The Pharmacist September/October 2018 - Page 39

KEY LEARNING POINTS • High blood pressure contributed to around half of all heart attacks and strokes in the UK • Medication to manage high blood pressure is not suitable for all patients, and some patients will need more than one medication to manage their condition • More than half of patients are non-adherent to their medication, leading to increased risk of heart attack and stroke are less effective in older people or those of Afro-Caribbean background. Most people will need more than one drug to control their blood pressure. It is estimated that more than half of patients do not take their medications as prescribed. This contributes to poor blood pressure control and increased risk of stroke and heart attack. Part of the problem is that the condition itself usually does not cause symptoms that act as a reminder to take medications. Switching to once-a-day tablets and advising patients to incorporate taking them into their daily routine can help. A dosette box (pill box with compartments for each day, and times of the day) may help patients adhere to their medication. These are available at most pharmacies, some supermarkets and some GP surgeries. monitoring (HBPM) to formally diagnose hypertension. ABPM is the most accurate method for confirming a diagnosis of hypertension and its use should reduce unnecessary treatment in people who do not have true hypertension. ABPM has also been shown to be superior to other methods of multiple blood pressure measurement for predicting blood pressure- related clinical events. If a person is unable to tolerate ABPM, HBPM is a suitable alternative to confirm the diagnosis of hypertension. Blood pressure medication Blood pressure medication reduces the risk of heart attack and stroke in people with high blood pressure. But current UK guidance does not recommend medication for everyone. If blood pressure is only slightly raised, simple blood and urine tests (including checking cholesterol and blood sugar levels) will be carried out, an ECG will be performed and the person’s medical history will be reviewed. What about side-effects? Any drug can have side-effects. These are often mild but can mean a particular drug may need to be stopped. Healthcare professionals should explain this when blood pressure medication is first prescribed. Different drugs act in different ways so an alternative drug, or combination of drugs, may be required. It can be hard to predict which drugs will work for each individual, but we know some Blood pressure research that is changing current practice One of the most recent important research trials is the BHF-funded PATHWAY-2 study. which is looking at the best drugs for people with resistant hypertension. This study compared drugs to identify the best fourth-line medication to use in patients whose blood pressure was not controlled, despite already taking three drugs. It demonstrated that a relatively old drug called spironolactone was better than other drugs tested in the trial. Although spironolactone was already recommended as a possible option for resistant hypertension in NICE blood pressure guidelines, the results of PATHWAY-2 will hopefully improve blood pressure control in this challenging patient group. The BHF is funding numerous research projects, including one looking at the best time to take medication and another looking at how genes could influence blood pressure. Over the past seven years, the British Heart Foundation has invested £35–40m in research on blood pressure. If the public are interested in taking part in clinical trials like these, they should visit the UK Clinical Trials Gateway website. Julie Ward is senior cardiac nurse at the British Heart Foundation September/October 2018 | The Pharmacist | 39