Recommendations for Systolic Blood Pressure in Elderly Addressed with Compounded Treatments
Most people expect symptoms to clue them in to the fact that their health isn’t up to par. Then they wait for those symptoms to escalate before deciding it’s time to visit the doctor or, in acute cases, the emergency department. Of course, hypertension doesn’t offer the courtesy of symptoms in most people, so it can worsen for years if they don’t get regular check-ups. Even when it’s caught by a doctor, people over the age of 60 may not be treated to reach to best blood pressure goal. As new guidelines for optimal systolic blood pressure are developed, you can reach out with counseling and compounded treatments to protect the health of your elderly patients.
New Guidelines for High Systolic Blood Pressure in Elderly
Treatment goals for high blood pressure have been unsettled since late 2013, when the Eighth Joint National Committee (JNC 8) relaxed the guidelines. In spite of concerns, including those expressed by five members of the committee, JNC 8 established goals of 150/90 mm Hg for hypertensive adults aged 60 or older and 140/90 mm Hg for all other adults. In late 2015, the Systolic Blood Pressure Intervention Trial (SPRINT) produced evidence to recommend other goals:
- Lowering systolic blood pressure to 120 mm Hg reduced cardiovascular events by 30 percent and all-cause mortality by nearly 25 percent compared to patients treated to a target of 140 mm Hg.1
The researchers continued to evaluate the effect of intensive treatment to 120 mm Hg participants who were 75 or older. Their results published in May 2016 in JAMA verified that this age group also had significantly lower rates of cardiovascular events and death from any cause compared to those with a target of 140 mm Hg.2
- Patients in the intensive treatment group had a slightly higher risk of dizzy spells, but were 21 percent less likely to fall and suffer an injury.3
- They were 38 percent less likely to be hospitalized for worsening heart failure compared to standard treatment.
- No differences in serious adverse events existed between intensive vs standard treatment.
- Intensive treatment was more likely to cause symptomatic hypotension—0.98 percent vs 0.55 percent in the standard group—but there wasn’t any difference in hypotension events.
The SPRINT results support intensive blood pressure therapy over the JNC 8 guidelines, although it’s not known whether the recommendations extend to extreme old age or frailty. A substudy, SPRINT-MIND, is currently ongoing to assess whether the lower blood-pressure target reduces the incidence of dementia, slows the decline of cognitive function or results in less cerebral small-vessel disease.
Pharmaceutical Treatment to Lower Blood Pressure
Patients in the intensive-therapy group in the SPRINT trial were treated with three or more antihypertensive medications, including:
- Calcium-channel blockers—amlodipine
- ACE inhibitor—lisinopril
Pharmaceutical choices are more complicated in the real world than in a study where investigators keep in touch with patients. Compounding pharmacists need to alert physicians to issues that affect patient adherence, such as costs and side effects. Ongoing pharmacist intervention improves blood pressure management, a vital job considering that blood pressure remains uncontrolled in half of all hypertensive patients and in 40 percent of those being treated.4 The big question that SPRINT didn’t answer is this: will the benefits be the same in the real world? Physicians raised concern about two areas directly related to pharmacists:5
- Blood pressure measurement: It’s time have patients take their own blood pressure at home because this gives a more accurate measure over time compared to those obtained in the clinic environment.
- Polypharmacy: To reach blood pressure targets, patients need a simple regimen. Adherence can be improved by compounding combination therapies for patients on multiple medications.
Proactive Roles for Compounding Pharmacists
Most adults visit their local pharmacy once a month—a habit that can do more for their health than they realize if you create an outreach plan.6
- Advertise blood pressure checks: Schedule a regular day and time when anyone can stop by your pharmacy to have their blood pressure checked.
- Medication management: During medication reviews, take blood pressure, encourage patients to use a blood pressure monitor at home and teach them how to use the monitor. Talk about digital products that maintain records they can give their doctor.
- Collaborate with doctors: Using blood pressure measured by the patient at home is a new concept for many physicians. Reach out to them, urge acceptance of measurements taken in the pharmacy and at home. Let them know you’re teaching patients and that today’s digital products maintain records showing blood pressure over time.
- Adherence: Patients often don’t think twice about stopping a medication when they have side effects. Let them know their health depends on talking with you or their doctor before stopping meds.
- Reminder notices: Establish a telephone protocol for staff to keep in touch with your elderly patients. A personal connection is the best way to ensure adherence to all their medications, which is especially important for patients on multiple meds.
- Store displays: Put up a display to boost blood pressure awareness. Keep it simple, but make sure to highlight the fact that the condition doesn’t have symptoms and leads to cardiovascular and kidney disease.
Counsel About Lifestyle Factors
Elderly adults are more likely to need medications to get their blood pressure under control, but lifestyle changes can still make a difference. A well-planned exercise program improves balance, lowers blood pressure, boosts cognition and mental health, and reduces the risk of immobility and frailty. Encourage patients to consult their doctor about their physical needs. Be prepared with handouts or references to local senior centers, physical therapists or exercise programs targeted to seniors.
Whether during medication review or when you talk about exercise, you have the opportunity to recommend topical compounded treatments and supplements that can help them stay active. Older patients face limited mobility from pain and stiffness, whether due to natural aging or arthritis. They’ll be able to say active with products such as glucosamine and chondroitin and topical NSAIDs or mixtures of salicylate, capsaicin and counterirritants.
You can also help patients by counseling about supplements known to be beneficial for lowering blood pressure, such as:7
- Omega-3 fatty acids
- Soluble fiber
- Beetroot juice
- Minerals—potassium, magnesium and calcium
Community Outreach Benefits Quality of Life in Elderly
Reaching out to individuals and to the larger community has an immeasurable impact on the quality of life for your elderly patients. The more you’re available, whether through speaking at senior centers or offering blood pressure checks at your pharmacy, the more you’ll help patients keep their blood pressure under control and enjoy an active life.
Pharmaceutica North America provides high-quality bulk APIs that treat hypertension and a diverse selection of pharmaceuticals and emollient delivery bases for topical formulations. Contact us today to see how we can help you meet all the needs of your elderly patients.
- “BP Targets Far Below Guidelines Cut Mortality, CV Events: SPRINT Trial,” September 2015, http://www.medscape.com/viewarticle/850866 ↩
- “Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged 75 Years and Older: A Randomized Clinical Trial,” May 2016, http://jama.jamanetwork.com/article.aspx?articleid=2524266 ↩
- “More From SPRINT: Intensive BP Targeting Cuts HF-Related Events Without Raising Fall Risk,” May 2016, http://www.medscape.com/viewarticle/863596 ↩
- “Improving Blood Pressure Control Through Pharmacist Interventions: A Meta-Analysis of Randomized Controlled Trials,” April 2014, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4187511/ ↩
- “Hypertension Management After SPRINT: Fast Forward or Pause?” November 2015, http://www.medscape.com/viewarticle/854501 ↩
- “Counseling Patients on High Blood Pressure,” November 2013, http://pharmacytoday.org/article/S1042-0991%2815%2931094-X/fulltext ↩
- “A Review of Nutritional Factors in Hypertension Management,” April 2013, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3649175/ ↩