Implementing the new guidelines for hypertension: JNC 7, ADA, WHO-ISH

The new guidelines issued by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) emphasize that aggressive blood pressure (BP) control is essential to reducing morbidity and mortality. Additionally, guidelines issued by the American Diabetes Association (ADA) and the World Health Organization-International Society of Hypertension (WHO-ISH) emphasize the critical need for lowering BP levels. Achieving BP goals is a challenge for patients and their physicians, and most patients are not at goal. Poor BP control is even more of a challenge for patients with diabetes and chronic kidney disease since their goals are even lower. The strategies for lowering BP levels include patient lifestyle changes, adherence to therapy, and regular monitoring of BP levels.

To summarize the antihypertension guidelines recommended by WHO-ISH, JNC 7, the ADA, and the Hypertension in African Americans Working Group (HAAW Group) of the International Society on Hypertension in Blacks and evaluate the pharmacist.s collaborative role in the management of hypertension by examining the results of programs designed to include pharmacist counseling.

The relevant literature was evaluated and reviewed. Emphasis was placed on literature that evaluated strategies to improve BP control.

Results from several programs and studies showed positive effects of pharmacist collaboration. A program that provided pharmacist academic detailing to physicians at 5 Veterans Affairs facilities resulted in significant increases in patients receiving beta-blocker therapy or thiazide diuretics and angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy. Another study in which hypertensive patients received clinical services from pharmacists showed significant improvement in patients. knowledge of hypertension and its management and in patient adherence, and also showed a significant increase in the number of patients whose BP stayed in the normal range. A 6-month, controlled, single-blind, parallel-group study of 51 hypertensive patients showed significant improvements in BP control, quality of life, and overall patient satisfaction in the study group that received treatment through a primary care team that included pharmacists. Among patients at a Veterans Administration medical center, results suggested that the intervention of a clinical pharmacist improved documentation of drug therapy and estimated patient compliance. A study of the effectiveness of comanagement in 197 hypertensive patients with physician-pharmacist collaboration using an evidence-based, systematic approach showed that a significantly larger number of patients in the study group achieved BP control than in the control group.

The expanded role of clinical pharmacists in programs for evaluating, monitoring, and treating patients with hypertension can result in improved adherence to therapy and established guidelines. As members of interdisciplinary health care teams, pharmacists should utilize the JNC 7 guidelines and scientific evidence to consult with physicians about medications, design effective formularies, and collaborate with physicians in evaluating and comanaging patients with hypertension.