Updated recommendations from the National Heart Foundation of Australia will allow pharmacists a wider scope to help manage the biggest risk factor for stroke
Some recommendations of the new 2016 guidelines include:
- Ambulatory or home blood pressure measurement when hypertension is suspected, to confirm blood pressure level
- Lower target blood pressure (≤ 120 mmHg) in high-risk patients – close follow-up recommended to identify treatment-related adverse effects including hypotension, syncope, electrolyte abnormalities and acute kidney injury
- Target blood pressure of <140 mmHg or lower in patients with uncomplicated hypertension
- Avoiding combination of ACE inhibitors and ARBs due to increased risk of adverse events
- Avoiding beta-blockers as first-line therapy
The change to a target blood pressure of <120 mmHg in particular patients groups is based on evidence from the SPRINT study published late last year, which confirmed additional benefits from more intensive blood pressure lowering in high-risk patients.
Updated evidence on the management of hypertension with comorbidities including chronic kidney disease, diabetes and peripheral arterial disease is also incorporated into the guidelines.
“Some might think there are too many guidelines on hypertension,” says Professor Garry Jennings from the Baker IDI Heart and Diabetes Institute and National Heart Foundation in an MJA editorial.
“However, given that hypertension is a major risk factor for premature death and disability from cardiovascular disease in Australia and globally, practitioners need a practical, contemporary and localised guide to best practice,” he says.
Clinical consultant Debbie Rigby says the new guidelines will potentially expand the population requiring blood pressure lowering medicines.
“Pharmacists can have a key role in screening and monitoring of blood pressure, as well as medication management,” she says.
Ambulatory or home blood pressure measure is another key opportunity for community pharmacists and accredited pharmacists conducting HMRs, says Rigby.
“Accredited pharmacists should routinely assess a patient’s absolute cardiovascular risk and recommend lifestyle changes and medications based on this risk, in line with these new guidelines,” she says.
“In addition to dispensing medicines, pharmacists can play a key role in providing advice about diet, alcohol consumption and weight reduction to reduce lifestyle risk factors.”
Rigby points out that while the new guidelines are useful for both prescribers and pharmacists, it needs to be remembered they are guidelines and not solid rules.
“There will still be areas of uncertainty and patient preferences, attitudes and beliefs should be considered in the decision to treat. Shared decision making can positively influence adherence and persistence to medicines,” she says.
Professor Jennings agrees that individualised treatment is important in treating people with hypertension.
“We know that despite the proliferation of guidelines, most people with hypertension do not achieve the goals of their therapy, irrespective of what country they live in and what guideline is being followed,” he says.
“In future, we need to move the emphasis from large tomes written by expert groups to providing decision support individualised to the patient.”
Read the full guidelines here.