Sample Book Chapter from the Collaborative Drug Therapy Management Handbook - Hypertension

Alvin Goo

February 04, 2008

In This Article

Introduction

Hypertension (HTN) affects approximately 50 million individuals in the United States and 1 billion worldwide. Unless broad and effective preventive measures are implemented, the prevalence of hypertension will continue to increase.[1] Hypertension is a major modifiable risk factor for cardiovascular disease (CVD). Current trends indicate hypertension is often undertreated and associated with poor medication and lifestyle adherence. Pharmacists play an important role then in providing patient education, identifying barriers to medication adherence, and assisting the patient in developing plans to address and improve adherence.

Numerous antihypertensive agents are available and should be tailored to address specific patient characteristics. The pharmacist's knowledge of evidence-based primary literature, pharmacokinetics, and when a particular class of antihypertensive agent provides greater benefit plays an important role in the recommendation and selection of appropriate cost-effective antihypertensive agents.The following treatment guidelines are adapted from the Seventh Report of the Joint National Committee on the Diagnosis, Evaluation, and Treatment of Hypertension for Classifying and Defining Blood Pressure levels for Adults (18 years and older).[1] For additional information, please see http://www.nhlbi.nih.gov/guidelines/hypertension.

Indications[1]

 

  1. Adult patients ≥18 years old at high risk for developing cardiovascular events who have been referred by their primary care provider or identified from medical databases. High-risk patients include, but are not limited to, patients with diabetes, renal disease, heart failure (HF), and those with previous cardiovascular events.

  2. At least two measurements are obtained on two separate visits with systolic blood pressure (SBP) >140 mmHg or diastolic blood pressure (DBP) >90 mmHg.

  3. Single blood pressure (BP) >180/110 mmHg should be evaluated and treated immediately or within 1 week. (See Table 1 and Table 2 .[1])

 

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