BPC 2009: Tackling hypertension in patients with diabetes

by Francesca Rivers and Nicola Cree

Diabetes is fast becoming a global epidemic — and the therapeutic options available are developing almost as rapidly. With diabetic patients often taking several drugs, medicines management is key to tackling the disease. Francesca Rivers and Nicola Cree report from BPC 2009


Eighty per cent of diabetic patients die from cardiovascular problems, so it is important to remember that diabetes is a cardiovascular disease, said Candy Norris, consultant pharmacist — cardiovascular, Harrogate and District NHS Foundation Trust.

Blood pressure targets are the key, Miss Norris said, adding that in the past 10 years there has been a big change in blood pressure targets, which has given pharmacists the opportunity to participate in helping patients to meet these targets.

Many clinical trials have failed to meet blood pressure targets, with systolic blood pressure being the most difficult to control, she said. Diabetic hypertension is the most complex part of diabetes management, she added.

The key thing in treating hypertension is to get the blood pressure down and not to worry about which drug is used, she added. On average, in Miss Norris’s Harrogate clinic, patients need three antihypertensive drugs — similar to results found in trials.

Pharmacists need to be directly managing the patients and helping with medicines management since these patients often take a large number of medicines, she said. Patients with diabetes also appear to have more of a problem with drug intolerances, she added.

Miss Norris told participants about the secondary care clinic she runs, which focuses on cardiovascular risk and medicines management. Patients are seen for 20 minutes every four weeks and drug changes are initiated so that the patients can be discharged to their GP.

A lot of these patients have medicines management problems that are discussed in a multidisciplinary team, Miss Norris said.

When dealing with patients on multiple drug treatments, it is important for pharmacists to build a relationship with each patient to help improve his or her confidence, she said. Miss Norris’s clinic helps to enable patient to self-manage through hand-held records and a telephone helpline.

It is important that therapies are reinforced long term because there is evidence that blood pressure control starts to disappear in time, she added.

In the clinic, 68.3 per cent of patients referred achieved their blood pressure target on discharge. Feedback from GPs has also shown that they support the service and believe it is effective.

Eighty-eight per cent of patients felt very confident about a pharmacist looking after their blood pressure tablets — the remaining 12 per cent were fairly confident.

In addition, 100 per cent of patients believed pharmacists listened to their concerns and provided reassurance.

Citation: The Salvadore URI: 10984256

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