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Managing Pain in Patients with High Blood Pressure: Is There No Safe PATH?

Pain and hypertension are two of the most prevalent conditions worldwide. Acetaminophen is often considered the “go-to” and the “safe” over-the-counter analgesic for patients with hypertension because it is not commonly believed to increase blood pressure or cardiovascular events. But is that assumption grounded in evidence?

Guest Authors: Lizzie Baumeister, PharmD and Austin Morgan, PharmD, BCACP, CDCES

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Thiazides in Chronic Kidney Disease: New Evidence Challenging Old Dogma

Thiazide diuretics have been in clinical use for more than 60 years. Small studies published in the 1950s/60s reported that chlorothiazide had less diuretic and antihypertensive effect in patients with lower glomerular filtration rates which led to the belief that thiazides are ineffective in advanced CKD.  The Chlorthalidone in Chronic Kidney Disease (CLICK) Trial challenges this dogma.

Guest Authors: Michael Ernst, PharmD, BCGP and Michelle A. Fravel, PharmD, BCPS

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Sequential Additions or Multicomponent Combination? Should Our Approach to Hypertension Be Re-examined?

Traditionally, hypertension management involves a stepwise approach where agents are titrated and added. Thus, achieving optimal BP control requires close follow-up, time, and resources.  Outside of these logistics, providers are prone to clinical inertia (aka fail to advance therapy when they should) and sometimes “push back” from patients who experience the burdens of treatment and follow-up. Perhaps it’s time to reconsider our approach to managing hypertension.

Guest Authors:  Erin Connolly, PharmD and Laura Varnum, PharmD, BCACP

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Is Home Blood Pressure Monitoring a “Home Run” for Blood Pressure Management?

Nearly 67 million people, which equates to 3 out of every 4 people, living with high blood pressure in the US remain uncontrolled, despite the clear and compelling benefits of achieving good control. Remote monitoring and self-management of BP may enable us to broadly achieve optimal BP control in most patients. Increased use of telehealth technology improves access to care, but the effects on the cost and quality of care, particularly in the context of hypertension management, have not been clearly established.

Guest Authors: Mary Taylor, PharmD and Megan Supple, PharmD, BCACP, CPP

Guest Panelist:  Joseph Saseen, PharmD, BCPS, BCACP, CLS

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Less Might Be Better: Deprescribing Antihypertensive Medications in Older Adults

Health care professionals often don’t think twice about adding a new medication when a patient is not at goal. But we’re reluctant to stop a medication for a chronic condition when the patient appears to be stable and doing well.  Polypharmacy in older adults is a significant problem.  It’s costly and increases the likelihood of adverse effects. Several observational studies have suggested that lower blood pressure and multiple antihypertensive medications may be harmful in the elderly. Is it possible to discontinue medications without causing serious harm?

Guest Authors: Keturah Weaver Pharm D, BCPS and Daniel Longyhore Pharm D, M.S., BCACP

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No Provider Status, No Problem: CCM as a Revenue Source in Community Pharmacy

Hypertension is poorly managed in the United States with only 25% of patients achieving optimal blood pressure (BP) control (BP less than 130/80 mmHg).  To achieve optimal control, patients require close follow-up and BP-lowering medication regimens need to be titrated and periodically adjusted. Community pharmacists are in a unique position to manage patients who have poorly controlled hypertension. However, significant barriers exist to implementing hypertension management services by community pharmacists including a lack of reimbursement. Is chronic care management (CCM) a viable payment model to support these services?

Guest Authors:  Kimberly Zitko, PharmD, BCACP, BCGP and Brittany Schmidt, PharmD, BCACP

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Should Bedtime be Med-Time for Hypertension?

Few medications are specifically dosed at night to optimize outcomes. However, antihypertensive medications may soon belong on our patients’ nightstands. It is common practice for patients to take all antihypertensive medications in the morning, but perhaps daytime dosing doesn’t maximize cardiovascular risk reduction? The potential benefits of chronotherapy and its impact on BP and CV outcomes have been investigated since the 1980s. However, current practice guidelines do not explicitly recommend dosing antihypertensive medications at bedtime.

Guest Authors:  Vivian Cheng, PharmD, BCPS and Joseph Saseen, PharmD, BCPS, BCACP

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Under Pressure: Does Directly Observing Medication Administration Lower Blood Pressure?

Treatment-resistant hypertension, the need for 4 or more medications to achieve goal blood pressure (BP), occurs in nearly 1 in 5 patients.1 But is it truly treatment-resistant? Nonadherence is often regarded as the primary cause in many patients.  But how can we distinguish between other causes of hypertension that should prompt additional diagnostic testing or treatment intensification? A recent study suggests there is a simple solution: watch them take their pills.

Guest Authors: Meagan Brown, PharmD, BCACP and Raven Jackson, PharmD

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Keeping Intensive Blood Pressure Goals in MIND: Does it Impact Cognitive Decline?

Intensive blood pressure (BP) control reduces the risk of cardiovascular events and mortality, but the verdict isn't in yet on the benefits of intensive control to prevent the development of dementia. Previous studies have shown an inconsistent relationship between blood pressure control and cognitive decline. SPRINT-MIND, using data from SPRINT, was designed to evaluate the effects of intensive BP control on cognitive outcomes including probable dementia and mild cognitive impairment.

Guest Authors:  Michelle Balli, PharmD, BCACP and Amy Robertson, PharmD, BCACP

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Hypertension – Time for Patients to Control the Wheel

Traditionally, the management of hypertension requires routine blood pressure checks by a health professional to adjust medications. Could self-monitoring lead to better outcomes?  Would a greater percentage of patients achieve their goal blood pressure (BP)?  Self-monitoring may be an efficient method to improve blood pressure control; however, results from published reports are inconsistent. The authors of the TASMINH4 study sought to compare the effectiveness of three different approaches to BP monitoring.

Guest Authors:  Vicky Shah, PharmD, BCPS and Daniel Longyhore, MS, PharmD, BCPS

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