The Main Challenges of Hypertension Control
Authors: Nancy Hanxi Xu and Gabrielle Gimenes Lima (FEBRAF, Brazil)
@NancyXu
The control of hypertension is still one of the great challenges we face today, even in developed countries. It is especially important to have the management of hypertension because besides this being a risk factor for cardiovascular diseases, there are studies that demonstrate that, in the United States, untreated hypertensive adults or those treated, but not controlled, had an increased risk of mortality, either by specific cardiovascular diseases, heart or cerebrovascular diseases.1,2
Despite the great advances in blood pressure measurement techniques and equipment and the development of effective antihypertensive drugs, these tools are not always used properly in practice. Thus, it results in a large number of hypertensive patients not yet properly diagnosed or with adequate medications. Even more, there is the problem of low adherence of patients treated with antihypertensive drugs, which is the most common cause of resistance to treatment, making it difficult to control blood pressure levels in these individuals.1
To improve the diagnosis of hypertension, we can evaluate different blood pressure levels through the combined use of blood pressure (BP) monitoring inside and outside the office (including ambulatory and residential BP monitoring). Since one of the major problems with the punctual BP assessment during the consultation is that the BP level at this time does not accurately reflect the BP levels of individuals in real-life conditions. Thus, with both types of monitoring, we are able to better analyse the pressure levels of an individual and diagnose possible hypertension and treat it.1
On the other hand, to improve the blood pressure control of already treated patients, we can simplify the therapeutic regimen, make use of residential BP monitoring for long-term monitoring of hypertensive patients. In addition, the implementation of mobile health technologies for PA telemonitoring in homes can also offer an opportunity for better control of BP levels.1
Finally, the management of drug therapy and other services of the clinical pharmacy has shown better results for hypertensive patients. However, the value of these services is not widely known. Pharmacists are an accessible community health resource, and we are equipped with clinical skills to improve the management of hypertension, which we must be well-positioned to work within multidisciplinary teams and to help patients prevent cardiovascular disease.3
References:
[1] Parati, G. Lombardi, C. Pengo, M. Bilo, G. Ochoa, J. Current challenges for hypertension management: From better hypertension diagnosis to improved patients' adherence and blood pressure control. 2020 Nov 10. https://doi.org/10.1016/j.ijcard.2021.01.070
[2] Zhou, D. Xi, B. Zhao, M. Wang L. Veeranki, S. Uncontrolled hypertension increases risk of all-cause and cardiovascular disease mortality in US adults: the NHANES III Linked Mortality Study. 2018 Jun 20. Scientific Reports volume 8, Article number: 9418.
[3] Schultz, B. Tilton, J. Jun, J. Scott-Horton, T. Quach, D. Touchette, D. Cost-Effectiveness Analysis of a Pharmacist-Led Medication Therapy Management Program: Hypertension Management. 2020 Oct 13. https://doi.org/10.1016/j.jval.2020.10.008
