Hypertension Management for the Primary Care Clinician / Edition 1

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Overview

Provides a resource of information for health care professionals who participate in providing optimal care to patients with hypertension. In addition, support will be provided in conveying important concepts, knowledge, and advice to the patient.

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Editorial Reviews

Doody's Review Service
Reviewer: Sally Ling, M.D.;FACP(University of Missouri-Kansas City School of Medicine)
Description: The book provides pharmacists interested in active participation in the treatment of patients with hypertension, an overview covering pathophysiology, the clinical exam, pharmacologic and nonpharmacological treatments.
Purpose: The purpose is to provide a resource for pharmacists and other healthcare professionals in the care of hypertensive patients.
Audience: This may be a useful reference for other physician extenders since in many settings the treatment of hypertension can be carried out effectively by a collaborative team approach.
Features: The book provides a review of the diagnosis and management of hypertension, including patient education, in the context of the JNC VII report. The sections on patient education are not optimal: templates for patient handouts may have been a better strategy. The chapters on disease management include very useful information on antihypertensive medications and hypertension treatment trials.
Assessment: Physician extenders may find this book helpful.

3 Stars from Doody
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Product Details

  • ISBN-13: 9781585280520
  • Publisher: American Society of Health-System Pharmacists
  • Publication date: 5/1/2004
  • Edition number: 1
  • Pages: 168
  • Product dimensions: 8.50 (w) x 11.00 (h) x 0.50 (d)

Table of Contents

Contents
About This Book .................................. xi
Chapter 1:

Introduction to Hypertension ............................... 1
Beth Bryles Phillips


Clinical Highlights ................................ 2

Overview of Hypertension ................. 2
Awareness ..................... 2
Classification ................ 3
Causes ........................... 3
Racial and Ethnic Differences ....................... 5
Gender and Age-Related Differences ........... 6
Target Organ Damage ................................... 6

Summary............ 7
References ......... 7
Chapter 2:

Pathophysiology of Hypertension ....................... 9
Jacqueline D. Joss

Clinical Highlights .............................. 10

Pathophysiology of Hypertension . 10
Essential (Primary) Hypertension ................ 10
Secondary Hypertension (Hypertension with an Identifiable Cause) ......................... 11


Target Organ Damage ................................. 13
Cardiac Complications ................................. 14
Cerebral Complications ................................ 14
Renal Disease ............. 14
Funduscopic Changes .................................. 14

Conclusion ....... 14
References ....... 15
Chapter 3:
Initial Patient Assessment ................................... 17
Alan H. Mutnick, Tina M. Hisel

Clinical Highlights .............................. 18
Medical History .................................. 18
Physical Assessment ......................... 18
Blood Pressure Measurement ..................... 18
Factors Associated with Inaccurate Blood Pressure Measurements ........................... 19
Assessment of Target Organ Damage .......22
Pulse Pressure and Arterial Stiffness .......... 25

Laboratory Assessment ....................25
Routine Laboratory Tests .............................26
Optional Laboratory Tests ...........................30
Laboratory Tests to Rule Out Secondary Causes of Hypertension..............................30

References .......33
Chapter 4:
Identification of Treatment Goals ......................35
Tina M. Hisel

Clinical Highlights ..............................36
Identification of Cardiovascular Risk Factors ..................36
Cigarette Smoking ....36
Dyslipidemia ...............36
Diabetes Mellitus .......38
Age .............................38
Family History of Premature CHD..............38
Obesity.........................38
Abdominal Obesity ...38
Physical Inactivity .....38
Psychosocial Factors 38
Ethnic Characteristics ...................................38
Small, Dense LDL ......38
Lipoprotein(a) .............39
Fibrinogen...................39
C-Reactive Protein .....39
Homocysteine ............39

Goals of Treatment ............................39
Blood Pressure Control ................................39
Risk Factor Modification ..............................39
Antiplatelet Therapy .40

Patient Involvement When Establishing Treatment Goals ..............................40
Patient Case .....42
References .......42
Chapter 5:
Pharmacology of Antihypertensive Agents ......45
Alan H. Mutnick

Clinical Highlights ..............................46
Angiotensin-Converting Enzyme Inhibitors ....................46
Angiotensin II Receptor Antagonists.................................53
α-Adrenergic Blocking Agents ........54
β-Adrenergic Blockers ......................54
Calcium Channel Blockers ...............55
Centrally Acting α-Agonists .............55
Direct-Acting Vasodilators ................56
Diuretics ...........56
Postganglionic Adrenergic Neuron Blockers ..................59
Summary..........59
References .......60
Chapter 6:
Initiation of Therapy.........61
Jacqueline D. Joss, Beth Bryles Phillips

Clinical Highlights ..............................62
Nonpharmacologic Therapy ............62
Weight Reduction ......63
The DASH Eating Plan .................................66
Physical Activity .........66
Moderation of Sodium Intake ....................66
Potassium Intake ....... 67
Calcium Intake ........... 67
Moderation of Alcohol Intake .................... 67

Smoking Cessation ...68
Caffeine Intake ...........68

Pharmacologic Therapy ................... 70
Guidelines for the Management of Hypertension ...................... 70
Concomitant Disease States That Influence Antihypertensive Therapy .................... 78
Effectiveness of Antihypertensive Therapy in Select Populations ................................ 78

Patient Considerations for Antihypertensive Therapy .82
Patient Cases ...85
References .......86
Appendix 6-1: Examples of Sites for Smoking Cessation on the Internet 90
Appendix 6-2: Indigent Care Drug Therapy Sites ......... 91
Chapter 7:
Education of Ambulatory Hypertensive Patients ................................93
Beth Bryles Phillips

Clinical Highlights ..............................94
Comprehensive Education ...............94
Drug Interactions ...............................95
Home Monitoring of Blood Pressure ................................96
Educational Approaches ...................98
Resources .........98
References .... 100
Appendix 7-1: Facts About Lowering Blood Pressure 101
What Is High Blood Pressure? ................... 101
How Is Blood Pressure Checked? .............. 101
How Can You Prevent or Control High Blood Pressure? ......... 102
What Else Affects Blood Pressure? ............ 111
Here’s a Recap ......... 112

Chapter 8:
Ongoing Evaluation and Management of the Ambulatory Patient
with Hypertension ....113
Tina M. Hisel, Jacqueline D. Joss

Clinical Highlights ............................ 114
Evaluating Response: Frequency of Clinic Visits ......... 114
Assessing Progress toward Goals of Therapy............... 115
Modification of the Treatment Plan ................................. 116
Considerations for Additional Therapy ... 116
Inadequate Response to Therapy ............ 116
Resistant Hypertension .............................. 119

Patient Case .. 126
References .....127
Chapter 9:
Referral to Other Health Care Providers ........ 129
Alan H. Mutnick

Clinical Highlights ........................... 130
The Care Plan: Involving Other Health Care Professionals.......................... 130
Triage and Referral of Ambulatory Patients with Hypertension ................ 130
Roles of Primary Care Physicians, Specialists, and Social Workers ........... 131
Health Insurance Portability and Accountability Act (HIPAA) of 1996..................... 132

Hypertensive Crises: Urgencies and Emergencies ..... 132
Summary....... 133
References .... 134
Chapter 10:
Evaluation of Therapeutic Outcomes ............. 135
Alan H. Mutnick

Clinical Highlights ........................... 136
FDA Modernization Act of 1997 . 136
Outcomes Research ........................137
Pharmacoeconomics ..................... 138
Decision Analysis ........................... 138
Literature Example ......................... 139
Summary....... 140
References ..... 141
Appendix 10-1: Suggested Readings ............................ 142
Continuing Education.... 145
Index ................................161      
Hypertension as a Risk Factor for Cardiovascular Disease ............................ 13

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