Nurse checking a patient's blood pressure

Handling a Silent Killer: Hypertension Management

In the United States, hypertension is a considerable public health threat. It has long been called the “silent killer” — and for good reason: Hypertension affects more than 65 million Americans1 and up to 30% of those who have the disease are unaware that they do.2 High blood pressure (hypertension) is found in every age group, regardless of gender, race, or ethnicity. Its worldwide prevalence is estimated at 1 billion and the disease is thought to cause 7 million deaths per year.

High blood pressure (HBP) is a significant risk factor for kidney disease and heart failure and leads to cardiovascular diseases such as heart attack and stroke. The American Society of Hypertension [leadership] recognizes that hypertension can no longer be considered a single entity disease as it is often times accompanied by obesity, diabetes, kidney disease, and other health problems.

The cause of hypertension cannot be identified in a large percentage of patients, however, some recognized causes include sleep apnea, certain diseases of the kidney, chronic steroid therapy, thyroid disease, and drug-induced or drug-related hypertension. Non-steroidal anti-inflammatory drugs, oral contraceptives, decongestants, cyclosporine, and adrenal steroids as well as cocaine and amphetamines have been associated with hypertension. In addition, resistant hypertension has resulted from non-adherence to therapy, inadequate dosing, and inappropriate combinations of drugs.2

The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure JNC7 categorizes high blood pressure (in mm/Hg) as follows:

  • Normal blood pressure is systolic <120 and diastolic <80
  • Prehypertension is systolic 120-139 or diastolic 80-89
  • Stage 1 hypertension is systolic 140-159 or diastolic 90-99
  • Stage 2 hypertension is systolic ≥160 or diastolic ≥100

All patients should be encouraged to practice lifestyle modifications, but this is particularly important in those with HBP. Lifestyle modifications include Weight reduction, a diet rich in fruits, vegetables, and low-fat dairy with limited saturated fats and reduced sodium, regular physical activity, and moderation of alcohol consumption.

Blood pressure should be monitored frequently. If the patient does not achieve the goal of blood pressure readings, then alterations to the pharmacological management of hypertension should be made. The clinician must balance the therapeutic effects with the side effects of drugs in order to optimize drug therapy.

Behavioral modification is another evidence-based approach to improving the patient’s compliance with therapy. Patient education, on the disease as well as pharmacologic (medication) and non-pharmacologic interventions (lifestyle modifications), is a cornerstone of successful treatment. Empathy from the healthcare team and honoring the culture of the patient are also very important.2 All members of the healthcare team (e.g. physicians, nurses, and pharmacists) must work together with the patient to improve lifestyle and blood pressure control.5

Trina von Waldner, B.S., Pharm.D., R.Ph., has been an active member of the pharmaceutical community for more than 25 years and began her career as a hospital pharmacist. She has served for six years as the Director of Pharmacy and Emergency Preparedness, Public Health. In 2007, she joined the College of Pharmacy faculty as the Director of Postgraduate Continuing Education and Outreach. In early 2012, she joined, where she presents live courses and contributes to the site’s CE curriculum.


Chisholm-Burns, M. et al. (2006) Pharmacotherapy Practice and Principles P. 10
The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7). (2003). U.S. Department of Health and Human Services.
Trend Tables, Health, United States. The Centers for Disease Control and Prevention, National Center for Health Statistics, 2011. 
The American Society of Hypertension. (2012). 
Hill, M.N. & Miller, N.H. (1996). Compliance enhancement. A call for multidisciplinary team approaches 93:4-6.