Pharmacy News

Entries for January 2018

How to Avoid Raising Your Blood Pressure with the New AHA/ACC Guidelines

By Rodney Sharp, R.Ph., consultant pharmacist, St. John Specialty Pharmacy, Farmington Hills

The new hypertension guidelines, which were released in November 2017, are contained in a 401-page PDF document. Previous guidelines identified high blood pressure as ≥ 140/90 mm Hg. The new guidelines state that high blood pressure patients are those with a systolic blood pressure (SBP) ≥ 130 mm Hg or diastolic blood pressure (DBP) ≥ 80 mm Hg. High normal and pre-hypertension diagnoses are no longer recognized. This means that more patients will be diagnosed with hypertension. The goal is to improve blood pressure control and to reduce the risk of cardiovascular disease (CVD) in these patients. The following are some of the important changes for what defines hypertension cases, according to the new guidelines:

  • Normal BP: < 120/80 mm Hg 
  • Elevated BP: 120-129/< 80 mmHg
  • Stage 1 HTN: 130-139 /80-89 mm Hg 
  • Stage 2 HTN: ≥ 140/90 mm Hg 
  • HTN Crisis: > 180/120 mm Hg

According to the new definition of stage 1 hypertension, a small percentage of patients will be asked to take medications. Meanwhile, the majority will be recommended for nonpharmacological interventions with healthy lifestyle changes including increased amounts of potassium and decreased amounts of sodium. Correctly measuring blood pressure is critical. Home and non-medical center testing are recommended for new patients. Many pharmacist blood pressure control studies are cited in the new guidelines. It is now suggested that blood pressure be recorded from both arms, and readings should be averaged over several days and/or weeks. As a pharmacist, I believe that these new guidelines will help us to solidify our role in managing hypertension. To see the new guidelines, please visit the guidelines here and the summary of the guidelines here.

Posted in: Professional Practice
Incorporating the 2017 ACC/AHA Hypertension Guidelines into Practice

By Aaron LePoire, Pharm.D., PGY1 pharmacy resident and Alexander Proux, Pharm.D., PGY1 pharmacy resident, Meijer, Ferris State University & Pfizer, Jenison
           
Look at any major medical publication from the last few months, and odds are one of them mentions the new guidelines for the treatment of hypertension. The biggest headline has been that blood pressure readings of 130/80 or higher are now considered to be hypertensive. The actual answer is a little bit more detailed.

The American College of Cardiology (ACC)/American Heart Association (AHA) guidelines change the classifications to stage one and stage two hypertension, as listed in Table 1.1 The question that naturally follows is when treatment should be initiated. The guidelines recommend pharmacologic treatment for patients with stage one hypertension and a 10-year ASCVD risk score of 10 percent or greater calculated using the ACC/AHA pooled cohort equation, and for any patients with stage two hypertension.1 Little has significantly changed regarding which agents should be initiated; however, it is important to note that the treatment goals are quite different. Rather than having general and condition specific goals as JNC 8 has, the ACC/AHA guideline sets treatment goals as the same across the board.2 The goals are for a target of <130/80 in patients with a 10-year ASCVD risk score of 10 percent or higher, and <140/90 in patients with a risk score of less than 10 percent. The authors do mention that a goal of <130/80 may be reasonable for the latter group, but do not give a firm recommendation. Finally, the guideline strongly recommends out of office blood pressure monitoring for all patients to both rule out white coat or masked hypertension, and also recommend closer monitoring to aid the more strict blood pressure goals.1

Table 1: Blood Pressure Classification

 Classification Blood Pressure
Elevated 120-129/80 mm Hg
Stage 1 HTN 130-139/80-89 mm Hg
Stage 2 HTN >140/90 mm Hg

 

The evidence is cited as originating primarily from three different publications: the SPRINT trial, the ACCORD trial, and a meta-analysis conducted by ACC/AHA in coordination with multiple other professional organizations. The meta-analysis echoed findings from JNC 8 almost completely, with the major differences based on SPRINT and ACCORD.3 The key limitation to the meta-analysis was the exclusion of past meta-analyses. The authors commented that this led them to not recommend differences for treatment goals as directed by patient age. The authors further commented that deferral to JNC 8 recommendations may be appropriate in this instance.1,3

The SPRINT trial was conducted in order to test more strict blood pressure control (<120/80) against the more commonly used treatment goal of <140/90. In this trial, the results showed a significant decrease in the primary composite endpoint (first occurrence of myocardial infarction, acute coronary syndrome, stroke, heart failure or cardiovascular death) with a number needed to treat of 62 in the stricter blood pressure control group. Additionally, the study reported statistically significant increases in adverse reactions such as hypotension, syncope, electrolyte abnormality and acute kidney injury in the stricter blood pressure control group. The authors concluded that tighter blood pressure control of <120/80 would lead to improved patient outcomes.4 One key factor to note for the SPRINT trial is that it excluded patients with diabetes. 

The ACCORD trial was conducted with the same treatment groups as SPRINT and with a similar study design, but specifically looked at patients with diabetes. The trial showed no significant change between the groups for the primary composite outcome (defined as first occurrence of nonfatal myocardial infarction, nonfatal stroke or cardiovascular death). Additionally, the trial found significant increases in serious adverse reactions including hypotension, bradycardia, hyperkalemia, and elevation of serum creatinine in the stricter blood pressure control group. The authors concluded that strict blood pressure control in patients with diabetes increased risk without benefit and is therefore not recommended.5

Despite the differences reported in these two trials, the meta-analysis of both concluded the benefits outweigh the risks of treatment to a lower blood pressure level of <120/80.3 In light of these results, the stricter blood pressure goals listed in the ACC/AHA guideline may be deemed appropriate. However, practitioners should be cognizant of patient specific factors, including diabetes, which may warrant a less strict blood pressure goal. With these new classifications and recommended goals for hypertension management, individuals with high blood pressure must be carefully considered before establishing a treatment goal. 


References:

  1. Whelton PK, Carey RM, Aronow WS, Casey Jr DE, Collins KJ, Dennison, Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith Jr SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams Sr KA, Williamson JD, Wright Jr JT, 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Hypertension. 2017;1-283. 
  2. James PA, Ortiz E, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: (JNC8). JAMA. 2014;311(5):507-20
  3. Reboussin D, Allen NB, Griswold ME, et al. High BP in adults: a systematic review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ ASPC/NMA/PCNA guideline for the prevention, detection, evaluation and management of high blood pressure in adults. J Am Coll Cardiol. 2017;S0735-1097(17):41519-1.
  4. Ambrosius WT, Sink KM, Foy CG, et al; and the SPRINT Study Research Group. The design and rationale of a multicenter clinical trial comparing two strategies for control of systolic blood pressure: the Systolic Blood Pressure Intervention Trial (SPRINT). Clin Trials. 2014;11(5):532-546.
  5. Cushman WC, Grimm RH Jr, Cutler JA, et al; and the ACCORD Study Group. Rationale and design for the blood pressure intervention of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Am J Cardiol. 2007;99(12A):44i-55i.
Posted in: Professional Practice
Don’t Miss the Upcoming MPA Annual Convention and Exposition!

By Heidi Pillen, Pharm.D., Director, Medication Use Policy and Clinical Services, Beaumont Health

The Michigan Pharmacists Association (MPA) Annual Convention & Exposition (ACE) will be held Feb. 23-25, 2018, at the Detroit Marriott at the Renaissance Center, 400 Renaissance Drive, Detroit, MI 48243. The Annual Convention will offer approximately 45 quality continuing education programs (for approximately 21 hours of live CE) throughout the weekend, including at least one pain, one law and one patient safety program each day. 

The Michigan Society of Health-Systems Pharmacists (MSHP) is coordinating two programs for the ACE. On Friday, Feb. 23, Beth Gorski and Heather Schalk will provide age-related updates in neurology. On Saturday, Feb. 24, Paula Hiller, Charlie Mollien and Ghada Abdallah will give a complete overview of the electronic prescribing process for controlled substances.

Other “don’t miss” sessions include the Keynote and the General Session. These events typically draw a large crowd of attendees on Friday and Saturday. A variety of continuing education programming is offered until 2 p.m. on Sunday afternoon.

For a break from educational offerings, the Exhibit Hall will be open on Friday and Saturday. In addition, networking luncheons with practitioners with similar interests are offered on Saturday for practice section members, student pharmacists, technicians and other attendees.

The ACE offers many unique opportunities for student pharmacists, including the MSHP Student Pharmacist Luncheon and the MPA Student Social. The luncheon is hosted on Saturday afternoon and allows students to network with other students from the three Michigan colleges of pharmacy as well as interact with experienced pharmacy leaders. The social offers an informal atmosphere to network with fellow student pharmacists, while enjoying a bite to eat.

On Saturday evening, attendees are encouraged to attend the cocktail reception and Annual Banquet & Awards Ceremony to celebrate the installation of the incoming president and the recognition of pharmacy leaders from Michigan with various awards.  This event fosters the development and inclusion of our future pharmacy leaders through the Michigan Pharmacy Foundation (MPF) Adopt-a-Student program, allowing student pharmacists to attend the event.

Other exciting opportunities include a 50/50 raffle that runs throughout the weekend, with the winning ticket drawn on Sunday. A minimum of $500 is awarded to the lucky ticket holder! In addition, the MPF Charity Auction, offering many unique items including jewelry, art, vacations, and autographed memorabilia is conducted throughout event.

Online registration is now open, click here to register early and save! 

Posted in: Continuing Education
Demonstrating Our Value

By Nancy MacDonald, Pharm.D., BCPS, FASHP, transition of care coordinator, department of pharmacy services, Henry Ford Hospital, Detroit and MSHP president

Happy New Year, everyone! I hope you all had a wonderful holiday season and enjoyed your time with family and friends. This is usually a time of year for us to look at the past 12-months and identify opportunities to improve ourselves personally and/or professionally. It is also a time of year for Michigan Society of Health-System Pharmacists (MSHP) to continue efforts improving patient access to pharmacists’ healthcare services. In 2018, MSHP will do this by highlighting and sharing how we demonstrate the value of pharmacy services.

I chose to make “Demonstrating Our Value” the MSHP 2018 theme after attending an American Society of Health-System Pharmacists state affiliate leader’s meeting. One of the discussions I participated in that struck me the most was about how we choose to belong to a particular group. One of the answers was that your belonging to a group likely comes down to what the value of the group is to you, and how this value impacts your life. I felt it was an important focus for MSHP as well since the organization’s value is related to its members and our Michigan patients.

Although pharmacists continually demonstrate their value to individual clinicians every day while consulting on various therapies or optimizing medication management, we are constantly challenged to describe the value of the pharmacy team and our activities to health-system administrators. We report outcomes which demonstrate how we provide safe, optimal and financially responsible care. As an organization, I believe there is an opportunity for MSHP to share more details on how we measure and report this important information. Are we measuring and reporting clinical, economic and humanistic outcomes to the hospital administrators? Exactly how does each health-system highlight and advocate for pharmacy services when we meet with administrators, individual provider organizations, legislators or with our patients? What tools or information technology are we using to demonstrate, report and track our value? How are we using pharmacist extenders to improve access to care and provide improved patient care? How are we partnering with others to improve public health and make healthcare more affordable? How are we educating Michigan patients about improved access to healthcare services via a pharmacist? What value does MSHP provide for its members or what value should we provide? Sharing this information with others in our State will help us further support efforts to improve access to our services.

In the fall of 2017, various MSHP leaders were invited to participate in a strategic planning meeting for 2018-2020. The participants were divided into three groups and challenged to incorporate the 2018 theme into their goals and objectives. The leaders focused on three key areas: the care of Michigan patients, MSHP members and pharmacy practice advancement. Many of the group’s final recommendations included ideas on demonstrating value for patients and members in an effort to advance our profession. These were a great start to this year’s focus and many ideas were incorporated into the 2018 committee charges, especially if they related to demonstrating value. The charges will help us answer those questions listed above and provide an opportunity to highlight the strong work going on in our State.

Developing committee charges can be daunting, but as I completed this task and presented them to the MSHP Board of Directors for approval, my excitement grew. MSHP has great leaders who were appointed as committee chairs to ensure these charges are completed. After having spent a few hours discussing the charges with them, I was also thrilled to hear the enthusiasm for our 2018 focus and the charges given to their committees. I expect this enthusiasm will only grow as we share this information with you at our meetings and via our publications. Please reach out to a Board member or committee chairperson if you have information to share about how your site demonstrates our value. 

I look forward to a great 2018, and I am excited to see how MSHP can support and showcase how we demonstrate our value! 

Posted in: Member News
Capital Area Pharmacist Association Update

By Cathleen Edick, Pharm.D., CDE, pharmacy program manager, McLaren, Lansing and central regional representative 

The Capital Area Pharmacists Association (CAPA) has five continuing education (CE) programs each year, and in October, CAPA decided to try something different. On Thursday, Oct. 19, 2017, Eric Roath, Pharm.D., hosted our first “Pharmacy Feud” where CAPA members faced off against Genesee County Pharmacists Association (GCPA) members. After quite a lot of fun and learning in a unique format, it was the CAPA members who took the lead in the final round. That evening we also honored our 2017 CAPA $500 scholarship winners: Jacqueline Saunders and Patricia Whiting. Jacqueline is a P4 student at Ferris State University (FSU) who has served as the fundraising chair for both Phi Lambda Sigma and American Society of Health-System Pharmacists. She plans to pursue a residency and has a special interest in oncology. Patricia is a P2 student at FSU who is completing the dual Pharm.D./M.B.A. program.  She is involved in several campus organizations including serving as the vice president of the American Pharmacists Association-Academy of Student Pharmacists and public relations chair for FSU’s National Organization for Women. She is exploring her pharmacy opportunities upon graduation.

Every year in October during Michigan Pharmacy Week, CAPA tries to make the public more aware of what pharmacists do. Similar to last year, over a two-week period CAPA hung banners stating, “Know your Pharmacist, Know your Medicines” over two busy intersections in the Lansing area. In addition to the banners, on Oct. 21, 2017, CAPA members interacted with the public at the Lansing City Market, taking blood pressures and discussing medication use as well as showcasing the “Medicine or Candy?” board to those who walked by.

Throughout the year, anytime there’s a 5th Saturday in a month, CAPA members serve the evening meal from 3-4:30 p.m. at the Advent House in Lansing. On average 80 to 100 people are there to enjoy the meal. The final time to serve in 2017 was Dec. 30, but there are four more opportunities to serve or coordinate the meal in 2018. It is so much fun to work with other CAPA members to help prep the meal in the kitchen or serve the meal to the community. Mark your calendar and watch for email reminders for the Advent House dates in 2018:

  • Saturday, March 31, 2018
  • Saturday, June 30, 2018
  • Saturday, Sept. 29, 2018
  • Saturday, Dec. 29, 2018

In lieu of a formal fundraising event during 2017, CAPA accepted donations for the scholarship fund via a donation bucket passed around at different CE events or via the CAPA website at www.CAPAPharm.org. Thanks to all who donated! This year, CAPA plans to continue collecting donations this way, but also plans to have some type of a social event in the late spring/early summer. Stay tuned for more details! 

CAPA has five CE program topics and dates for 2018. More details will be shared as the date nears, but mark your calendars for: 

  • Tuesday, Jan. 23 - Specialty Pharmacy 101
  • Tuesday, March 20 - Guidelines for Prescribing Opioids
  • Thursday, May 10 - HTN, new guidelines
  • Monday, Oct. 22 - Wits and Wagers for Pharmacy
  • Wednesday, Dec. 5 - Law/Policy Update
Posted in: Member News
Page 2 of 3First   Previous   1  [2]  3  Next   Last