Intensive Treatment and Support in Hypertension Management

The recent guidelines released by the European Society of Cardiology (ESC) have set a new target for blood pressure management at 120/70 mmHg. However, many individuals are significantly far from this goal. Experts believe that pharmacists can play a crucial role in helping patients reach these targets by providing pharmaceutical services such as blood pressure monitoring and medication reviews, which can optimize treatment and support patient adherence.

Hypertension often presents no symptoms, making it essential to emphasize the benefits of treatment. Studies indicate that reducing elevated blood pressure by 20/10 mmHg can halve the risk of mortality. With increasing concerns about dementia, it becomes even more vital to manage blood pressure effectively, especially starting from age 45.

Determining the appropriate blood pressure target and the composition of medical treatment is influenced by multiple factors, including the patient's age, cardiovascular risk, comorbidities, drug interactions, and potential side effects. It is crucial for healthcare providers to collaboratively establish these targets with patients, a fact that many patients may not be aware of. The guiding principle remains ALARA (As Low As Reasonably Achievable), ensuring that blood pressure does not exceed 160/90 mmHg while avoiding excessively low levels that could lead to dizziness and increased fall risk.

Initial treatment approaches continue to emphasize lifestyle modifications, which can be as effective as pharmacological interventions when consistently applied. For instance, a healthier diet has the potential to lower blood pressure by up to 11 mmHg. Pharmacists are encouraged to review patients' medications for sodium content; some effervescent, meltable, or soluble tablets contain significant amounts of salt, potentially leading patients to exceed the recommended daily sodium limit of 5 to 6 grams.

Current recommendations suggest initiating pharmacological therapy with a low-dose combination of two medications instead of a single agent. First-line options include thiazide and thiazide-like diuretics, ACE inhibitors, sartans, and calcium channel blockers. Treatment effectiveness should be evaluated within four to six weeks, rather than waiting three months. If the initial combination is inadequate, a third class of medication should be introduced right away instead of increasing the dose of the existing combination. The next step entails increasing the dosage of the three-drug regimen, followed by adding a fourth medication if necessary.