Irish pharmacies leading the way in monitoring hypertension

Irish Pharmacy News spoke to Alice Gallagher, supervising pharmacist at Sion Hill Pharmacy in Dublin.

What is hypertension?

Hypertension, or high blood pressure, rarely has noticeable symptoms, but if left untreated it can increase your risk of developing heart disease or stroke. Hypertension is responsible for significant premature mortality, reduced quality of life and significant costs to the health and social care system. Almost 64% of people over the age of 50 here have high blood pressure, with many unaware that they suffer from the condition. There are various risk factors which include age, family history and certain medical conditions. The only way to find out if your blood pressure is high is to have your blood pressure checked.

How do you measure blood pressure?

Blood pressure is the force exerted on artery walls as the heart pumps blood through the body. Hypertension occurs when blood pressure is consistently higher than the pressure needed to carry blood through the body. Two numbers are used to measure the level of blood pressure. One number records blood pressure when the pressure is at its highest i.e. as the heart muscle squeezes out the blood from your heart. This is called systolic. The other number is when your heart relaxes i.e. allows the blood to flow back into the heart. This is called diastolic. The normal level of blood pressure is usually about 120 (systolic) over 80 (diastolic).

What services does your pharmacy offer?

We offer a walk in blood pressure check. Following from this if a patient has higher readings we would refer them on to the GP. We can also offer the 24 hour monitor to anyone who wishes to get their BP checked before they go to their doctor. By measuring the blood pressure over a 24 hour period, the doctor can get a clearer picture of how a patient’s blood pressure changes over the course of the day and night.

When, and how, did you identify a need for blood pressure monitoring services in your pharmacy?

We started offering free blood pressure monitoring services in the pharmacy as soon as we opened three years ago. After referring several patients on to their GP’s, we realised that 24 hour BP monitoring is a service we should also be providing. We introduced this new service in January 2017. Whilst it is an expensive initial outlay, we see the benefits in the number of people we are referring to their GPs.

Is this a growing area for the business?

Since we opened, there has been a notable increase in the number of customers coming into the pharmacy to avail of our free blood pressure check service. We have one 24 hour monitor, which we hire out to patients for 50 euro. We average one or two patients per week. Health promotion and management is part of our role as pharmacists, so it is great to be able to assist with this.

How do you use these services to build relationships with patients?

In a community pharmacy setting we have the opportunity to start a conversation with patients on a less formal basis. Some people are reluctant to make an appointment with their GP, so we can talk to them about getting their BP checked. We are also available to provide health and lifestyle advice which can positively impact a patients’ wellbeing. These include cutting your intake of salt to less than 6g per day, eating a low fat, balanced diet, increasing your level of physical activity, cutting down on alcohol, weight loss where appropriate, smoking cessation. We have resources on site which can guide patients in making simple changes in their daily lives, such as smoking cessation advice. If we can start discussions with patients it may lead to improved outcomes.

What products are available in pharmacies to treat high blood pressure?

If you are diagnosed with high blood pressure you may be prescribed one or more medications to keep it under control. Common blood pressure medications include:

• Angiotension-converting enzyme (ACE inhibitors) reduce blood pressure by relaxing your blood vessels. Common examples include lisinopril, perindopril

• Angiotensin-2 receptor blockers (ARBs). ARBs work in a similar way to ACE inhibitors by widening your blood vessels. Common examples are candesartan, irbesartan, losartan, valsartan and olmesartan

• Beta blockers. Beta blockers can reduce blood pressure by making your heart beat more slowly and with less force. Common exmaples are bisoprolol, nebivolol and atenolol

• Calcium channel blockers. These work by widening your blood vessels. Common examples are amlodipine, nifedipine, felodipine, diltaizem and verapamil

• Diuretics. Diuretics work by flushing excess water and salt from the body through urine. Common examples include bendrofluamethiazide and indapamide.

What do you believe Irish pharmacies’ role in managing high blood pressure should be?

According to the Irish Heart Foundation, more than half the adults in Ireland over the age of 45 have high blood pressure, but about four in every five men and two out of three women with high blood pressure are not being treated. Many pharmacies around the country are now offering blood pressure checks to patients. Some, like us, also do 24-hour blood pressure monitoring. We think it’s important that Irish pharmacies continue to lead the way in this area. Pharmacies are offer an accessible and low cost option where patients can check their blood pressure and receive expert advice about how to decrease their risk factors and manage the condition.

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