The document discusses the role of clinical pharmacists in treating hypertension. It begins with definitions of hypertension and discusses diagnosing and assessing hypertension through medical history, lab tests, and monitoring blood pressure levels. It then covers lifestyle changes, medications, and the roles of clinical pharmacists in managing drug therapy, counseling patients, and working with physicians and nurses to optimize treatment of hypertension. The clinical pharmacist aims to prevent medication-related problems and optimize patient outcomes through their expertise in pharmacotherapy.

1. ROLE OF CLINICAL PHARMACIST IN THE TREATMENT OF
HYPERTENSION DISEASE AND
MANAGEMENT.
Prepared By:
Abul Mukarim Mohd Khubayeb
ID: 522211021
Batch: 26th
M.Pharm, University of Development Alternative.

2. CONTENTS
 Hypertension
 Clinical approach to hypertension
 Important to control hypertension
 Symptoms
 Types
 Causes
 Diagnosis
 Can Hypertension be prevented or avoided?
 Risk factors for hypertension
 Treatment
 Medications
 Role of a clinical pharmacist
 WHO response for Hypertension

3. WHAT IS HYPERTENSION?
High blood pressure, also called hypertension, is blood
pressure that is higher than normal.
Blood pressure changes throughout the day based on your
activities. Having blood pressure measures consistently above
normal may result in a diagnosis of high blood pressure (or
hypertension).
The high blood pressure levels, the more risk you have for other
health problems, such as heart disease, heart attack, and stroke.

4. CLINICAL APPROACH TO HYPERTENSION
HISTORY
Following the documentation of hypertension, which
is confirmed after an elevated blood pressure (BP) on
at least 3 separate occasions (based on the average
of 2 or more readings taken at each of ≥2 follow-up
visits after initial screening), a detailed history should
extract the following information:
 Extent of end-organ damage (eg, heart, brain,
kidneys, eyes).
 Assessment of patients’ cardiovascular risk status.
 Exclusion of secondary causes of hypertension.

5. CONT..
Patients may have undiagnosed hypertension for years
without having had their BP checked. Therefore, a careful
history of end-organ damage should be obtained.
The Seventh Report of the Joint National Committee on
Prevention, Detection, Evaluation, and Treatment of High
Blood Pressure (JNC 7) identifies the following as targets
of end- organ damage:
 Heart: left ventricular hypertrophy, angina/previous
myocardial infarction, previous coronary
revascularization, and heart failure
 Brain: stroke or transient ischemic attack, dementia
 Chronic kidney disease
 Peripheral arterial disease
 Retinopathy.

6. CONT..
The historical and physical findings that suggest the
possibility of secondary hypertension are:
 a history of known renal disease, abdominal masses,
anemia, and urochrome pigmentation.
 A history of sweating, labile hypertension, and
palpitations suggests the diagnosis of
pheochromocytoma.
 A history of cold or heat tolerance, sweating, lack of
energy, and bradycardia or tachycardia may indicate
hypothyroidism or hyperthyroidism.
 A history of obstructive sleep apnea may be noted.
 A history of weakness suggests hyperaldosteronism.
 Kidney stones raise the possibility of
hyperparathyroidism.

7. PATIENT’S RELEVANT HISTORY
 Duration of hypertension.
 Previous therapies: responses and side effects.
 Family history of hypertension and cardiovascular
disease.
 Dietary and psychosocial history.
 Other risk factors: weight change, dyslipidemia,
smoking, diabetes, physical inactivity.
 Evidence of target organ damage: history of TIA,
stroke, transient blindness.

8. CONT..
 Evidence of secondary hypertension: history of
renal disease; change in appearance; muscle
weakness; spells of sweating, palpitations, tremor;
erratic sleep, snoring, daytime somnolence;
symptoms of hypo-or hyperthyroidism; use of
agents that may increase blood pressure.
 angina, myocardial infarction, congestive heart
failure; sexual function.
 Other comorbidities.

9. IMPORTANT TO CONTROL HYPERTENSION
 One of the major risk factors for cardiovascular
disease.
 31% adults in the affect with hypertension.
 Associated with developing other co-morbid
disease.
 Untreated can lead to heart failure, heart attack,
damage arteries which can prevent blood from
getting to the vital organs.

10. SYMPTOMS
Hypertension is called a "silent killer". Most people
with hypertension are unaware of the problem
because it may have no warning signs or symptoms.
For this reason, it is essential that blood pressure is
measured regularly.
When symptoms do occur, they can include early
morning headaches, nosebleeds, irregular heart
rhythms, vision changes, and buzzing in the ears.
Severe hypertension can cause fatigue, nausea,
vomiting, confusion, anxiety, chest pain, and muscle
tremors.

11. CONT…
The only way to detect hypertension is to have a
health professional measure blood pressure. Having
blood pressure measured is quick and painless.
Although individuals can measure their own blood
pressure using automated devices, an evaluation by
a health professional is important for assessment of
risk and associated conditions.
Detecting hypertension is done with a quick and
painless test of blood pressure. This can be done at
home, but a health professional can help assess any
risks or associated conditions.

12. TYPES OF HYPERTENSION
 Primary hypertension. This is also called essential
hypertension. It is called this when there is no
known cause for your high blood pressure. This is
the most common type of hypertension. This type of
blood pressure usually takes many years to
develop. It probably is a result of your lifestyle,
environment, and how your body changes as you
age.

13. CONT…
 Secondary hypertension. This is when a health
problem or medicine is causing your high blood
pressure. Things that can cause secondary
hypertension include:
 Kidney problems.
 Sleep apnea.
 Thyroid or adrenal gland problems.
 Some medicines.

14. CAUSES HIGH BLOOD PRESSURE?
Food, medicine, lifestyle, age, and genetics can
cause high blood pressure. Your doctor can help you
find out what might be causing yours. Common
factors that can lead to high blood pressure include:
 A diet high in salt, fat, and/or cholesterol.
 Chronic conditions such as kidney and hormone
problems, diabetes, and high cholesterol.
 Family history, especially if your parents or other
close relatives have high blood pressure.

15. CONT…
 Lack of physical activity.
 Older age (the older you are, the more likely you
are to have high blood pressure).
 Being overweight or obese.
 Race (non-Hispanic black people are more likely to
have high blood pressure than people of other
races).
 Some birth control medicines and other medicines.
 Stress.
 Tobacco use or drinking too much alcohol

16. DIAGNOSIS
High blood pressure is diagnosed with a blood
pressure monitor. This is a common test for all doctor
visits. A nurse will place a band (cuff) around your
arm. The band is attached to a small pump and a
meter. He or she will squeeze the pump. It will feel
tight around your arm. Then he or she will stop and
watch the meter. This provides the nurse with 2
numbers that make up your blood pressure. The top
number is your systolic reading. The bottom number
is your diastolic reading. You may also hear the
doctor or nurse say a blood pressure is “120 over 80.”

17. LABORATORY TEST
Recommended laboratory tests in the initial
evaluation of hypertensive patients. Repeat
measurements of renal function, serum electrolytes,
fasting glucose, and lipids may be obtained after the
introduction of a new antihypertensive agent and then
annually or more frequently if clinically indicated.
More extensive laboratory testing is appropriate for
patients with apparent drug resistant hypertension or
when the clinical evaluation suggests a secondary
form of hypertension.

18. BASIC LABORATORY TESTS
System Test
Renal Microscopic urinalysis, albumin excretion, serum
BUN and/or creatinine
Endocrine Serum sodium, potassium, calcium, TSH
Metabolic Fasting blood glucose, total cholesterol, HDL and
LDL (often computed) cholesterol, triglycerides
Others Hematocrit, electrocardiogram

19. BLOOD PRESSURE LEVELS
The Seventh Report of the Joint National
Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood
Pressure (2003 Guideline)
Normal systolic: less than
120 mm Hg
diastolic: less than
80 mm Hg
At Risk
(prehypertension)
systolic: 120–139
mm Hg
diastolic: 80–89 mm
Hg
High Blood Pressure
(hypertension)
systolic: 140 mm Hg
or higher
diastolic: 90 mm Hg
or higher
The American College of Cardiology/
American Heart Association Guideline
for the Prevention, Detection, Evaluation,
and Management of High Blood Pressure
in Adults (2017 Guideline)
Normal systolic: less than
120 mm Hg
diastolic: less than
80 mm Hg
Elevated systolic: 120–129
mm Hg
diastolic: less than
80 mm Hg
High Blood Pressure
(hypertension)
systolic: 130 mm Hg
or higher
diastolic: 80 mm Hg
or higher

20. CAN HYPERTENSION BE PREVENTED OR
AVOIDED?
If your high blood pressure is caused by lifestyle
factors, you can take steps to reduce your risk:
 Lose weight.
 Stop smoking.
 Eat properly.
 Exercise.
 Lower your salt intake.
 Reduce your alcohol consumption.
 Learn relaxation methods.
If your high blood pressure is caused by disease or the medicine you take, talk to your
doctor. He or she may be able to prescribe a different medicine. Additionally, treating
any underlying disease (such as controlling your diabetes) can help reduce your high
blood pressure.

21. RISK FACTORS FOR HYPERTENSION
Modifiable risk factors include unhealthy diets
(excessive salt consumption, a diet high in saturated
fat and trans fats, low intake of fruits and vegetables),
physical inactivity, consumption of tobacco and
alcohol, and being overweight or obese.
Non-modifiable risk factors include a family history of
hypertension, age over 65 years and co-existing
diseases such as diabetes or kidney disease.

22. TREATMENT
Changing your lifestyle can help control and manage
high blood pressure. Your doctor may recommend
that you make lifestyle changes including:
 Eating a heart-healthy diet with less salt
 Getting regular physical activity
 Maintaining a healthy weight or losing weight if
you're overweight or obese
 Limiting the amount of alcohol you drink
But sometimes lifestyle changes aren't enough. If diet
and exercise don't help, your doctor may recommend
medication to lower your blood pressure.

23. MEDICATIONS
The type of medication your doctor prescribes for high
blood pressure depends on your blood pressure
measurements and overall health. Two or more blood
pressure drugs often work better than one. Sometimes
finding the most effective medication or combination of
drugs is a matter of trial and error.
 You should aim for a blood pressure treatment goal of
less than 130/80 mm Hg if:
 You're a healthy adult age 65 or older.
 You're a healthy adult younger than age 65 with a 10%
or higher risk of developing cardiovascular disease in
the next 10 years.
 You have chronic kidney disease, diabetes or coronary
artery disease.

24. MEDICATIONS USED TO TREAT HIGH BLOOD
PRESSURE INCLUDE:
 Diuretics. Diuretics, sometimes called water pills,
are medications that help your kidneys eliminate
sodium and water from the body. These drugs are
often the first medications tried to treat high blood
pressure.
 Angiotensin-converting enzyme (ACE)
inhibitors. These medications — such as lisinopril
(Prinivil, Zestril), benazepril (Lotensin), captopril
and others — help relax blood vessels by blocking
the formation of a natural chemical that narrows
blood vessels.

25. CONT..
 Angiotensin II receptor blockers (ARBs). These
medications relax blood vessels by blocking the
action, not the formation, of a natural chemical that
narrows blood vessels. ARBs include candesartan
(Atacand), losartan (Cozaar) and others.
 Calcium channel blockers. These medications —
including amlodipine (Norvasc), diltiazem
(Cardizem, Tiazac, others) and others — help relax
the muscles of your blood vessels. Some slow your
heart rate. Calcium channel blockers may work
better for older people and people of African
heritage than do ACE inhibitors alone.

26. ADDITIONAL MEDICATIONS SOMETIMES USED
TO TREAT HYPERTENSION
If you're having trouble reaching your blood pressure
goal with combinations of the above medications,
your doctor may prescribe:
 Alpha blockers.
 Alpha-beta blockers.
 Beta blockers.
 Aldosterone antagonists.
 Renin inhibitors.
 Vasodilators.
 Central-acting agents.

27. TREATING RESISTANT HYPERTENSION
Treating resistant hypertension may involve many
steps, including:
 Changing your high blood pressure medications to
determine which combinations and doses work best
 Reviewing all the medications you take, including
those that you take for other conditions or buy
without a prescription
 Monitoring your blood pressure at home to see if
going to the doctor causes your blood pressure to
increase (white coat hypertension)
 Making healthy lifestyle changes, such as eating a
healthy diet with less salt, maintaining a healthy
weight and limiting alcohol

28. POTENTIAL FUTURE TREATMENTS
Researchers continue to study catheter-based
ultrasound and radiofrequency ablation of the
kidney's sympathetic nerves (renal denervation) as a
treatment for resistant hypertension. Early studies
showed some benefit, but more-robust studies found
that the therapy does not significantly lower blood
pressure in people with resistant hypertension. More
research is underway to determine what role, if any,
this therapy may have in treating hypertension.

29. ALTERNATIVE MEDICINE
Although diet and exercise are the most appropriate
tactics to lower your blood pressure, some supplements
also may help lower it. However, more research is needed
to determine the potential benefits. These supplements
include:
 Fiber, such as blond psyllium and wheat bran
 Minerals, such as magnesium, calcium and potassium
 Folic acid
 Supplements or products that increase nitric oxide or widen
blood vessels (vasodilators), such as cocoa, coenzyme Q10,
L-arginine and garlic
 Omega-3 fatty acids, found in fatty fish, high-dose fish oil
supplements and flaxseed
Researchers are also studying whether vitamin D can reduce blood
pressure, but evidence is conflicting. More research is needed.

30. LIFESTYLE AND HOME REMEDIES
 Eat healthy foods.
 Decrease the salt in your diet.
 Maintain a healthy weight.
 Increase physical activity.
 Limit alcohol.
 Don't smoke.
 Manage stress.
 Monitor your blood pressure at home.
 Practice relaxation or slow, deep breathing.
 Control blood pressure during pregnancy.

31. WHAT IS THE ROLE OF A CLINICAL
PHARMACIST?
Clinical pharmacists practice in all health care
settings and utilize in-depth knowledge of
medications and disease states to manage
medication therapy as part of a multi professional
team. Clinical pharmacists are responsible and
accountable for medication therapy and patient
outcomes.

32. HEALTH CARE SYSTEM
Composed of physician, pharmacist, nurses
 Physician: diagnosis, prescription, monitoring, medical care.
 Pharmacist: prescription, dispensing, counseling, monitoring,
pharmaceutical care.
 Nurse: administering, monitoring, nursing care.
Load to physician & nurse ; high due to the system of "physicians are all
in all in hospital for the treatment of patient, with the help of nurse.

33. FOR PRACTICING CLINICAL PHARMACY
As a clinical pharmacist should be need to complete
one of this programme:
 Competence of health care practitioners
 B.Pharm to M.Pharm to PharmD
 PharmD + Pre-registration + registration
 Residency programs
 Continuing Professional Development
 Informed general public – increased expectation

34. LEVEL OF ACTION OF CLINICAL PHARMACISTS
Clinical pharmacy activities may influence the correct
use of medicines at three different levels:
 Before the prescription
 Clinical trials
 Formularies
 Drug information
 Drug-related policies

35. DURING THE PRESCRIPTION
 Counselling activity
 Clinical pharmacists can influence the attitudes and
priorities of prescribers in their choice of correct
treatments.
 The clinical pharmacist monitors, detects and
prevents the medication related problems
 The clinical pharmacist pays special attention to the
dosage of drugs which need therapeutic monitoring
Community pharmacists can also make prescription decisions
directly, when over the counter drugs are counselled.

36. MEDICATION-RELATED PROBLEMS
 Untreated indications.
 Improper drug selection.
 Sub therapeutic dosage.
 Medication Failure to receive.
 Medication Over dosage.
 Adverse drug reactions.
 Drug interactions.
 Medication use without indication.

37. AFTER THE PRESCRIPTION IS WRITTEN.
 Counselling
 Preparation of personalized formulation
 Drug use evaluation
 Outcome research
 Pharma-coeconomic studies

38. FUNCTIONS OF CLINICAL PHARMACISTS
 Taking the medical history of the patient
 Patient care
 Formulation and management of drug policies
 Drug information
 Teaching & training to medical and paramedical staff
 Research and development
 Participation in drug utilization studies
 Patient counseling
 Therapeutic drug monitoring
 Drug interaction surveillance
 Adverse drug reaction reporting
 Safe use of drugs

39. CLINICAL PHARMACY SPECIALISTS
 Usually requires residency in a specialty area, in
addition to a pharmacy practice residency
 Job functions depend on the specialty and the
institution
 Usually has teaching and / or research
responsibilities
 Represent pharmacy for medication use meeting /
committee in specialty areas

40. WHO RESPONSE FOR HYPERTENSION
The World Health Organization (WHO) is supporting
countries to reduce hypertension as a public health
problem.
To support governments in strengthening the prevention
and control of cardiovascular disease, WHO and the
United States Centers for Disease Control and Prevention
(U.S. CDC) launched the Global Hearts Initiative in
September 2016, which includes the HEARTS technical
package. The six modules of the HEARTS technical
package (Healthy-lifestyle counselling, Evidence-based
treatment protocols, Access to essential medicines and
technology, Risk-based management, Team-based care,
and Systems for monitoring) provide a strategic approach
to improve cardiovascular health in countries across the
world.

41. CONT..
In September 2017, WHO began a partnership with
Resolve to Save Lives, an initiative of Vital Strategies, to
support national governments to implement the Global
Hearts Initiative. Other partners contributing to the Global
Hearts Initiative are: the CDC Foundation, the Global
Health Advocacy Incubator, the Johns Hopkins Bloomberg
School of Public Health, the Pan American Health
Organization (PAHO) and the U.S. CDC. Since
implementation of the programmed in 2017 in 18 low- and
middle-income countries, 3 million people have been put
on protocol-based hypertension treatment through person-
centered models of care. These programmed demonstrate
the feasibility and effectiveness of standardized
hypertension control programme.

42. Submitted to
Dr. Kallol Debnath
Associate Professor
Dept. Of Pharmacy, UODA.