ADULT HYPERTENSION PROTOCOL STANFORD …

STANFORD HOSPITAL AND CLINICS

ADULT HYPERTENSION PROTOCOL

STANFORD COORDINATED CARE

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I.

PURPOSE

To establish guidelines for the monitoring of antihypertensive therapy in adult patients and

to define the roles and responsibilities of the collaborating clinical pharmacist and pharmacy

resident.

SUPPORTIVE INFORMATION

Goal of Therapy

The ultimate goal of antihypertensive therapy is the reduction of cardiovascular and renal

morbidity and mortality. Since most persons with hypertension, especially those age >50

years, will reach the DBP goal once SBP is at goal, the primary focus should be on achieving

the SBP goal. Treating SBP and DBP to targets that are 180 systolic

on 3 BP meds

Add another second- or third-line drug and increase doses of other

agents. If other agent(s) at or above mid-dose, add a combination

of 2 additional drugs.

Address reasons for non-adherence, enlisting family members and

other social support, use electronic medication monitor to provide

feedback and reinforcement.

Consult patient¡¯s physician

Adult Hypertension Protocol ¨C Stanford Coordinated Care

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STANFORD HOSPITAL AND CLINICS

ADULT HYPERTENSION PROTOCOL

STANFORD COORDINATED CARE

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Table 3: First Line Drug Choices

Diagnosis

Uncomplicated Hypertension

Drug Class

Thiazide diuretic (maximum dose 25 mg)

Diabetes mellitus with or without proteinuria

ACE inhibitor or ARB

Isolated systolic hypertension (elderly)

Diuretic

CCB (long-acting dihydropyridine)

ACE inhibitor

Beta-blocker

Diuretic

ARB

Aldosterone antagonist

Diuretic

ACE inhibitor/ARB

Beta-blocker

Long-acting CCB

ACE inhibitor

Beta-blocker

Aldosterone antagonist

Diuretic

ACE inhibitor

Short-acting ACE inhibitor

ARB

Heart failure: left ventricular dysfunction

High risk CHD

Post MI

Stroke Prevention

Chronic kidney disease

*See individual drug protocols for exclusion criteria and algorithm.

Table 4: Drugs the May Have Unfavorable Effects on Comorbid Conditions

Condition

Angiodema

Bronchospastic disease

Gout

Heart block (second or third degree)

Hyponatremia

Potassium >5 mEq/L before treatment

Pregnancy or those likely to become pregnant

Drug Therapy to Avoid

ACEI

Beta-blocker

Thiazide diuretic

Beta-blocker, CCB (non-DHP)

Thiazide diuretic

Potassium sparing diuretic, aldosterone antagonist

ACEI, ARB

Adult Hypertension Protocol ¨C Stanford Coordinated Care

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