Pharmacotherapy of Hypertension

Abstract

Background:

Hypertension is a leading risk factor for death and disability in Canada. Pharmacists can help to improve the treatment and control of hypertension through collaboration with physicians and patients to improve pharmacotherapy.

Objective:

To review appropriate pharmacotherapy for hypertension, as outlined in the recommendations of the Canadian Hypertension Education Program.

Methods:

The recommendations of the Canadian Hypertension Education Program were reviewed with a view to identifying gaps in the recommendations as they apply to pharmacy practice. For some of these gaps, it was determined that pharmacists could provide further care to patients with hypertension, and opportunities for pharmacist involvement are suggested here.

Results:

Initial pharmacotherapy for uncomplicated hypertension includes thiazide-type diuretics, beta-blockers for patients under 60 years of age, angiotensin-converting enzyme (ACE) inhibitors, long-acting calcium channel blockers, and angiotensin receptor blockers. For additive hypotensive action in two-drug combinations, either a diuretic or a calcium channel blocker should be combined with a beta-blocker, ACE inhibitor, or angiotensin receptor blocker. Other combinations are less effective or unproven. Areas where pharmacists must become more actively involved in the management of patients with hypertension include provision of balanced information about benefits and side effects, identification of secondary druginduced causes of hypertension or drug interactions, and suggestion of adjustments to medication dosage for patients with renal dysfunction.

Conclusions:

There are specific and unique roles for pharmacists in the management of hypertension. Pharmacists can play a greater role in improving the pharmacological management of hypertensive patients, aided in part by regular updates to the recommendations of the Canadian Hypertension Education Program.