Hypertension

Guideline Toolkit
for Pharmacists
Nearly half of American adults have high blood
pressure, but you can make a difference.

The American Heart Association’s efforts to improve healthy choices related to

living with high blood pressure is proudly supported by TYLENOL®. The 2017
Guideline for the Prevention, Detection, Evaluation and Management of High
Blood Pressure in Adults (2017 Hypertension Clinical Practice Guideline)
has important implications for the treatment of an estimated 116 million adults
in the United States.
As pharmacists, our
resources can help you
integrate the guideline as
you consult and educate
clients with high blood
pressure.

American Heart Association’s efforts to improve healthy choices

related to living with high blood pressure is proudly supported by TYLENOL®. heart.org/bptools
 HIGHLIGHTS
8 Things to Know
From the 2017 Hypertension Guideline that Will Impact Pharmacy
1 6
Blood pressure classifications have
changed. The guideline establishes a new
evidence-based classification of BP in adults, with
hypertension defined by systolic and diastolic BPs
that are lower than the previous thresholds.
2
The prevalence of hypertension
in America is higher. Nearly half of
all adults in the United States will have high BP
under the updated classifications.
3
Treating high blood pressure begins
with accurate measurements.
Accurate measurement of BP is essential
for categorizing BP, determining the risk of
atherosclerotic cardiovascular disease and
managing high BP. Diagnosis and management
of hypertension should be based on accurate
measurements not only in a doctor’s office but
also through self-monitoring.
4
High BP could be the result of a
secondary cause. Secondary causes
are responsible for about 10% of high blood
pressure cases. Many of these can either be
cured or require specific treatments.
5
Lifestyle changes are a first line
of treatment for many patients.
Nonpharmacologic interventions aimed at
addressing poor dietary habits, physical inactivity
and/or excessive consumption of alcohol are
fundamentally important in managing the
underlying causes of high BP in most adults.
2 Hypertension Guideline Toolkit for Pharmacists
Medicine can help control high
blood pressure when lifestyle
changes are not enough. Pharmacists
should discuss the importance of medication
management and all prescription and over-the-
counter medications with patients.
7
Four drug classes are recommended
as first choice for patients with high
blood pressure. They are thiazide diuretics,
calcium channel blockers, angiotensin
converting enzyme inhibitors and angiotensin
receptor blockers. For many adults with high
blood pressure, pharmacotherapy requires
more than one agent or a combination of BP
medicines.
8
Improving treatment and control of
hypertension may require special
consideration. Most adults receiving
antihypertensive drug therapy have an
average systolic BP and/or diastolic BP
above the target level recommended in this
guideline. Recommendations to improve
treatment and control are provided for high
blood pressure in adults with one or more
comorbidities, or those who have resistant
hypertension or a hypertensive crisis.
Dispensing Advice
Top 10 Things to Know
 THE PROBLEM

High blood pressure is often the first in a series of

health-related events. It can lead to devastating
consequences such as:
Coronary heart disease
Higher BP has been associated with an
increased risk of cardiovascular disease
STROKE (CVD), and the rate of myocardial infarction
increases as BP increases.

VISION LOSS Stroke

Hypertension is the leading modifiable risk
factor for stroke because it’s the leading cause
of stroke.
HEART FAILURE

HEART ATTACK Heart failure

High BP is associated with increased risk of
heart failure in both men and women,
and hypertension is present in 75% of patients
with chronic heart failure.

KIDNEY FAILURE Kidney disease/failure

Hypertension is the second leading cause
of kidney failure, and nearly half of patients
.
with chronic kidney disease do not have
SEXUAL adequately controlled hypertension.
DYSFUNCTION
Vision loss
Long-term hypertension can harm vision in
many ways, including retinopathy,
choroidopathy (fluid buildup under the retina)
and optic neuropathy.

Dispensing Advice
Educate clients about the
importance of taking medicines as
prescribed and overall medicine
management as a way to prevent
these consequences.
Hypertension, the “silent
killer,” is associated with
a variety of life-threatening
diseases or conditions.

3
 A SOLUTION

Knowledge
Is Power
Educate your clients about the
latest high blood pressure guideline.
Encourage them to regularly check
their blood pressure. Tell them that
high BP is treatable. Make sure
clients are aware:

• The sooner they know about

high BP, the better. It possibly can be
managed by making lifestyle changes such
as eating better and exercising.

• If lifestyle changes aren’t enough to Pharmacists are a key part of team-

control high BP, it is very treatable.
Medicines can effectively control it.
• They must actively participate in
their treatment plan, taking medicines
as prescribed, regularly checking their
blood pressure and keeping appointments
with their health care provider. Pharmacists
play a critical role in helping ensure
medication adherence for their clients. If
barriers such as cost, transportation, etc.
prevent clients from taking medicines as
prescribed, pharmacists should work with
the prescribing physician to recommend a
change.
based care for high BP. Randomized
control trials (RCTs) showed that team-
based hypertension care involving
pharmacist intervention resulted in
reductions in systolic blood pressure
and diastolic blood pressure and/
or greater achievement of BP goals
when compared with usual care. The
patients also were better at keeping
appointments and taking their BP
medicine as directed under the team-
based-care model.

4 Hypertension Guideline Toolkit for Pharmacists

 THE RISK

Hypertension and CVD Risk Factors

The guideline recommends screening for and managing these risk factors.

Several modifiable CVD risk factors are commonly found In addition, several
in people with hypertension, including: relatively fixed risk
factors associated with
Current cigarette smoking, secondhand smoke hypertension should be
considered, including:
Diabetes mellitus • Chronic kidney disease
• Family history
Dyslipidemia/hypercholesterolemia
• Increased age

Overweight/obesity • Low socioeconomic/

educational status

Physical inactivity/low fitness • Male sex

• Obstructive sleep apnea
Unhealthy diet
• Psychosocial stress

Alcohol consumption
Dispensing Advice
Help your clients
understand the risks
of high BP and the
substantial benefits
of lowering their BP.
Emphasize the central
role they play in
Nearly half of American adults have
preventing and
high blood pressure. managing elevated BP.

A 10 mm Hg reduction in systolic blood pressure can significantly

reduce risk of several conditions:

Coronary 17% 27% Heart 28%

Heart Disease reduced Stroke reduced Failure reduced
risk risk risk

5
 RISK FACTORS

UPDATED Categories of Hypertension

BP (mm Hg)
The updated categories BP CATEGORY
Systolic Diastolic
reflect a more aggressive
NORMAL <120 and <80
approach to managing
ELEVATED 120-129 and <80
BP, with elimination
of the prehypertension HYPERTENSION

category, and lowering Stage 1 130-139 or 80-89

of the threshold for Stage 2 ≥140 or ≥90
hypertension to 130/80 HYPERTENSIVE >180 and/ >120
CRISIS or
mm Hg.

Dispensing Advice
Help your clients understand their BP readings. Print this table, circle their BP
category, and give it to them along with other appropriate resources. The table is
available in English, Spanish and Traditional Chinese.

6 Hypertension Guideline Toolkit for Pharmacists

 MEASURING AND MONITORING BP

Measuring BP
Accurate measurement of BP is essential to The guideline describes six key steps
proper prevention, detection and management of for proper measurement of BP.
BP. Although measurement of BP seems relatively
easy, errors are common and can result in a
misleading estimation of an individual’s true STEPS FOR ACCURATE BP MEASUREMENT
level of BP and impact treatment. Recognizing 1

SEAT PATIENT WITH FEET FLAT ON THE

the importance of accurate measurement of BP,

FLOOR, RELAXED AND QUIET FOR 5 MIN.
HAVE PATIENT EMPTY BLADDER AND AVOID
CAFFEINE, EXERCISE AND SMOKING FOR
30 MINUTES. REMOVE CLOTHING FROM ARM.

the 2017 guideline focuses on the standards for

accurate measurement of BP.

A team-based approach to care is 3 2

recommended. Such an approach has been FIRST VISIT, RECORD BP IN BOTH

ARMS, USING THE ARM WITH
USE PROPERLY VALIDATED,
CALIBRATED BP MEASUREMENT
HIGHER READING. SEPARATE DEVICE. SUPPORT PATIENT’S ARM

associated with lower systolic and diastolic REPEATED MEASUREMENTS

BY 1-2 MINUTES.*
AND POSITION CUFF ON BARE ARM
AT LEVEL OF THE RIGHT ATRIUM.
USE CORRECT CUFF SIZE.

measurements as well as an increased proportion

*For auscultatory determinations, use a palpated estimate of Usual sizes based on arm circumference:
radial pulse obliteration pressure to estimate SBP. Inflate the cuff 22-26 cm = Small Adult
20-30 mm Hg above this level for an auscultatory determination
of BP level. For auscultatory readings, deflate the cuff pressure,
27-24 cm = Adult
2 mm Hg per second and listen for Korotkoff sounds. 35-44 cm = Large Adult
45-52 cm = Adult Thigh

of people with controlled BP. Teams consisting

**For auscultatory technique, record SBP and DBP as onset of
the first Korotkoff sound and disappearance of all Korotkoff
sounds respectively, using the nearest even number.

4 5 6

of physicians, nurses, physician assistants and RECORD SBP AND DBP**. NOTE
TIME OF MOST RECENT BP MED
TAKEN BEFORE MEASUREMENT.
USE AN AVERAGE OF 2 READINGS
OBTAINED ON 2 OCCASIONS TO ESTIMATE
THE INDIVIDUAL’S LEVEL OF BP.
PROVIDE PATIENT THE
SBP/DBP READINGS BOTH
VERBALLY AND IN WRITING.

pharmacists can have the greatest impact on AHA recommended blood pressure levels
improving the monitoring and management of LEARN MORE AT
HEART.ORG/HBPROUTINE
BLOOD PRESSURE CATEGORY

NORMAL
SYSTOLIC mm Hg
(upper number)
LESS THAN 120 and
DIASTOLIC mm Hg
(lower number)
LESS THAN 80

blood pressure. ELEVATED

HIGH BLOOD PRESSURE
(HYPERTENSION) STAGE 1
120-129

130-139
and

or
LESS THAN 80

80-89
American Heart Association’s efforts to improve HIGH BLOOD PRESSURE
140 OR HIGHER or 90 OR HIGHER
healthy choices related to living with high blood (HYPERTENSION) STAGE 2
pressure is proudly supported by TYLENOL®.

HYPERTENSIVE CRISIS HIGHER THAN 180 and/or HIGHER THAN 120

© 2018 American Heart Association, Inc., All rights reserved.

Use of the wrong size cuff is the most common

error in measuring BP. The discrepancy in systolic
BP can be as great as 10 mm Hg if the cuff
is too small; the difference in diastolic BP can
be as great as 8 mm Hg. To ensure accurate Risk Calculator
measurements, the guideline offers the following The appropriate diagnosis of elevated BP
recommendations for selecting the appropriate or hypertension should involve accurate
size cuff. measurement of BP, self-monitoring of BP in the
home, screening for white-coat hypertension
Arm Circumference Usual Cuff or masked hypertension and for secondary
(cm, inches) Size causes of hypertension, and evaluating the use
22-26 (8.5-10.2) Small adult of BP-increasing medications and substances.
27-34 (10.6-13.3) Adult In addition, BP readings from self-monitoring
should be integrated into practice to confirm
35-44 (13.8-17.3) Large adult
the diagnosis. For patients with a diagnosis of
45-52 (17.7-20.5) Adult thigh
stage 1 hypertension, the ASCVD Risk Calculator
should be used to estimate the patient’s 10-year
Dispensing Advice and lifetime risk for atherosclerotic CVD. This
estimate is a factor in determining the most
Download the ASCVD Risk appropriate treatment. A team-based approach is
Calculator or launch a web version. recommended.

7
 MEASURING AND MONITORING BP

Self-Monitoring
Patient self-monitoring of BP is an important focus of the 2017
guideline. It can help confirm the diagnosis of high BP. It also
can help health care providers determine whether treatments are
working. Patient training should be done under medical supervision,
with focus on evaluating the device used in the home and providing
detailed instructions for proper measurement.

To get the most accurate home measurement

of blood pressure, follow these tips:

The American
Be still. Don’t smoke, drink caffeinated beverages or exercise
within 30 minutes before measuring your blood pressure. Heart Association
recommends an
Sit correctly. Sit with your back straight and supported (on a automatic, cuff-style,
dining chair, rather than a sofa). Your feet should be flat on the bicep (upper arm)
floor and legs uncrossed. monitor.

Ensure >5 minutes of quiet rest before blood pressure

measurement with your left arm resting comfortable on a flat Dispensing Advice
surface at the heart level.
Emphasize the
Place the bottom of the cuff above the bend in the elbow. importance of
monitoring BP at
Take at least two readings 1 minute apart in the home and encourage
morning before taking medications and in the evening before
clients to use online
supper. Optimally, measure and record BP daily. Ideally, obtain
resources to help ensure
weekly BP readings beginning two weeks after a change in the
treatment regimen and during the week before a clinic visit. accurate measurements
and tracking. Print this
Take multiple readings and record the results. Each quick reference to
time you measure, take two or three readings 1 minute apart help clients learn how
and record the results.
to monitor their blood
pressure at home.
Don’t take the measurements over clothes.

8 Hypertension Guideline Toolkit for Pharmacists

 SECONDARY HYPERTENSION

Screening for Secondary Hypertension

Primary
aldosteronism
(8-20%)
Renovascular Drugs
disease or alcohol*
(5-34%) (2-4%)

Obstructive Renal
sleep apnea parenchymal
(25-50%) disease
(1-2%)

Common Causes of
Secondary Hypertension

Determining whether hypertension has a secondary cause is

also a component of the appropriate diagnosis of elevated
BP or hypertension. Above are the most common causes
of secondary hypertension with prevalence indicated in
parentheses.

Note: Some uncommon, but important causes of secondary

hypertension include pheochromocytoma/paraganglioma,
Cushing’s syndrome, hypo- or hyperthyroidism, aortic coarctation Secondary causes
and others. of hypertension are
responsible for high
See more information on secondary hypertension,
clinical implications, prevalence, physical examination and BP in approximately
screening tests. 10% of patients with
hypertension.
Algorithm for Screening Secondary Hypertension

*such as sodium containing antacids, caffeine, nicotine, NSAIDS, oral contraceptives and others

9
 IDENTIFYING BP RAISERS
Identifying Medications and Substances
that May Cause Elevated BP
Several medications and other substances may
cause elevated BP. Be sure to ask your clients about
their use of medications, including over-the-counter
medicines or other substances. Discuss how these
substances may increase BP and identify any
that your patients should avoid, limit or
stop to help maintain a healthy BP.
Chronic pain affects more adults than coronary
heart disease, diabetes and cancer combined.
As a result, the use of pain relievers is common.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
can increase BP because they reduce renal blood
flow and cause sodium retention. Clients older
than 65 years are at most risk for this effect. For
clients with high blood pressure, pay extra attention
when selecting medications for pain relief. Certain
pain relievers can interfere with their hypertension
management, and acetaminophen may be a more
appropriate pain relief option, depending on
indication and risk.
10
BP Raisers
Learn What Could Raise Your Blood Pressure
Many things can affect your blood pressure (BP). It is critical to understand what medications
and substances you should avoid to support a healthy BP.
SMALL CHANGES CAN MAKE A BIG DIFFERENCE
Be your own health advocate by following a healthy lifestyle, such as reducing sodium
and checking your blood pressure as part of your daily routine.
High blood pressure – a systolic blood pressure reading of 130 mmHg and above or a diastolic
reading of 80 mmHg and above – is a serious health condition that can increase your risk of
heart disease and stroke. Take these steps to control your risk.
AVOID:
• Illicit and recreational drugs
TALK TO YOUR HEALTHCARE
PROVIDER ABOUT STARTING,
• Herbal supplements STOPPING OR CHANGING:
• Foods that contain tyramine when • NSAID pain medication (drugs like
taking antidepressants, such as MAOIs acetaminophen are less likely to increase BP)
(monoamine-oxidase inhibitors) • Amphetamines
• Certain medications to treat mental health
• Corticosteroids, such as prednisone
LIMIT:
• Alcohol to less than 1 drink a
• Immunosuppressants
• Oral birth control (consider alternative
day for women and less than forms such as barrier, IUD, abstinence)
2 drinks a day for men
• Caffeine to less than 300 mg per day
• Certain cancer medications
(such as angiogenesis inhibitors)
(about 2-3 cups of coffee); avoid with
hypertension
• Decongestants and some cold
medicines; avoid with severe or
NOTE: Do you suffer from chronic pain? Certain
medicines can raise your BP or make your BP
medication less effective. Talk to your healthcare
uncontrolled hypertension provider for guidance if you have any questions.
American Heart Association’s efforts to improve healthy choices related
to living with high blood pressure is proudly supported by TYLENOL®.
heart.org/bptools
© 2018 American Heart Association, Inc., All rights reserved.
Download this infographic to help
easily identify potential BP Raisers.
Dispensing Advice
Encourage your clients to talk openly
about which over-the-counter medicines
and substances they consider using.
Print the list of medications and
substances shown above, create
an encouraging environment and start
the conversation with your clients.
Encourage clients with elevated BP or
hypertension to consider using pain
relievers other than NSAIDs, depending
on the indications and risks.
Hypertension Guideline Toolkit for Pharmacists

Nonpharmacological Interventions
Guideline-recommended treatment includes
nonpharmacologic interventions for patients with
elevated BP or stage 1 hypertension and an
estimated 10-year CVD risk of less than 10%.
A combination of antihypertensive medication
and nonpharmacologic interventions is
recommended for patients with stage 1
hypertension and an estimated 10-year
ASCVD risk of 10% or higher and for all
patients with stage 2 hypertension.
Dispensing Advice
Talk to your patients about the
benefits of lifestyle changes in
reducing BP. Give them the “What
Can I Do To Improve My Blood
Pressure” resource as a reminder
for them at home.
Pharmacological Interventions
Antihypertensive Medication
The BP threshold for antihypertensive medication
should be determined based on the average BP
levels and CVD risk.
BP Threshold Patient
(mm Hg) Scenario
≥130/80 ASCVD risk
of 10% or higher
OR
Clinical CVD
≥140/90 ASCVD risk
less than 10%
TREATMENTS
Nonpharmacologic Interventions
The guideline recommends several
nonpharmacologic interventions
that have been shown to reduce systolic BP
by as much as 11 mm Hg in adults with
hypertension. These interventions also can help
prevent hypertension in adults with normal BP.
• Weight loss for patients who are
overweight or obese
• Heart-healthy diet (such as DASH)
• Sodium reduction
• Potassium supplementation (preferably in
dietary modification)
• Increased physical activity with structured
exercise program
• Limitation of alcohol to one (women)
or two (men) standard drinks per day*
*In the United States, one “standard” drink contains
roughly 14 g of pure alcohol, which is typically found in
12 ounces of regular beer (usually about 5% alcohol),
5 ounces of wine (usually about 12% alcohol) and 1.5
ounces of distilled spirits (usually about 40% alcohol).
Several different BP thresholds and goals for
the long-term treatment of hypertension with
pharmacological therapy are recommended in
the guideline. Use this quick reference for a
summary.
Initiation of antihypertensive drug therapy with
a single antihypertensive drug is reasonable in
adults with stage 1 hypertension and BP goal
<130/80 mm Hg with dosage titration and
sequential addition of other agents to achieve the
BP target. (COR IIa, LOE C-EO)
11
 TREATMENTS

Initiation of antihypertensive drug therapy sympathomimetric activity and combined

with two first-line agents of different classes, alpha- and beta-receptor)
either as separate agents or in a fixed-dose • Direct renin inhibitor
combination, is recommended in adults with • Alpha-1 blockers
stage 2 hypertension and an average BP more • Central alpha2-agonist and other centrally
than 20/10 mm Hg above their BP target. (COR acting drugs
I, LOE C-EO) • Direct vasodilators

Four classes of oral antihypertensive drugs 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
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).

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.

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

12 Hypertension Guideline Toolkit for Pharmacists

 TREATMENTS

Treatment For the following comorbidities:

• Diabetes mellitus

of Hypertension • Chronic kidney disease

• After renal transplantation
• Heart failure

in Patients With • Stable ischemic heart disease

• Peripheral artery disease

Comorbidities BP Threshold ≥130/80 mm Hg

BP Goal <130/80 mm Hg
When setting BP thresholds and
goals of pharmacologic therapy, For secondary stroke prevention

you should consider your clients’

comorbidities. BP Threshold ≥140/90 mm Hg
BP Goal <130/80 mm Hg

The guideline also includes several recommendations for specific antihypertensive medications
according to these comorbidities as well as others, such as acute intracerebral hemorrhage,
atrial fibrillation, valvular heart disease and aortic disease.

Resistant Hypertension
Studies have found that patients with resistant hypertension are at high risk for cardiovascular
complications. The prevalence of resistant hypertension has been identified as anywhere from
3%-30% of patients who required at least three or more medications to reach blood pressure
control. The guideline defines treatment resistance and offers recommendations for evaluating
and treating patients.
Algorithm for Diagnosis, Evaluation and Treatment

13
 SPECIAL PATIENT GROUPS AND EMERGENCIES

The guideline recommends

Hypertensive Crises:
special attention to Emergencies and
specific patient groups.
Urgencies
Recommendations include: BLOOD
PRESSURE
Black Adults Hypertensive HIGHER THAN
180/120 mm Hg
In black adults with hypertension but without emergencies IS A CRISIS.
heart failure or chronic kidney disease, are defined as
including those with diabetes mellitus, initial severe elevation
antihypertensive treatment should include a of BP (greater than 180/120 mm
thiazide-type diuretic or a calcium-channel Hg) associated with evidence of new or
blocker. In addition, especially for black adults worsening target organ damage. In such
with hypertension, two or more antihypertensive
cases, BP must be immediately reduced to
medications are recommended to achieve a BP
prevent or limit further damage.
target of less than 130/80 mm Hg.

Pregnant Women The guideline provides an algorithm

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.
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.

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.

14 Hypertension Guideline Toolkit for Pharmacists


In addition to a team-based approach to managing
hypertension, other strategies focus on promoting
lifestyle modifications and improving adherence to
antihypertensive medication.
Promoting lifestyle modifications
Small changes can make a big difference.
Patients adopting and maintaining lifestyle
modifications can improve their blood
pressure. Encourage the use of strategies
that can help promote necessary behavioral
changes such as the following:
• Set goals.
• Provide feedback.
• Emphasize importance
of self-monitoring.
• Promote self-sufficiency.
• Schedule consistent follow-up.
• Use motivation interventions.
These strategies are most effective
when combined.
Dispensing Advice
Consider the cultural and social
contexts and health literacy of your
clients. Create an encouraging,
blame-free environment. Talk openly
about expectations and goals. Listen
to their concerns. Answer their
questions.
TAKING CONTROL
Improving adherence to
antihypertensive medication
Only 1 in 5
patients has sufficiently high adherence
to achieve the benefits observed in clinical trials.
Research has shown that as many as 25% of
patients do not fill their initial prescription for
antihypertensive therapy. Use strategies that
have been found to be effective in
improving adherence, such as the
following:
• Educate patients about hypertension, its
consequences and potential side effects of
medication.
• Collaborate with patients to establish goals of
therapy and plan of care.
• Prescribe medication as once-daily dosing
• Integrate pill-taking into routine activities
of daily living with support tools such as
reminders, pillboxes, packaging and other
aids.
• Use fixed-dose combination agents when
available.
• Use medication adherence scales to facilitate
identification of barriers.
• Recognize patients for achieving treatment
goals.
15
 Helpful Links and Other Resources
Here are some AHA tools and resources to help with client education.
They have been developed with guidance from AHA volunteers who face
the same challenges as your clients.

www.heart.org/bp

2017 Hypertension Clinical Practice Guideline

Professional Heart Daily

Target BP: BP Guideline

Patient Resources
Blood Pressure Fact Sheets

© Copyright 2020 American Heart Association, Inc., a 501(c)(3) not-for-profit. All rights reserved. Unauthorized use prohibited.