease doubles with each 20 mmHg increase in systolic blood pressure or each 10 mmHg increase in diastolic blood pressure. ⁶ The risk of death from ischemic heart disease and stroke increases progressively and linearly with increasing blood pressure in individuals ages 40 to 89.⁷

Not only are the costs associated with hypertension high, but so is the treatment of its complications. According to the Amer-

ican Heart Association and the National Heart, Lung and Blood Institute, the cost of cardiovascular disease and stroke in 2008 in the United States will approach $450 billion. This estimate includes direct costs ( associated with physician visits, hospitalizations, prescription medications and home healthcare services) and indirect costs (including lost productivity).

The good news is that clinical trials have shown that antihypertensive therapy can significantly reduce the risk of adverse events and complications. Medication 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. ⁸ Unfortunately, not all the news is good. A recent analysis of the National Health and Nutrition Examination Survey (NHANES) 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. ⁹ A cross-sectional analysis of Framingham Heart Study participants 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. Pharmacists can play a vital role in identifying these causes and helping to correct or prevent them. The pharmacist can identify patients who are not adhering to lifestyle modifications or medication regimens. There may be many reasons for nonadherence, including confusion about the directions, forgetfulness and concerns about side effects or the cost of medications. In order to help the patient, the

ETIOLOGY AND RISK FACTORS

Blood pressure is controlled by a variety of physiological factors, including vascular function, renal function, central nervous system stimulation and baroreceptors. Alterations in any of these can cause elevations in blood pressure. In most patients, the cause of hypertension is often unknown (primary hypertension), but for some patients, the elevation in blood pressure has an identifiable cause ( secondary hypertension).

A variety of risk factors for developing primary hypertension have been identified. Some of these are controllable, while others are not (Table 1). Controllable risk factors include lack of physical activity, stress, obesity (body mass index of 30 or higher), elevated alcohol intake and elevated salt intake. Uncontrollable risk factors include age, race and hereditary. In general, as a patient ages, the risk of developing hypertension increases because the blood vessels become less elastic. Men are more likely to develop hypertension between the ages of 35 and 55, while women are more likely to develop hypertension after menopause. Hypertension occurs more