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

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

July 31, 2020

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?

Should Bedtime be Med-Time for Hypertension?

March 27, 2020

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?

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

November 8, 2019

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?

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

April 12, 2019

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

Hypertension – Time for Patients to Control the Wheel

June 15, 2018

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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Strategies for Managing Hypertension: Is the Paradigm Shifting?

Strategies for Managing Hypertension: Is the Paradigm Shifting?

May 10, 2018

Forty-five percent of all adults in the United States have high blood pressure — that’s more than 100 million people! Of those treated with pharmacotherapy, more than half are not achieving their blood pressure goals. Thus, millions of Americans are receiving suboptimal care.  A recently published systematic review and meta-analysis examined various implementation strategies to improve BP control in patients with high blood pressure. Which implementation strategies work best?

Guest Author: Lauren G Pamulapati, PharmD

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SPRINTing towards lower BP goals : A re-analysis of the ACCORD-BP trial

SPRINTing towards lower BP goals : A re-analysis of the ACCORD-BP trial

February 2, 2018

The new 2017 ACC/AHA guidelines recommend a BP goal of <130/80 mmHg for everyone – including patients with diabetes. The 2018 ADA guidelines also recommend a goal of <130/80 mmHg, but only in patients at high risk of cardiovascular disease and only when it can be achieved without undue treatment burden. This change in recommendations is largely driven by results of the Systolic Blood Pressure Intervention Trial (SPRINT), which demonstrated a 25% reduction in the primary composite outcome of CV events with intensive BP control (SBP target <120 mmHg). However, extrapolating these findings to patients with T2DM has been challenging as patients with diabetes were excluded from SPRINT. A recent re-analysis of the ACCORD-BP study shed some new light.

Guest Authors: Kevin Cowart, Pharm.D. and Karen Sando, Pharm.D.

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Top Ten Things Every Clinician Should Know About the 2017 Hypertension Guidelines

Top Ten Things Every Clinician Should Know About the 2017 Hypertension Guidelines

December 15, 2017

We interview Eric MacLaughlin, Joseph Saseen, and Kristin Rieser about the ACC/AHA Guidelines for the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure in Adults released in November 2017.  Dr. MacLaughin, a member of the Guideline Writing Committee, gives a insiders view of the guidelines development process and explains the rationale for lower blood pressure goals.  Drs. Saseen and Rieser talk about some of the practical considerations that we all must consider as we move forward to making these recommendations a reality.

Guests:  Kristin Rieser, Pharm.D., Joseph Saseen, Pharm.D, and Eric MacLaughlin, Pharm.D.

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Think Before You Make a RAS Decision: Evaluating the Use of RAS Blockers in Patients with Diabetes

Think Before You Make a RAS Decision: Evaluating the Use of RAS Blockers in Patients with Diabetes

February 24, 2017

Hypertension affects more than 70% of patients with type 2 diabetes mellitus and further increases the risk of cardiovascular disease in this high-risk population. While renin angiotensin system (RAS) blockers are clearly indicated in patients with heart failure, chronic kidney disease with proteinuria, and coronary artery disease (CAD), experts have come to different conclusions regarding their role as initial antihypertensive therapy for patients with diabetes.

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PATHWAY-2: Does the road lead to spironolactone for resistant hypertension?

PATHWAY-2: Does the road lead to spironolactone for resistant hypertension?

June 3, 2016

Resistant hypertension (RH) is frequently encountered in primary care practice and often presents a significant clinical challenge because limited evidence-based guidance exists. RH is a major cause of cardiovascular disease and death, and has been associated with a 50% increased risk of myocardial infarction, stroke, congestive heart failure, and chronic kidney disease when compared to patients without RH. The American Heart Association defines RH as uncontrolled BP despite maximal treatment with a three-drug regimen, ideally including a diuretic. The exact prevalence of RH is unknown, but large randomized controlled trials suggest it affects one in five patients with elevated BP.  Previous research findings suggest chlorthalidone, spironolactone, and eplerenone are all effective add-on therapies when BP remains uncontrolled with typical first line agents.  The Pathway-2 study provides the first direct comparative evaluation of three different four-drug antihypertensive regimens.

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