Hypertension

Case Scenarios: Hypertension

MD is a 48-year-old woman who periodically visits Your-Rx-Done-Right Pharmacy for her children's and her own medications. Today, she comes to see the pharmacist after visiting her doctor, who told her that her blood pressure is high. The doctor explained to her that, if her blood pressure remains elevated at her next visit, he will consider putting her on a medication to help control it.

She explains that her husband has recently gotten laid off from his job, and she has had to pick up extra shifts at her job to help compensate for his income loss. She also is concerned that her son is doing poorly in school lately, leading him to consider dropping out. She tells the pharmacist that, due to all the stress in her life, she has recently started smoking again and has gained 10 pounds over the past year.

The pharmacist can see that MD appears overwhelmed by the various problems in her life. The pharmacist is concerned that, in her current state, MD will not focus enough attention on her own health or recognize the importance of adequately controlling her blood pressure. The pharmacist knows that patients with chronic conditions are more likely to be nonadherent to therapy, particularly if the condition lacks symptoms, as does hypertension. With these issues in mind, the pharmacist takes MD into the private counseling area to discuss their importance.

MD is rather distraught at the possibility of adding a new medication. She states, "I already have so much on my plate right now that I'm not sure I can handle something else. Why do I need to take a medication? I don't feel any different. Is there anything else I can do besides taking a medication to help lower my blood pressure?"

Several months later, the pharmacist receives a phone call from MD, who is at her doctor's office for an appointment. A new medical intern working at the doctor's office is evaluating MD's hypertension. MD mentioned to him that the pharmacist had spent time discussing the importance of controlling her blood pressure. Not wanting to look bad in front of the attending physician, the intern asks the pharmacist for a recommendation on how to control MD's blood pressure "since you seem to be well-educated on the condition." The intern tells the pharmacist that MD's blood pressure was reported as 165/105 mm Hg.

Several months later, MD returns to pick up refills of her hydrochlorothiazide and lisinopril prescriptions. She thanks the pharmacist for talking to her previously and explaining her condition to her. She happily reports that her most recent blood pressure readings were below her goal.

MD comments that she has developed a cough that has persisted for the past month. She states, "Between this cough and needing to get up at night to go to the bathroom, I'm exhausted from lack of sleep. Can you recommend something to me to help with this cough? I don't have any other symptoms - just a cough."