Hypertension: A Clinical Pharmacist's Synopsis of JNC 7

Abstract

Despite its high prevalence, hypertension is not well controlled in the United States. According to the latest update of the National Health and Nutrition Examination Survey, NHANES III, 20% of participants aged 18 to 74 years suffered from hypertension, which is defined as having a mean systolic blood pressure (SBP) ≥ 140 mm Hg, having a mean diastolic blood pressure (DBP) ≥ 90 mm Hg, or being prescribed medication for hypertension. Of these, 30% were previously unaware of their hypertension, 18% were aware of their condition but their disease was neither treated nor controlled, 27% were being treated but their disease was not under control, and only 25% were both being treated and had their disease controlled. 1 Undiagnosed, untreated, and uncontrolled hypertension clearly places a substantial strain on the health care delivery system. 2 It is our role as pharmacy practitioners to assist in the management of hypertension, in an effort to decrease the prevalence of undiagnosed, untreated, and uncontrolled hypertension. As pharmacists, we have the knowledge and expertise to assist health care providers in ensuring that patients are receiving the appropriate antihypertensive agent based on their medical history, response to existing or previous therapy, adverse drug reactions, and current medical literature. EtiologyThere are 2 types of hypertension: essential and secondary. More than 90% of patients have essential hypertension. 3 It is described as high blood pressure (BP) with no identifiable cause. In contrast, secondary hypertension has an identifiable cause. Fewer than 5% of people who suffer from high blood pressure have secondary hypertension. 4 The causes of secondary hypertension can include but are not limited to renal disease, coarctation of the aorta, primary aldosteronism, Cushing's syndrome, pheochromocytoma, pregnancy, hyper-or hypothyroidism, and hyperparathyroidism. Secondary hypertension can also be drug-induced. Some medications that induce hypertension are estrogens, glucocorticoids, nonsteroidal anti-inflammatory agents, oral contraceptives, tricyclic antidepressants, venlafaxine, and oral decongestants. When a secondary cause is identified, treatment should be directed at removing the offending agent or treating the underlying condition. 4 Clinical Presentation and DiagnosisTypically, patients with essential hypertension are asymptomatic. Usually, the only sign of primary hypertension is an elevated blood pressure. Patients with secondary hypertension tend to complain of symptoms suggestive of the underlying condition. The diagnosis of hypertension should not be based on one elevated BP measurement. The average of 2 or more readings, taken at 2 or more visits after the initial screening, should be used to diagnose hypertension. Hypertension affects more than 50 million Americans. The National High Blood Pressure Education Program recently presented the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). This repor...