Ask Your Pharmacist

November 30, 2022

Q:

Can you give me a bit of a primer on high blood pressure? I’m worried my husband may have it.

A:

A diagnosis of hypertension requires accurate measurement of blood pressure. Your community pharmacist is trained to measure your blood pressure for you as part of monitoring how well your blood pressure lowering medication(s) is/are working for you. At many pharmacies these BP measurements can be logged with your patient profile and printed out for you prior to your visit to your doctor or nurse practitioner. This way, you can track your progress from one visit to the next with your primary care practitioner. Except for people with very high blood pressure, hypertension is usually diagnosed over a period of months and after your doctor or nurse practitioner has examined the pattern of your blood pressure measurements over time.

Home blood pressure monitoring devices are an accurate way to measure your blood pressure. Hypertension Canada recommends blood pressure monitoring occur in a sitting position with your back supported. You should be resting for at least five minutes to get a proper blood pressure measurement. Your arm should be bare and supported. A properly fitting cuff is essential to getting an accurate blood pressure measurement. Your pharmacy team can help measure you for an appropriate cuff size. The middle of the blood pressure cuff should be at heart level. The lower level of the cuff should be three cm above the elbow crease. There should be no talking or moving during blood pressure measurements. Your feet should be flat on the floor and your legs in an uncrossed position. Generally, three resting blood pressure measurements are taken at each visit to your pharmacist, and the first one is discarded.  

There are different blood pressure targets for starting blood pressure lowering medication depending on your cardiovascular risk and other medical conditions (i.e., diabetes, kidney disease) as well as different goals for blood pressure. A person at low cardiovascular risk may have a goal blood pressure of 140/90 mmHg or under, while someone with diabetes may have a goal blood pressure of under 130/80 mmHg. Talk to your pharmacist or other health care provider about your cardiovascular risk level, and about specific goals of therapy for your blood pressure medications. It can take four to six weeks after starting a new blood pressure lowering medication, or after dose changes, for the full blood pressure lowering effect to occur. Once you are started on blood pressure lowering medication, you are generally on it for life (in one form or another). Although medication therapy is important to lower your blood pressure, non-drug therapy is also very important. Removing salt from your diet can have the same magnitude of blood pressure lowering effect as a single blood pressure medication. Achieving a daily salt intake of under 5 g per day (i.e., less than 2 grams per day of sodium) may decrease your blood pressure up to 10 to 15 mmHg. Live an active lifestyle. Thirty minutes of moderate aerobic physical activity (i.e., cycling, gardening, lane lap swimming) most days of the week is an effective way to lower your blood pressure.

A common reason for lack of blood pressure control in people started on blood pressure medication is missing doses of medications. Because hypertension is silent, we may fool ourselves into believing that we are okay and don’t really need to continue taking these nuisance pills. Hypertension is a chronic disease and the majority of Canadians will require life-long treatment. Many blood pressure medications come in combination formulations today to lessen the number of tablets you are required to ingest daily. Another great idea is to combine taking your daily blood pressure medication with an already established routine. One example of this is placing your pills beside your alarm clock and taking them as soon as the alarm rings in the morning. Another example is placing the pill next to your car keys that you need before you leave for work. Whatever the solution is for you, it is important to try not to miss doses or run out of refills on your medication. If you are having difficulty remembering to take your pills, or if you want to know if you are on the simplest blood pressure lowering medication therapy possible, make an appointment with your pharmacist for a medication review. For more information, check out the Heart and Stroke Foundation at: https://www.heartandstroke.ca/heart-disease/risk-and-prevention/condition-risk-factors/high-blood-pressure

Dr. Kevin Duplisea (PharmD BSc. Pharm, BSc. ACPR) is a pharmacist at Shoppers Drug Mart in Quispamsis, New Brunswick. His opinions are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment. Send your questions to AskYourNBPharmacist@gmail.com.