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1、ThePharmacists’RoleinTreatingHypertensionThomasOwens,MDSaintFrancisUniversityCERMUSAObjectivesEnhanceyourunderstandingofhypertensiontoincludecardiovascularrisks,management,andgoalsforindividualpatientsReviewanddiscussthecurrentpharmacotherapystandardsofcareforhypertensionDescribethe
2、pharmacist’sroleincounselingpatientsonhypertensivemedicationsHypertension>140/90mmHgUnitedStates:65millionadultsRiskfactorsinclude:Stroke,myocardialinfarction,heartfailure,peripheralvasculardisease,aorticdissection,chronicrenalfailureHypertensionpricetag:$59.7billionWexler&Feldman,2
3、005HypertensionTypicalonsetseconddecadeoflifePrimaryHypertensionidentifiablebehaviorsSecondaryHypertensionmorediscreteCecil,2004EthnicGroupsAfricanAmericans43%female&39%maleRatio1:3Increaseinsodiumsensitivity?Caucasians28%female29%maleMexicanAmericansRatio1:4or1:5DASHDietCecil,2004D
4、ietarySodiumIntakeSaltHypothesis?StronggeneticunderpinningADA,2005MetabolicSyndromeRiskofHypertensionincreaseswithBMIObesityaccountsfor50%to60%ofnewcasesofhypertensionCecil,2004PotentialCausesofHypertensionExpandedplasmavolumeplussympatheticoveractivityPeripheralvasoconstrictionRena
5、lsaltretentionRenalwaterretentionSleepApneawww.sleepconsultants.com,2007Cecil,2004BloodPressureEquationBloodPressure=CardiacOutputxPeripheralVascularResistanceMostpharmacologicagentslowerSomepharmacologicagentslowerSomepharmacologicagentslowerbothCecil,2004GeneticsofHighBPSympatheti
6、cup-regulationleadstoacascadeofeventsPeripheralvascularresistanceGeneticfactors30%ofcases2xaslikelyifparentshavehypertensionDiscoveryedge.mayo.com,2007;ADA,2003Systolic&Diastolic??Whatismoreimportant?DependsonageLivelongenoughalmostalldevelopsystolichypertension12080systolicdiastoli
7、cCecil,2004AgeDependantRiseinBP(Whelton&Rocella,1995)FraminghamStudy(age:50-79)(Khan,Wong,Larson,&Levy,1999)SystolicHypertensionDecreaseddistensibilityoflargearteriesMajorityofuncontrolledhypertensionDuetofocusondiastolicBPCecil,2004RiskofcardiovascularmortalitybysystolicBP(National
8、HighBloodPressureEd
