CPG Related to Prescribing Medication Collaboration Cafe'

Prescribing Recommendations from the CPG and Impact on Specific Populations

The American College of Cardiology/American Heart Association (ACC/AHA) guidelines are widely used for the management of hypertension. They emphasize lifestyle modifications as the first line of treatment, including dietary changes (DASH diet), regular exercise, weight management, and limiting alcohol consumption. When lifestyle changes are insufficient, pharmacotherapy is recommended.

Here's how these recommendations and pharmacokinetic principles impact specific populations:

• Pediatric Populations:
  • Hypertension in children and adolescents is increasingly recognized, often linked to obesity and underlying medical conditions.
  • CPGs recommend careful blood pressure measurement and diagnosis, considering age-specific norms.
  • Pharmacokinetic principles:
    • Children's metabolism and renal function differ from adults, requiring age-based dosing adjustments.
    • Liquid formulations or chewable tablets may be preferred for ease of administration.
    • Monitoring for growth and development is essential, as some antihypertensive medications can affect these processes.
    • Medication adherence can be difficult, so family involvement is key.
• Pregnant Populations:
  • Hypertension during pregnancy can lead to serious complications, such as preeclampsia and eclampsia.
  • CPGs recommend specific antihypertensive medications that are safe for both the mother and the fetus.
  • Pharmacokinetic principles:
    • Pregnancy-related physiological changes, such as increased blood volume and renal blood flow, can affect drug distribution and elimination.
    • Some antihypertensive medications are contraindicated during pregnancy due to teratogenic risks.
    • Careful monitoring of blood pressure and fetal well-being is crucial.
  • Labetalol, nifedipine, and methyldopa are commonly used. ACE inhibitors, ARBs, and direct renin inhibitors are contraindicated.
• Older Adult Populations:
  • Hypertension is highly prevalent in older adults, often accompanied by comorbidities and polypharmacy.
  • CPGs recommend a gradual approach to lowering blood pressure, considering the risk of orthostatic hypotension and other adverse effects.
  • Pharmacokinetic principles:
    • Age-related decline in renal and hepatic function can affect drug clearance, increasing the risk of drug accumulation and toxicity.
    • Older adults may have increased sensitivity to certain antihypertensive medications.
    • Polypharmacy increases the risk of drug interactions.
    • Start low and go slow is very important with this population.

Applying Clinical Guidelines to Future Practice

In my future practice, I will apply the CPGs for hypertension management by:

• Comprehensive Assessment:
  • Conducting thorough patient assessments, including blood pressure measurement, medical history, and risk factor evaluation.
  • Considering the patient's age, comorbidities, and individual circumstances.
• Lifestyle Modifications:
  • Emphasizing the importance of lifestyle modifications as the foundation of hypertension management.
  • Providing patient education and support to promote adherence to healthy behaviors.
• Pharmacotherapy:
  • Selecting appropriate antihypertensive medications based on the CPGs and patient characteristics.
  • Tailoring medication regimens to individual needs, considering pharmacokinetic principles and potential drug interactions.
  • Closely monitoring patients for therapeutic response and adverse effects.
• Patient Education:
  • Providing clear and concise information about hypertension, its management, and the importance of medication adherence.
  • Addressing patient concerns and answering questions.
• Interprofessional Collaboration:
  • Collaborating with other healthcare professionals, such as physicians, pharmacists, and dietitians, to provide comprehensive care.
  • Ensuring seamless transitions of care between inpatient and outpatient settings.
• Staying Current:
  • Continuously reviewing updated CPGs and research to provide evidence based care.

By adhering to these principles, I can contribute to the effective management of hypertension and improve the cardiovascular health of my patients

Hypertension: A Summary and Rationale

Hypertension, or high blood pressure, is a chronic medical condition in which the blood pressure in the arteries is persistently elevated. ¹ It's a significant public health concern, as it increases the risk of heart disease, stroke, kidney disease, and other serious health problems. My rationale for selecting hypertension is its prevalence, the critical role of medication management in its control, and the diverse population it affects, including vulnerable groups like pediatrics, pregnant women, and older adults.