Abstract
In an effort to bring global attention to the world's number one killer, the Canadian Pharmacists Association will be participating in this year's World Hypertension Day 2008.
Hypertension is estimated to be the world's leading cause of death, 1 responsible for about 7 million deaths a year, most of which are suffered by those living in low-income regions of the world. It is estimated that 1 billion people worldwide are currently diagnosed with hypertension, a number that is expected to grow to more than 1.5 billion by 2025. Hypertension is a significant burden to already fragile health care systems, as well as to social and economic development. 2
Antihypertensive treatment has dramatically improved the prognosis associated with hypertension. 2 There are more strategies to choose from today, which are better tolerated than older medications such as diuretics and beta blockers. Treatment prevents morbidity and mortality related to heart failure, myocardial infarction, stroke, and end-stage renal disease. (A 10 mmHg reduction in blood pressure has been demonstrated to reduce the risk of major cardiovascular events by 20%–25%, with larger effects on stroke than on coronary outcomes. 2 ) While today's treatments are safe and effective, there is ongoing concern that blood pressure control in hypertensive patients is suboptimal.
In Canada, physicians are doing a better job of detecting and treating hypertension than they did 15 years ago; however, a significant proportion of patients still continue to experience difficulties achieving their therapeutic targets. 3 What is the solution to this preventable disease that has become an epidemic? The solution involves you, the pharmacist.
Increasing demands on Canada's health care system mean that pharmacists are taking on a greater role in the management of chronic diseases. Most patients see their pharmacist more frequently than they do their family physician (on average, 14 versus 2 times a year). 4 This provides pharmacists with an opportunity to play a key role in the management of patients with hypertension.
Pharmacists can choose from several avenues when taking on greater involvement in the management of patients. These include screening, control, education, adherence, ensuring appropriate pharma-cotherapy, and identification of other diseases and risk factors. 4 In addition, pharmacists can identify patients who may be at high risk for hypertension and who should be monitoring their blood pressure at home.
Home blood pressure monitoring is one way to ensure optimal blood pressure control in a select group of patients, and pharmacists have a key role to play in this emerging new strategy. 5 This involves proper selection and education on the appropriate measuring device, as well as offering patients access to in-pharmacy blood pressure measuring devices. Once the patient knows how to measure his/her blood pressure, pharmacists can play an active intervention role by making recommendations to the prescriber with the goal of helping the patient achieve treatment goals.
Patients who participate in blood pressure monitoring programs are more likely to take on greater ownership and responsibility for their own health. Several Canadian initiatives, including the IMPACCT program and A-CHAMP, have demonstrated the effect of blood pressure control and pharmacist intervention in helping patients to achieve their therapeutic targets. 6 In addition, public recommendations from the 2008 Canadian Hypertension Education Program continue to emphasize the importance of regular blood pressure measurement (personal communication). (The magnitude of blood pressure reduction achieved is a much more important predictor of cardiovascular benefits than the choice of drug. 2 )
World Hypertension Day, a global initiative from the World Hypertension League, will take place on May 17, 2008, using the theme “Measure Your Blood Pressure — At Home.” The entire week of May 12 will be dedicated to raising public awareness of the serious consequences of suboptimal blood pressure control. CPhA is preparing web-based tools to encourage pharmacists to work with patients on this issue. These include tips on who should purchase a home blood pressure monitor; what the pharmacist can do; and how to conduct a proper blood pressure reading.
Pharmacists should play a greater role in this major public health issue and become better allies with their hypertensive patients. Research has shown that patients who have a good relationship with their pharmacist are also more likely to have better overall health. CPhA challenges you to get involved in educating your patients about this life-threatening disease by participating in World Hypertension Day 2008.