Blood pressure goals should be individualized, especially for older persons who may have difficulty tolerating complicated pharmacotherapy regimens.
The medication therapy management (MTM) provider should review the medication profile to screen for other medications that may be contributing to hypertension.
Because blood pressure medications may make patients feel worse than the disorder of hypertension itself, nonadherence is a likely problem. MTM providers need to be vigilant for nonadherence to medications and recommend changes in pharmacotherapy, if needed, to promote adherence.
Regular follow-up and monitoring are key to helping patients achieve blood pressure goals and reduce the risk of end-organ damage.
INTRODUCTION TO HYPERTENSION
Primary (essential) hypertension is persistently elevated arterial blood pressure (BP) in the absence of an identifiable cause.1,2 The relationship between BP and risk of cardiovascular disease is significant and independent of other risk factors.
Blood pressure should be classified on the basis of at least two readings taken on at least two separate occasions (Table 27-1). When systolic and diastolic blood pressure levels fall into different categories, the higher category should be selected in classifying blood pressure.
TABLE 27-1Classification of Blood Pressure in Adults (Age ≥ 18 Years)a |Favorite Table|Download (.pdf) TABLE 27-1 Classification of Blood Pressure in Adults (Age ≥ 18 Years)a
|Classification ||Systolic Blood Pressure (mmHg) || ||Diastolic Blood Pressure (mmHg) |
|Normal ||<120 ||and ||<80 |
|Prehypertensionb ||120-139 ||or ||80-89 |
|Stage 1 hypertension ||140-159 ||or ||90-99 |
|Stage 2 hypertension ||≥160 ||or ||≥100 |
Other Terms Associated with Hypertension
Hypertensive emergency: BP > 180/120mmHg with ongoing or progressive target organ damage
Hypertensive urgency: Systolic blood pressure (SBP) > 180 mmHg or diastolic blood pressure (DBP) > 110 mmHg without evidence of progressive target organ damage
Isolated systolic hypertension: SBP ≥ 140 mmHg and DBP ≤ 90 mmHg; this is common in the elderly.
Masked hypertension: Home BP is significantly higher than anticipated on the basis of the in-clinic BP measurement (opposite of white-coat hypertension).
Orthostatic hypotension: Decrease in SBP of >20 mmHg or decrease in DBP of >10 mmHg when changing from a supine to a standing position.
Pseudohypertension: A falsely elevated BP secondary to calcified arteries that are not compressed by the cuff when taking the BP measurement.