AHA High Blood Pressure Toolkit-Pharmacists

12 Hypertension Guideline Toolkit for Pharmacists TREATMENTS BP Status Recommended Follow-up/Reassessment Normal 1 year Elevated 3-6 months Stage 1 hypertension • Monthly until BP goal met with BP-lowering medication + nonpharmacologic interventions • 3-6 months after BP goal met Stage 2 hypertension • Monthly until BP goal met with BP-lowering medication + nonpharmacologic interventions • 3-6 months after BP goal met Follow-up visits to reassess BP and monitor adherence and response to treatment should be regularly scheduled according to guideline recommendations. Use of self-monitoring, team-based care and telehealth strategies is recommended. Initiation of antihypertensive drug therapy with two first-line agents of different classes, either as separate agents or in a fixed-dose combination, is recommended in adults with stage 2 hypertension and an average BP more than 20/10 mm Hg above their BP target. (COR I, LOE C-EO) Four classes of oral antihypertensive drugs are recommended as first-line agents to treat hypertension: • Thiazide or thiazide-type diuretics • Angiotensin-converting enzyme (ACE) inhibitors • Angiotensin receptor blockers (ARBs) • Calcium-channel blockers (dihydropyridines and nondihydropyridines) Six general classes of oral antihypertensive drugs are recommended as second-line agents: • Diuretics (loop, potassium sparing and aldosterone antagonists) • Beta-blockers (cardioselective and vasodilatory, noncardioselective, intrinsic sympathomimetric activity and combined alpha- and beta-receptor) • Direct renin inhibitor • Alpha-1 blockers • Central alpha2-agonist and other centrally acting drugs • Direct vasodilators Oral Antihypertensive Drugs Simultaneous use of an ACE inhibitor, ARB and/ or renin inhibitor is potentially harmful and is not recommended for treating adults with hypertension. COR III: Harm, LOE A Avoid drug combinations that have similar mechanisms of action or clinical effects. For example, two drugs from the same class should not be administered together (e.g., two different beta blockers, ACE inhibitors or nondihydropyridine CCBs). Likewise, two drugs from classes that target the same BP control system are less effective and potentially harmful when used together (e.g., ACE inhibitors, ARBs).