Prescribing

If medication is needed for blood pressure management, this will usually be under the direction of the GP practice. Increasingly, the practice-based or PCN pharmacist may be the lead within the GP surgery for this cohort of patients, so building a relationship between the community pharmacy and the GP surgery will be helpful to both parties. The pharmacy should use prescriptions for medication as an opportunity to support lifestyle interventions.

Pharmacy teams should be familiar with the medicines commonly prescribed and be able to advise patients on the treatment guidelines (see Table 1 and also NICE NG136 and SIGN 149).

¹For women considering pregnancy or who are pregnant or breastfeeding, see NICE's guideline on hypertension in pregnancy. For people with chronic kidney disease, see NICE's guideline on chronic kidney disease. For people with heart failure, see NICE's guideline on chronic heart failure.

²See MHRA drug safety updates on ACE inhibitors and angiotensin-II receptor antiagonists: not for use in pregnancy, which states 'Use in women who are planning pregnancy should be avoided unless absolutely necessary, in which case the potential risks and benefits should be discussed', Ace inhibitors and angiotensin-II receptor and antiagonists: use during breastfeeding and clarification: ACE inhibitors and angiotensin-II receptor antiagonists. See also NICE's guideline on hypertension in pregnancy.

³ Consider an ARB, in preference to an ACE inhibitor in adults of African and Caribbean family origin.

⁴At the time of publication (August 2019), not all preparations of spironolactone have a UK marketing authorisation for this indication.

Abbreviations: ABPM: ambulatory blood pressure monitoring. ACEi: ACE inhibitor. ARB: angiotensin-11 receptor blocker. BP: blood pressure. CCB: calcium-channel blocker. HBPM, home blood pressure monitoring.