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Hypertension Update 2018

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Overview

This issue will bring you up to date on the recent guidelines for the management of hypertension in adults.

Key Takeaways:
• Two guidelines, two definitions of hypertension: The 2017 ACC/AHA guideline defines stage 1 hypertension as a BP of 130/80 mmHg or above. In contrast, the hypertension guideline from the 8th Joint National Committee (JNC 8) defines hypertension as BP of 140/90 mmHg or above - an ongoing controversy.
• Think preventive: ACC/AHA recommends lifestyle changes for patients with "elevated" BP and those with stage 1 hypertension who have a 10-year cardiovascular risk less than 10%.
• First Line Treatments: Both JNC 8 and ACC/AHA recommend thiazide-type diuretics (TTDs), angiotensin converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and calcium channel blockers (CCBs) as first line drug options.

Hypertension is a leading cause of cardiovascular disease, stroke, heart failure, and kidney disease. According to a recent update from the CDC National Center for Health Statistics, nearly 30% of adults in the US have hypertension. The rate of hypertension is similar among women (28%) and men (30%). It is more common among US non-hispanic black adults than any other ethnicity. Within age groups, the incidence ranges from 7.5% among adults 18-39 years old to 63% in those age 60 and older. Of concern is that hypertension control has not been improving. In 2015-2016, only 48% of adults with hypertension had achieved control which, at the time, was considered blood pressure less than 140/90 mmHg.

Recently, the American College of Cardiology (ACC) and the American Heart Association (AHA) released an updated guideline for the prevention, detection, evaluation and management of hypertension.2 The 2017 ACC/AHA guideline was developed and approved in collaboration with 9 other professional groups, including the American Pharmacists Association (APhA). A multidisciplinary, team-based approach to hypertension management is strongly recommended (including the patient, primary provider, and other professionals such as cardiologists, nurses, physician assistants, pharmacists, and dietitians)...

Details

Publication Date: 04/23/2018
Expiration Date: 04/23/2021
CE Credit: 1.5 (0.15 CEU)
Type of Activity: Knowledge-based

This program was developed by The Rx Consultant and published by Continuing Education Network, Inc. The Rx Consultant accepts no advertising or financial support from the pharmaceutical industry and is funded solely by the purchase of programs. The Rx Consultant is dedicated to providing unbiased, balanced information to health care practitioners.

Programs developed by The Rx Consultant are written by health care providers with expertise in the topic area, peer-reviewed, extensively edited, and fact-checked. This development process was created to insure that every program presents information that is current, accurate, relevant to "real world" health care providers, and written in an easy reading, "plain English" style.

Authors

Kimberly M. Crosby, PharmD, BCPS, CDE, BC-ADM, BCGP is an Associate Professor in the Family Medicine Department, College of Medicine, at the University of Oklahoma (OU) School of Community Medicine. She practices as a clinical pharmacist for the Tulsa Family Medicine Clinic and the OU Bedlam Clinics.

Disclosure Statement

Dr. Crosby reports no financial relationship with the manufacturer(s) or provider(s) of any commercial product(s) or service(s) that appear in this issue.

Target Audience

This accredited program is targeted to pharmacists and nurses.

Goals & Objectives

At the conclusion of this program, participants will be able to:

    1. Discuss the JNC 8 and 2017 ACC/AHA guidelines, and describe at least 3 significant differences between them. State the ACC/AHA definitions for normal blood pressure (BP), elevated BP, stage 1 hypertension and stage 2 hypertension.
    2. Provide recommendations for initial antihypertensive therapy based on JNC 8 and ACC/AHA guidelines.
    3. Explain the current role of b-blockers in hypertension management. Discuss considerations in the choice of ACE inhibitors vs. ARBs; hydrochlorothiazide vs. chlorthalidone; and dihydropyridine (DHP) vs. nonDHP calcium channel blockers.
    4. Discuss the ACC/AHA recommendations for nondrug management of hypertension, including BP monitoring.

Accreditation Statements

The Rx Consultant is a publication of Continuing Education Network, Inc.

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Continuing Education Network, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education as a provider of continuing pharmacy education.

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Continuing Education Network is approved by the California Board of Registered Nursing, Provider Number CEP 13118. Programs approved by CA BRN are accepted by most State Boards of Nursing.

ACPE Universal Activity Number: 0428-0000-18-005-H01-P


Exam & Credit Statement Procedures

Upon successful completion of this program and the post test (70%), 1.5 hours of continuing education credit will be awarded. To receive credit and your exam score, please complete the exam questions and program evaluation.

Editorial and Review Board

Chief Editor and CE Administrator


Terry M. Baker, PharmD

Managing Editor


Tracy Farnen, PharmD

Associate Editors


James Chan, PharmD, PhD
Pharmacy Quality and Outcomes Coordinator
Kaiser Permanente
Oakland, CA

Associate Clinical Professor
School of Pharmacy
University of California San Francisco
San Francisco, CA

Richard Ron Finley, B.S. Pharm.,R.Ph.
Clinical Pharmacist (volunteer faculty)
University of California, San Francisco (UCSF) Memory and Aging Center
Lecturer (Emeritus) UCSF, Department of Clinical Pharmacy
Health Sciences Clinical Professor, UCSF School of Pharmacy
San Francisco, CA

Consultant Pharmacist
Ray Dolby Brain Health Center, Sutter Health/CPMC
San Francisco, CA

Consult Pharmacist Aging and Adult Health Services
San Francisco Health Department
San Francisco, CA

Julio R. Lopez, PharmD, FCSHP
Chief of Pharmacy Service
VA Northern California Health Care System

Adjunct Clinical Professor
College of Pharmacy
Touro University
Vallejo, CA

Assistant Clinical Professor
School of Pharmacy
University of California, San Francisco
San Francisco, CA Adjunct Professor
Thomas J. Long School of Pharmacy
University of the Pacific
Stockton, CA

Visiting Associate Professor and Lecturer
Nursing School
Samuel Merritt University
Oakland, CA

Pamela Mausner, MD

Helen Berlie, Pharm.D. CDE, BCACP
Clinical Assistant Professor, Pharmacy Practice
Wayne State University
Detroit, MI

Ambulatory Care Specialist - Diabetes
Health Centers Detroit Medical Group
Detroit, MI

Senior Editorial Advisor


Gerard Hatheway, PharmD, PhD

Editorial Advisors


Belinda M. Danielson, RPh
Christopher M. DeSoto, PharmD
Angie S. Graham, PharmD
Cynthia Chan Huang, PharmD, MBA
Fred Plageman, PharmD

Editorial Advisor and Clinical Practice Consultant for Nurse Practitioners


Emily K.
Meuleman, RN, C, MS

About the Rx Consultant

The Rx Consultant is a monthly publication dedicated to providing health care professionals with the information they need to educate patients about drugs and manage drug therapy. The reader is responsible for confirming the information presented here and interpreting it in relation to each patient's specific situation before utilizing the information.

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