Pharmaceutical

care plan

HYPERTENSION

By: Komal Haleem

Pharm-D

Hypertension, also known as high or raised blood pressure, is a condition in which the blood vessels have persistently raised pressure. The higher the pressure the harder the heart has to pump. When systolic blood pressure is equal to or above 140 mm Hg and/or a diastolic blood pressure equal to or above 90 mm Hg BP is considered to be raised or high.

WHO

TYPES:• 2 major types

• 4 less frequently found types.

2TYPES

Primary or essential

hypertension:

• most common type

• no obvious or yet identifiable cause

• diagnosed in the majority of people in

about 95% of cases

Secondary

HypertensionCAUSES:

Kidney damage or impaired function

Tumours or overactivity of the adrenal gland

Thyroid dysfunction

Coarctation of the aorta

Pregnancy-related conditions

Sleep Apnea Syndrome

Medication, recreational drugs, drinks & food

IN

MAJORITY

OF CASES

OTHER TYPES

Malignant Hypertension:

• most severe form

• Progressive

• rapidly leads to organ damage

Isolated Systolic Hypertension:

• the systolic blood pressure, (the top

number), is consistently above 160 mm Hg,

and the diastolic below 90 mm Hg.

OTHER TYPES

White coat hypertension:

• anxiety-induced hypertension

• BP is only high when tested by a health professional.

• Doesn’t need to be treated.

Resistant Hypertension:

• If blood pressure cannot be reduced to below 140/90

mmHg, despite a triple-drug regimen

STAGES

CAUSES

• multifactorial

• High salt intake or salt sensitivity

• Genetic predisposition

• A particular abnormality of the arteries, which

results in an increased resistance in arterioles

SIGNS AND SYMPTOMS:

Often no symptoms

Therefore, periodic blood pressure screenings are advised

Extremely high blood pressure leads to:

• Severe headache

• Fatigue or confusion

• Dizziness

• Nausea

• Problems with vision

• Chest pains

• Breathing problems

• Irregular heartbeat

• Blood in the urine

DIAGNOSTIC

TESTS

TOOLS FOR MEASURING B.P

TREATMENT

•

MANAGEMENT

3 18

• Alcohol, General anesthetics, Alpha Blockers,

• Analgesics(Aspirin, Ketorolac), Beta Blockers,

• Ca channel blockers, Anti diabetics

ACE inhibitors:

• ACE INHIBITORS, ALCOHOL

• Alpha blockers, AnalgesicsBeta

Blockers:

• Beta blockers, Antidepressants, Ca saltsDiuretics:

• Alpha Blocker, Anesthetics, AnalgesicsARBs:

• Beta Blockers, Grape fruit juiceCCBs:

• Alcohol, Analgesics

• General anestheticsAlpha

blockers:

DRUG INTERACTIONS

2.Lifestyle Changes

• aaerobic physical activity for at least 30

minutes per day reduces systolic blood

pressure by approximately 4 to 9 mmHg

Lifestyle Changes• Weight reduction lowers systolic blood

pressure by 5 to 20 mm Hg per 22 lbs (10

kg) body weight loss

Lifestyle Changes

LESSNO

SMOKING

•

•

CASE STUDY

• Name: Mr.Abdul Qayyum

• Chief Complaint: severe pain in left knee

• Diagnosis:

• partially torn ligament

• Stage 1 hypertension.

• exercises regularly

MEDICAL HISTORY

• Appears fit.

• Doesn’t have any chronic medical

condition

• Hasn’t countered any major illnesses in

the past 10 years.

CURRENT MEDICAL

TREATMENT

• Not taking any drug on regular basis

REVIEW OF SYSTEMS

• Gained 2 pounds in the past 12

months

• Fatigues easily

• No headaches or visual disturbances

• Denies shortness of breath,

chest pain or palpitations

• No history of nausea, vomiting,

abdominal pain or change in

bowel habits

FAMILY HISTORY

• Father had high blood pressure

and died at age of 59 from MI

• Mother has type 2 DM

• 2 younger sisters, apparently

healthy, but one is obese and

her blood glucose level was

mildly elevated in a

recent evaluation

SOCIAL HISTORY

• Worked as an attorney for 24 years

• he joined a firm 5 years ago, where he

oversees criminal defense section

• has 2 adult children

• doesn’t drink

• pack-a-day smoker

• denies ever using illicit drugs

Treatment plan??

• lifestyle modifications, order blood

work.

LIFE SYTLE MODIFICATIONS

• use of DASH diet

• sodium restriction.

• Regular exercise

• weight loss

• Smoking cessation

LABORATORY STUDIES

• Fasting plasma glucose (FPG) 150 mg/Dl

Total cholesterol (TC) 220 mg/dL

Low-density lipoprotein cholesterol (LDL-C) 150 mg/dL

High-density lipoprotein cholesterol (HDL-C) 50 mg/dL

Triglycerides (TG) 75 mg/dL

ASSESSMENT:

• FPG exceeds the WHO threshold

marking for type 2 DM

• So, BP goal should be <130/80 mm Hg

• LDL-C goal should be <100 mg/dL.

Treatment plan??

• Initiate antihypertensive treatment with a

thiazide diuretic

• Initiate cholesterol-lowering treatment with a

statin

• Initiate dual therapy with an ACE inhibitor and a

statin

• Initiate treatment of all 3 conditions with

metformin, an ACE inhibitor, and a statin

DECISION

• American Diabetes Association (ADA) guidelines

recommendations for patients with newly diagnosed

T2DM: lifestyle modifications plus metformin

• JNC 7 recommends a thiazide diuretic as first-line drug

therapy

• But the presence of T2DM suggests that an ACE

inhibitor is a better choice

TREATMENT GUIDELINES

PATIENT MONITORING AND

FOLLOW-UP:• 3-month follow-up

• Nonadherent

• minimally following the lifestyle

modifications

• Because no symptoms

MONITORING LAB WORK:

Blood pressure 147/91 mm Hg

• FPG 96 mg/dL

• A1C 6.7%

• TC 188 mg/Dl

• LDL-C 123 mg/dL

• HDL-C 41 mg/dL

• TG 72 mg/dL

• Add a diuretic to the ACE inhibitor &

increase the statin dose

• Add a calcium channel blocker (CCB)

and increase the statin dose

• Add a β-blocker

• Replace the ACE inhibitor with a

thiazide diuretic

MODIFICATION OF

TREATMENT PLAN??

Decision:

TREATMENT ALTERNATIVES:

• CCB is a good second choice,if diuretic

causes side effects

PATIENT OUTCOMES:

• The patients hyperglycemia,

hyperlipidemia & hypertension

all three issues are well

managed.