Eric J. MacLaughlin

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: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Glenn N. Levine, MD, FACC, FAHA, Chair Patrick T. O’Gara, MD, MACC, FAHA, Chair-Elect Jonathan L. Halperin, MD, FACC, FAHA, Immediate Past Chair Sana M. Al-Khatib, MD, MHS, FACC, FAHA Joshua A. Beckman, MD, MS, FAHA Kim K. Birtcher, MS, PharmD, AACC Biykem Bozkurt, MD, PhD, FACC, FAHA

Assessing Medication Adherence in the Elderly Which Tools to Use in Clinical Practice

Adherence to prescribed medication regimens is difficult for all patients and particularly challenging for the elderly. Medication adherence demands a working relationship between a patient or caregiver and prescriber that values open, honest discussion about medications, i.e. the administration schedule, intended benefits, adverse effects and costs.Although nonadherence to medications may be common among the elderly, fundamental reasons leading to nonadherence vary among patients. Demographic characteristics may help to identify elderly patients who are at risk for nonadherence. Inadequate or marginal health literacy among the elderly is common and warrants assessment. The number of co-morbid conditions and presence of cognitive, vision and/or hearing impairment may predispose the elderly to nonadherence. Similarly, medications themselves may contribute to nonadherence secondary to adverse effects or costs. Especially worrisome is nonadherence to ‘less forgiving’ drugs that, when missed, may lead to an adverse event (e.g. withdrawal symptoms) or disease exacerbation.Traditional methods for assessing medication adherence are unreliable. Direct questioning at the patient interview may not provide accurate assessments, especially if closed-ended, judgmental questions are posed. Prescription refill records and pill counts often overestimate true adherence rates. However, if elders are asked to describe how they take their medicines (using the Drug Regimen Unassisted Grading Scale or MedTake test tools), adherence problems can be identified in a nonthreatening manner.Medication nonadherence should be suspected in elders who experience a decline in functional abilities. Predictors of medication nonadherence include specific disease states, such as cardiovascular diseases and depression. Technological aids to assessing medication adherence are available, but their utility is, thus far, primarily limited to a few research studies. These computerised devices, which assess adherence to oral and inhaled medications, may offer insight into difficult medication management problems. The most practical method of medication adherence assessment for most elderly patients may be through patient or caregiver interview using open-ended, nonthreatening and nonjudgmental questions.

Effect of pharmacist intervention and initiation of home blood pressure monitoring in patients with uncontrolled hypertension.

This prospective, randomized, controlled study evaluated the impact of pharmacist‐initiated home blood pressure monitoring and intervention on blood pressure control, therapy compliance, and quality of life (QOL). Subjects were 36 patients with uncontrolled stage 1 or 2 hypertension. Eighteen subjects received home blood pressure monitors, a diary, and instructions to measure blood pressure twice every morning. Home measurements were evaluated by a clinical pharmacist by telephone, and the patients family physician was contacted with recommendations if mean monthly values were 140/90 mm Hg or higher. Eighteen control patients did not receive home monitors or pharmacist intervention. Office blood pressure measurements and QOL surveys (SF‐36) were obtained at baseline and after 6 months. Mean absolute reductions in systolic and diastolic pressures were significantly reduced from baseline in intervention subjects (17.0 and 10.5 mm Hg, both p<0.0001) but not in controls (7.0 and 3.8 mm Hg, p=0.12 and p=0.09). More intervention subjects (8) had blood pressure values below 140/90 at 6 months compared with controls (4). During the study 83.3% (15) of intervention subjects had drug therapy changes versus 33% (6) of controls (p<0.01). Compliance and QOL were not significantly affected. Our data suggest that the combination of pharmacist intervention with home monitoring can improve blood pressure control in patients with uncontrolled hypertension. This may be related to increased modifications of drug regimens.

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: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Paul K. Whelton, MB, MD, MSc, FAHA, Chair, Writing Committee, Robert M. Carey, MD, FAHA, Vice Chair, Writing Committee, Wilbert S. Aronow, MD, FACC, FAHA, Writing Committee Member, Donald E. Casey, Jr., MD, MPH, MBA, FAHA, Writing Committee Member, Karen J. Collins, MBA, Writing Committee Member, Cheryl Dennison Himmelfarb, RN, ANP, PhD, FAHA, Writing Committee Member, Sondra M. DePalma, MHS, PA-C, CLS, AACC, Writing Committee Member, Samuel Gidding, MD, FACC, FAHA, Writing Committee Member, Kenneth A. Jamerson, MD, Writing Committee Member, Daniel W. Jones, MD, FAHA, Writing Committee Member, Eric J. MacLaughlin, PharmD, Writing Committee Member, Paul Muntner, PhD, FAHA, Writing Committee Member, Bruce Ovbiagele, MD, MSc, MAS, MBA, FAHA, Writing Committee Member, Sidney C. Smith, Jr., MD, MACC, FAHA, Writing Committee Member, Crystal C. Spencer, JD, Writing Committee Member, Randall S. Stafford, MD, PhD, Writing Committee Member, Sandra J. Taler, MD, FAHA, Writing Committee Member, Randal J. Thomas, MD, MS, FACC, FAHA, Writing Committee Member, Kim A. Williams, Sr., MD, MACC, FAHA, Writing Committee Member, Jeff D. Williamson, MD, MHS, Writing Committee Member, Jackson T. Wright, Jr., MD, PhD, FAHA, Writing Committee Member

Cyclooxygenase-2 Inhibitors: A Painful Lesson

Non-steroidal anti-inflammatory drugs (NSAIDs) represent a clinically important class of agents. NSAIDs are commonly used in treatment of conditions such as headache, fever, inflammation and joint pain. Complications often arise from chronic use of NSAIDs. Gastrointestinal (GI) toxicity in the form of gastritis, peptic erosions and ulcerations and GI bleeds limit usage of NSAIDs. These toxicities are thought to be due to cyclooxygenase (COX)-1 blockade. COX-1 generates cytoprotective prostanoids such as prostaglandin (PG) E2 and prostacyclin (PGI2). COX-2 inhibitors, commonly referred to as coxibs, were developed to inhibit inflammatory prostanoids without interfering with production of COX-1 prostanoids. Concerns over cardiovascular safety, however, have evolved based on the concept of inhibition of COX-2-derived endothelial prostanoids without inhibition of platelet thromboxane A2, leading to increased cardiovascular risk. The Celecoxib Long-Term Arthritis Safety Study (CLASS) trial did not show a significant increase in cardiovascular risk for celecoxib (Celebrex), but results of the Vioxx Gastrointestinal Outcomes Research (VIGOR) study showed an increased cardiovascular risk with long-term daily usage of rofecoxib in patients with rheumatoid arthritis. The Adenomatous Poly Prevention on Vioxx (APPROVe) trial further evaluated cardiovascular effects of rofecoxib and recently led to removal of this drug from the marketplace. Coxibs affect renal function via blockade of normal COX-2 functions. COX-2 expression increases in high renin states and in response to a high-sodium diet or water deprivation. PGI2 and PGE2 are the most important renal prostanoids. PGI2 inhibition results in hyperkalemia. PGE2 inhibition results in sodium retention, which leads to hypertension, peripheral edema and potentially exacerbation of heart failure. This review article discusses beneficial and deleterious effects associated with prostanoids produced by COX-1 and COX-2 in various organs and how blockade of these products translates into clinical medicine.

Osteoporosis screening and education in community pharmacies using a team approach.

Study Objectives. To develop a model for osteoporosis screening and education in community pharmacies using a team approach, compare bone mineral density T‐scores between quantitative ultrasound (QUS) and dual‐energy x‐ray absorptiometry (DXA), and determine patient satisfaction with this pharmacist‐provided osteoporosis screening and education program.

Essential Components of a Faculty Development Program for Pharmacy Practice Faculty

Prospective, ongoing faculty development programs are important in the initial orientation and short- and long-term development of faculty in higher education. Pharmacy practice faculty are likely to benefit from a comprehensive faculty development program due to the complex nature of their positions, incomplete training in select areas, and multiple demands on their time. The need for faculty development programs is supported by the increased need for pharmacy practice faculty due to the increased number of colleges and schools of pharmacy, expanding enrollment in existing colleges and schools, and loss of existing senior faculty to retirement or other opportunities within or outside the academy. This White Paper describes a comprehensive faculty development program that is designed to enhance the satisfaction, retention, and productivity of new and existing pharmacy practice faculty. A comprehensive faculty development program will facilitate growth throughout a faculty members career in pertinent areas. The structure of such a program includes an orientation program to provide an overview of responsibilities and abilities, a mentoring program to provide one-on-one guidance from a mentor, and a sustained faculty development program to provide targeted development based on individual and career needs. The content areas to be covered in each component include the institution (e.g., culture, structure, roles, responsibilities), student-related activities, teaching abilities, scholarship and research abilities, practice abilities and the practice site, and professional abilities (e.g., leadership, career planning, balancing responsibilities). A general framework for a comprehensive pharmacy practice faculty development program is provided to guide each college, school, department, and division in the design and delivery of a program that meets the needs and desires of the institution and its faculty.Prospective, ongoing faculty development programs are important in the initial orientation and short‐ and long‐term development of faculty in higher education. Pharmacy practice faculty are likely to benefit from a comprehensive faculty development program due to the complex nature of their positions, incomplete training in select areas, and multiple demands on their time. The need for faculty development programs is supported by the increased need for pharmacy practice faculty due to the increased number of colleges and schools of pharmacy, expanding enrollment in existing colleges and schools, and loss of existing senior faculty to retirement or other opportunities within or outside the academy. This White Paper describes a comprehensive faculty development program that is designed to enhance the satisfaction, retention, and productivity of new and existing pharmacy practice faculty. A comprehensive faculty development program will facilitate growth throughout a faculty members career in pertinent areas. The structure of such a program includes an orientation program to provide an overview of responsibilities and abilities, a mentoring program to provide one‐on‐one guidance from a mentor, and a sustained faculty development program to provide targeted development based on individual and career needs. The content areas to be covered in each component include the institution (e.g., culture, structure, roles, responsibilities), student‐related activities, teaching abilities, scholarship and research abilities, practice abilities and the practice site, and professional abilities (e.g., leadership, career planning, balancing responsibilities). A general framework for a comprehensive pharmacy practice faculty development program is provided to guide each college, school, department, and division in the design and delivery of a program that meets the needs and desires of the institution and its faculty.

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: Executive Summary

Paul K. Whelton, MB, MD, MSc, FAHA, Chair, Writing Committee, Robert M. Carey, MD, FAHA, Vice Chair, Writing Committee, Wilbert S. Aronow, MD, FACC, FAHA, Writing Committee Member, Donald E. Casey, Jr., MD, MPH, MBA, FAHA, Writing Committee Member, Karen J. Collins, MBA, Writing Committee Member, Cheryl Dennison Himmelfarb, RN, ANP, PhD, FAHA, Writing Committee Member, Sondra M. DePalma, MHS, PA-C, CLS, AACC, Writing Committee Member, Samuel Gidding, MD, FACC, FAHA, Writing Committee Member, Kenneth A. Jamerson, MD, Writing Committee Member, Daniel W. Jones, MD, FAHA, Writing Committee Member, Eric J. MacLaughlin, PharmD, Writing Committee Member, Paul Muntner, PhD, FAHA, Writing Committee Member, Bruce Ovbiagele, MD, MSc, MAS, MBA, FAHA, Writing Committee Member, Sidney C. Smith, Jr., MD, MACC, FAHA, Writing Committee Member, Crystal C. Spencer, JD, Writing Committee Member, Randall S. Stafford, MD, PhD, Writing Committee Member, Sandra J. Taler, MD, FAHA, Writing Committee Member, Randal J. Thomas, MD, MS, FACC, FAHA, Writing Committee Member, Kim A. Williams, Sr., MD, MACC, FAHA, Writing Committee Member, Jeff D. Williamson, MD, MHS, Writing Committee Member, Jackson T. Wright, Jr., MD, PhD, FAHA, Writing Committee Member

Blood pressure rising: differences between current clinical and recommended measurement techniques

Strict observation to recommended blood pressure (BP) measurement technique is often not followed in outpatient clinics. The goal of this study was to determine if there was a significant difference in readings obtained using typical clinic procedures versus when following recommended guidelines. One hundred and fifty patients with initial BP readings obtained through usual care above normal per the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (systolic ≥120 mm Hg and/or diastolic ≥80 mm Hg) were included in this prospective cohort study. After obtaining informed consent, BP was reassessed following the American Heart Association guidelines and compared with readings obtained through usual care. BP readings obtained using the recommended technique were significantly lower than usual care (-12.4 mm Hg systolic and -6.0 mm Hg diastolic; P < .0001, respectively). Similar differences existed for those with a preexisting diagnosis of hypertension, those without a preexisting diagnosis, nonelderly (ie, <65 years), and elderly (≥65 years). In patients with a preexisting diagnosis of hypertension (n = 92/150), patients were twice as likely to be considered at goal when following recommended technique (26% vs. 54%; P = .0002). Significant differences exist when BP readings are obtained using recommended technique. Failure to follow guidelines for measurement may have significant clinical implications on treatment decisions.

Physician–Pharmacist Collaborative Management of Asthma in Primary Care

To determine if asthma control improves in patients who receive physician–pharmacist collaborative management (PPCM) during visits to primary care medical offices.