Hypertension and Management of the Common Cold

Article excerpt

Goals

1. To offer a comprehensive overview of hypertension classification and management.

2. To provide pharmacists with information concerning appropriate selections of cold and flu medications for patients with hypertension.

Objectives

Discuss the epidemiology, definition, and classiFication of patients with hypertension. Identify lifestyle modifications and explain the importance of each in reducing hypertension.

Interpret JNC-UI guidelines on the recommended use of pharmacological agents for hypertension.

Identify common cold products that are recommended in hypertensive patients.

Counsel patients with hypertension seeking medications for the management of symptoms associated with the common cold.

Introduction

As much as 25% of a pharmacist's medication duties will involve patients with hypertension. This is due to the large percentage of Americans with hypertension, which affects as many as 50 million adults in the United States.1 Although the direct cause of hypertension is usually not known, the disease is easily detected and almost always controllable. Despite efforts to increase awareness, only 27% of the hypertensive population has adequate blood pressure (BP) control (BP <140/90 mmHg). BP <140/90 mmHg will significantly reduce the risk of cardiovascular and cerebrovascular morbidity and mortality.2 Morbidities associated with hypertension are stroke, myocardial infarction (MI), and other heart disease, and end-stage renal disease and other diseases of the kidney. The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure released its sixth report (JNC-VI) late in 1997. These published guidelines are the standard by which hypertension is managed. In this article, we will review information presented in the report, including BP goals, risk and BP stratification, and the prevention and treatment of hypertension. Secondly this article will focus on the role of the pharmacist in managing hypertension while treating the common cold. A relative paucity of information is available on managing these patients; however, it is critical for the pharmacist to understand, since many of these hypertensive patients will visit their pharmacy to receive cough and cold products as well as advice on which product to choose.

Blood pressure goals

To determine BP goals, it is first imperative to understand the definition of hypertension. The pathophysiological definition of hypertension is a higher than normal force of blood against the interior of the arterial wall. This sustained abnormal pressure can lead to arteriosclerosis, MI, stroke, an enlarged heart, and kidney disease. Historically, a practical, clinically useful definition of hypertension is a systolic blood pressure (SBP) >=140 mmHg and/or diastolic blood pressure (DBP) >=90 mmHg or current treatment of by pertension with an antihypertensive medication. Based on this definition, the patient goal is to achieve BP values of less than 140/90 mmHg. A recent study found that goal DBPs <85 mmHg are associated with a lower rate of cardiovascular events;s noting that JNC-VI stated that home readings of >=135/85 mmHg should be viewed as elevated. These new data suggest that the goal BP in the future may be lower than 140/90 mmHg. The JNC-VI guidelines also suggest an optimal BP is <120/80 mmHg, which leads to a further reduction in cardiovascular risk.2 BP goals for the diabetic patient with hypertension are somewhat lower than the goal for nondiabetic pa tients. The American Diabetes Association and JNC-VI both recommend a goal SBP <=130 mmHg and DBP <=85 mmHg for patients with Type I or Type HI diabetes?2,4

Classification of hypertension

It is important to realize that the purpose of identifying and treating hypertensive patients is to reduce cardiovascular-related morbidity and mortality. Pharmacists need to measure and detect hypertension and then refer patients to their primary care physician. …