高血压英文ppt精品课件the pharmacists role in treating

The Pharmacists Role in Treating Hypertension Thomas Owens, MD Saint Francis University CERMUSA Objectives Enhance your understanding of hypertension to include cardiovascular risks, management, and goals for individual patients Review and discuss the current pharmacotherapy standards of care for hypertension Describe the pharmacists role in counseling patients on hypertensive medications Hypertension 140/90 mm Hg United States: 65 million adults Risk factors include: Stroke, myocardial infarction, heart failure, peripheral vascular disease, aortic dissection, chronic renal failure Hypertension price tag: $59.7 billion Wexler ADA, 2003 Systolic ARB = angiotensin receptor blocker; BP = blood pressure; CT = computed tomography. (Williams JNC, 2005 Major Challenges for Science Identify the key gene- environment interactions Eliminate the patient and medical provider barriers ADA, 2003 Counseling Patients: Target Blood Pressure Most patients below 140/90 mm Hg Patients w/ diabetes or chronic disease 130/80 mm Hg Help patients self-monitor BP 1/3 do not know they are hypertensive Research studies on targeting BP Cecil, 2004 Improve Hypertension Control Rates Titrating blood pressure medications to achieve target goals Most patients require 2 or 3 antihypertensive medications Patient compliance with multi-drug regimens ADA, 2005 Patient Compliance and Quality of Life Hypertension requires lifelong treatment Medications can produce side effects Men often concerned with sexual dysfunction Patients with controlled BP, rate a significantly higher quality of life Cecil, 2004 Patient Compliance Principles Titrating medical therapy based on home readings Long-acting preparations w/ once daily dosing Low dose combinations of medications from different drug classes Fixed-dose combinations to reduce overall number of pills JNC, 2005 Drug Therapy Old method: high-dose monotherapy Recent studies (ex. ALLHAT) At least 2 medications of different classes to treat mild hypertension 3 or 4 different medications to treat more difficult cases Thiazide-type antihypertensive medications cost- effective Initial treatment: Beta blockers, Angiotensin-converting enzyme (ACE) inhibitors, Angiotensin receptor blockers, Calcium antagonists Cecil, 2004 Stage 2 Drug Therapy JNC recommends: 2 drug combination Additional medications needed for each 10 mm Hg of systolic BP above goal Great majority should include low-dose diuretic High-risk conditions (heart failure/diabetes) Angiotensin-converting enzyme inhibitors (ACE- Is) Angiotensin receptor blockers (ARBs) Cecil, 2004 Cardio Events in Hypertensive Patients Verdecchia, Carin, Circo,2001 Left Ventricular Hypertrophy , 2007 Counseling Patients: Contradictions & Side Effects Considerations For Individualizing Antihypertensive Drug Therapy Hypertensive Sub-Populations Hypertensive patients with nephrosclerosis Diabetic hypertensive patients Hypertensive patients with coronary artery disease Isolated systolic hypertension in older persons Hypertensive disorders of women Oral contraceptives Pregnanc