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After reading this chapter, the student pharmacist, community practice resident, or pharmacist should be able to:


  1. Accurately measure blood pressure (BP).

  2. Appropriately classify severity of hypertension (HTN) by using the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) staging classification.

  3. Identify compelling indications to assist with selection of appropriate pharmacotherapeutic agents for treatment of HTN.

  4. Educate patients of the impact of lifestyle changes on BP control.

  5. Develop pharmacotherapy treatment plans for patients with HTN, including those with compelling indications, difficult to treat HTN, and special populations.

  6. Identify potential barriers to implementing services for patients with HTN in a community pharmacy.

  7. Design workflow in a community pharmacy to establish and maintain services for patients with HTN.


Epidemiology of Hypertension in the United States


The 2011 Update on Heart Disease and Stroke Statistics indicates that 29% of adults (≥18 years) in the United States have high BP.1 According to the most recent National Health and Nutrition Examination Survey (NHANES), 30.4% (66.9 million) of US adults (≥18 years) have HTN, defined as average BP ≥140/90 mm Hg, or currently using blood pressure lowering medication.2


HTN prevalence varies with age, sex, race, and ethnicity.1,3 The prevalence of high BP is greater in men in the age group of 18–44 years. Women and men have equal prevalence from the age of 45–64 years. Women have a higher prevalence of high BP starting at age 65. Prevalence of HTN is greatest among black Americans. Black Americans have a higher average BP and develop HTN at an earlier age than white Americans. American Indians and Native Alaskans also have increased prevalence compared with white and Asian adults. Puerto Rican Americans have the highest rate of HTN-related deaths compared with other Hispanic populations. The rate of HTN-related mortality is similar between Hispanic and non-Hispanic whites. Being born outside the United States, speaking a non-English language at home, and fewer years of living in the United States are associated with decreased prevalence of HTN.


Among those with HTN, 69.9% have received pharmacological treatment between 2005 and 2008.3 This was a slight increase compared with 1999–2002 when 60.3% of patients with HTN received pharmacological treatment. Patients without a usual source of medical care were the least likely to receive pharmacological treatment (19.7%). Overall disease control, defined as BP <140 mm Hg systolic and <90 mm Hg diastolic, in the United states was 53.5% between 2003 and 2010.2 Of those with uncontrolled HTN, 39.4% were unaware they had elevated blood pressures, 15.8% were aware they had HTN but were not being treated with medications, and 44.8% were aware they had HTN and were being treated with medications. Hypertension unawareness had highest prevalence among those who did not receive health-care in the previous year, those without a usual source of health-care, adults aged 18-44 years, and those without health insurance. Hypertension awareness without treatment with medications had highest prevalence among those without a usual ...

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