The presentation contains an introduction to hypertension and a detailed step by step guidelines and care plan for a clinical case.

1. Pharmaceutical
care plan
HYPERTENSION
By: Komal Haleem
Pharm-D

3. 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

4. TYPES:
• 2 major types
• 4 less frequently found types.
2
TYPES

5. Primary or essential
hypertension:
• most common type
• no obvious or yet identifiable cause
• diagnosed in the majority of people in
about 95% of cases

6. Secondary
Hypertension
CAUSES:
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

7. 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.

8. 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

9. STAGES

10. CAUSES
• multifactorial
• High salt intake or salt sensitivity
• Genetic predisposition
• A particular abnormality of the arteries, which
results in an increased resistance in arterioles

11. 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

12. DIAGNOSTIC
TESTS

13. TOOLS FOR MEASURING B.P

14. TREATMENT

17. •

18. MANAGEMENT
3 18

20. • Alcohol, General anesthetics, Alpha Blockers,
• Analgesics(Aspirin, Ketorolac), Beta Blockers,
• Ca channel blockers, Anti diabetics
ACE
inhibitors:
• ACE INHIBITORS, ALCOHOL
• Alpha blockers, Analgesics
Beta
Blockers:
• Beta blockers, Antidepressants, Ca salts
Diuretics:
• Alpha Blocker, Anesthetics, Analgesics
ARBs:
• Beta Blockers, Grape fruit juiceCCBs:
• Alcohol, Analgesics
• General anesthetics
Alpha
blockers:
DRUG INTERACTIONS

21. 2.Lifestyle Changes
• aaerobic physical activity for at least 30
minutes per day reduces systolic blood
pressure by approximately 4 to 9 mmHg

22. Lifestyle Changes
• Weight reduction lowers systolic blood
pressure by 5 to 20 mm Hg per 22 lbs (10
kg) body weight loss

23. Lifestyle Changes
LESSNO
SMOKING

25. •

26. •

27. CASE STUDY
• Name: Mr.Abdul Qayyum
• Chief Complaint: severe pain in left knee
• Diagnosis:
• partially torn ligament
• Stage 1 hypertension.
• exercises regularly

28. MEDICAL HISTORY
• Appears fit.
• Doesn’t have any chronic medical
condition
• Hasn’t countered any major illnesses in
the past 10 years.

29. CURRENT MEDICAL
TREATMENT
• Not taking any drug on regular basis

30. 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

31. 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

32. 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

34. Treatment plan??
• lifestyle modifications, order blood
work.

35. LIFE SYTLE MODIFICATIONS
• use of DASH diet
• sodium restriction.
• Regular exercise
• weight loss
• Smoking cessation

36. 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

37. 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.

38. 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

39. • 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

40. PATIENT MONITORING AND
FOLLOW-UP:
• 3-month follow-up
• Nonadherent
• minimally following the lifestyle
modifications
• Because no symptoms

41. 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

42. • 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:

43. TREATMENT ALTERNATIVES:
• CCB is a good second choice,if diuretic
causes side effects

44. PATIENT OUTCOMES:
• The patients hyperglycemia,
hyperlipidemia & hypertension
all three issues are well
managed.