AHA High Blood Pressure Toolkit-Pharmacists

14 Hypertension Guideline Toolkit for Pharmacists SPECIAL PATIENT GROUPS AND EMERGENCIES The guideline recommends special attention to specific patient groups. Recommendations include: Black Adults In black adults with hypertension but without heart failure or chronic kidney disease, including those with diabetes mellitus, initial antihypertensive treatment should include a thiazide-type diuretic or a calcium-channel blocker. In addition, especially for black adults with hypertension, two or more antihypertensive medications are recommended to achieve a BP target of less than 130/80 mm Hg . Pregnant Women In pregnant women, antihypertensive medication should be transitioned to methyldopa, nifedipine and/or labetalol during pregnancy. ACE inhibitors, ARBs or direct renin inhibitors should not be used during pregnancy. Older Persons For patients 65 years and older, who are noninstitutionalized ambulatory community- dwelling adults, with an average systolic BP of 130 mm Hg or higher, the treatment goal should be a systolic BP of less than 130 mm Hg. Hypertensive Crises: Emergencies and Urgencies Hypertensive emergencies are defined as severe elevation of BP (greater than 180/120 mm Hg) associated with evidence of new or worsening target organ damage. In such cases, BP must be immediately reduced to prevent or limit further damage. The guideline provides an algorithm for diagnosing and managing a hypertensive crisis as well as a list of intravenous antihypertensive drugs for treating hypertensive emergencies. Intravenous Antihypertensive Drugs for Treatment of Hypertensive Emergencies Read the full guidelines for instructions on persons undergoing surgical procedures. BLOOD PRESSURE HIGHER THAN 180/120 mm Hg IS A CRISIS. For patients with hypertension and a high burden of comorbidity and limited life expectancy, clinical judgment, patient preferences and a team-based approach should be used to assess risk/benefit for decisions regarding intensity of BP lowering and choice of antihypertensive medications.