CEimpact Podcast

Addressing the Challenge of Uncontrolled Hypertension

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Uncontrolled hypertension continues to drive cardiovascular risk and remains a major gap in chronic disease management. This episode discusses what pharmacists need to know to support treatment adherence, identify therapeutic gaps, and address barriers to blood pressure control. Listen to strengthen your role in helping patients achieve meaningful, sustained outcomes. 

HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact

GUEST
Ryan Jacobsen, PharmD, BCPS
Clinical Pharmacy Specialist
U of Iowa HealthCare

Joshua Davis Kinsey and Ryan Jacobsen have no relevant financial relationships to disclose. 

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CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Identify common causes and consequences of uncontrolled hypertension in various patient populations.
2. Describe the pharmacist's role in recognizing gaps in therapy, addressing adherence, and supporting blood pressure control.

0.05 CEU/0.5 Hr
UAN: 0107-0000-25-271-H01-P
Initial release date: 8/11/2025
Expiration date: 8/11/2026
Additional CPE details can be found here.

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Speaker 1:

Hey CE Impact subscribers, welcome to the Game Changers Clinical Conversations podcast. I'm your host, josh Kinsey, and as always, I'm excited about our conversation today. Uncontrolled hypertension remains one of the most significant and preventable drivers of cardiovascular disease and poor patient outcomes. In this episode, we'll discuss how pharmacists can take action to close care gaps, support effective treatment and help patients achieve better blood pressure control. It's great to have Ryan Jacobson as our guest today. Ryan, thank you for being here.

Speaker 2:

Thanks, josh, it's great to be here.

Speaker 1:

Yeah. So for those of our listeners that don't know, you go ahead and take a couple of minutes. Introduce yourself. Tell us a little bit about your practice site.

Speaker 2:

Yeah, thanks. Thanks for inviting me to be here. It's great to finally be on your podcast. I've listened to a few and I've really enjoyed them. So I'm a clinical pharmacist here at the University of Iowa Health Care. I've been here for over 20 years now in the ambulatory care arena and I've worked in a number of different areas, ranging from general internal medicine to. And I've worked in a number of different areas, ranging from general internal medicine to anticoagulation management, geriatric nephrology, and for probably the past 10 years or so, I'm the clinical pharmacist in our heart and vascular clinic. So I spend my days working side by side with our team of cardiologists and nurses and, most importantly, our patients, to try to optimize their cardiovascular health. I'm also a faculty member, associate professor, with the University of Iowa College of Pharmacy, so it's great to be here, yeah, great.

Speaker 1:

Well, thanks for taking time out of your summer schedule to join us for this. You're certainly well poised as the expert here, being in the cardiovascular clinic, so we really appreciate you imparting some of your wisdom on us. So with that, as I always like to do, kind of lay a foundation for our listeners, just to kind of make sure everybody's on the same page for what we're going to talk about today. So let's talk about uncontrolled hypertension, like what you know. Is there a specific definition? What does it mean when we say a patient is uncontrolled and you know what are some of those like? How do we identify that there can? Is it a certain timeframe? Is it a certain reading for so many times? If you can just kind of speak to the, to the idea of uncontrolled hypertension for a little bit, yeah, and even a little bit more background.

Speaker 2:

you know hypertension is well-established as a leading cause of cardiovascular-related morbidity and mortality. It's the leading preventable cause of cardiovascular death. In fact it's second to only cigarette smoking in terms of overall preventable deaths. Despite the fact that we have well-established treatments that lower that morbidity and mortality, we're still not controlling hypertension, and so this is certainly a timely topic, although it's been over 15 years ago now. There was sort of a call to action in a New England Journal article that highlighted the fact that hypertension is such a significant driver of cardiovascular disease yet we are falling far short in controlling that, despite well-established therapies and high quality evidence.

Speaker 2:

You know it's estimated that approximately 50% maybe a little bit lower than that overall of adults have hypertension. Of course, those prevalence rates vary a little bit. In older individuals over the age of 60. 70% of patients have hypertension, and younger adults those rates may be as low as 25%. Amongst those patients that have hypertension, about 60% are aware and that means 40% are unaware. And I know the focus of today's podcast is really on uncontrolled hypertension, and I think you know your goal is to probably address those patients who've been diagnosed, who've been prescribed a therapy, whether lifestyle or medication and aren't achieving their goals. But I think we'd be remiss today if we didn't also highlight the fact that 40% of patients with hypertension aren't even aware of it.

Speaker 1:

Right. Yeah go ahead and what I was just gonna say to me, that that is also, you know, a potential secondary definition of uncontrolled hypertension, because it is uncontrolled, because they don't even know they have it.

Speaker 2:

So yeah, absolutely so. I think, you know, once we get to some strategies, you know, I want to highlight some things I think we can do. We must do to increase awareness so that we can best care for those patients who don't even know they have high blood pressure and are therefore at risk Some of the long-term complications. Aware of their disease, about 60% or so 50% are prescribed medications, but only 20% are achieving their treatment goals, and so that's really that patient population we're going to talk a little bit more about today, and there's a big opportunity throughout the system of care to address this really significant unmet need.

Speaker 1:

Yeah, yeah, I mean just if anybody got lost. In all the data there, the fact of people who are uncontrolled is significantly high, like that's. The take home point is that it's just.

Speaker 1:

I mean in addition to the fact that pretty much one in two people that you meet are going to have hypertension, you know, the likelihood of them being uncontrolled is also extremely high. So that's great great background, great information. I appreciate that. Can you speak to a little bit about? Well, is there a specific like? How do we classify someone as saying you're uncontrolled? Like what? What gets us to that point?

Speaker 2:

So in order for a blood pressure reading to be considered accurate, a good technique is essential, and this starts with diagnosis and it continues all the way through management and monitoring to make sure patients are achieving their treatment goals. So, while we don't have time today to maybe go through all the steps of accurate measurement, it really starts with that, and so making sure that we have a good measurement of their blood pressure is the starting point. And remind me the question again, or your point.

Speaker 1:

Yeah, no, the specific question was like how do we say that someone is uncontrolled, like, is it X number of readings over you know whatever that are high, or is it you know?

Speaker 2:

Yeah, yeah. So I was running all the steps of proper technique through my head and I lost my train of thought. So in order to consider an accurate reading, we need at least two, the average of at least two readings on at least two different occasions. And so, generally speaking, once a patient's been diagnosed, you know, that's something that we should also highlight today is that home blood pressure monitoring should really be a key part of patient management. In fact, it's even recommended that home blood pressure monitoring be used to confirm the diagnosis of hypertension.

Speaker 2:

Some patients have white coat hypertension, or some patients will have what we call masked hypertension, where they actually have normal office blood pressure readings, but they have elevated readings at home. And so if patients are monitoring their blood pressure regularly generally that would be on a day-to-day basis if we're in the process of optimizing their treatment, you know, certainly some patients get into a situation where they're checking their blood pressure too frequently and that can drive a lot of anxiety unnecessarily, and so every patient's going to be unique in terms of the frequency of blood pressure monitoring, but at least you know on a month, on a weekly basis, if those average readings and they're checking it correctly are above their treatment goal. And just to highlight, the treatment goal for the majority of patients is going to be less than 130 over 80, based on the latest iteration of the American Heart Association guidelines, which were published in 2017. It's worth noting that there's an anticipated update coming in August.

Speaker 1:

I was going to say I think there's something coming soon, isn't there, yeah?

Speaker 2:

Yep. The next iteration of the guidelines is scheduled to be released in August, so we'll look forward to those. But I think suffice it to say that home blood pressure monitoring is going to continue to be an important part of patient management, and usually what I tell patients is you know you have an occasional reading above your treatment goal. It's not anything to get overly concerned about. But if the majority of your readings that we're seeing over a given timeframe are above that treatment goal of less than 130 over 80, then really that's a situation that warrants attention and digging into what may be driving suboptimal treatment.

Speaker 1:

That's great, yeah, and you mentioned something there that I want to touch on and we're going to touch on it later in more detail, but that's an opportunity for the pharmacy teams to really get involved with proper technique of testing at home. That's something where we can provide the education, we can oversee the process, give tips, tricks, that kind of thing, and also make sure that they're buying a reputable product, something that is known for giving good results and that is, you know, user-friendly and stuff like that. So another opportunity for pharmacies to kind of for pharmacy team members to get involved with that process.

Speaker 2:

So yeah, and I think I'll just add, since it came up in the discussion, in terms of treatment goals. I think that's a big opportunity to reinforce throughout the continuum of care. Believe it or not, most patients are not familiar with what their treatment goal is.

Speaker 2:

A lot of patients, I'll ask them well, what's your treatment goal? What do you know about your treatment goal? Oh well, either I don't know or less than 120 over 80, everybody kind of remembers that number. So I think you know this is a big opportunity for pharmacists, especially in the community pharmacy. It's an easy thing to ask a patient when they're picking up their prescriptions, and you notice blood pressure medications in that list of meds to say how are you doing with your treatment goal? How's your home blood pressure monitoring going? Oh, you don't have a home blood pressure monitor. Let me show you some of the validated monitors that we have here and we can help get you set up and help explain how to use them.

Speaker 1:

Yeah, absolutely yeah. So let's talk briefly, before we get into deeper dives, of some of those opportunities that pharmacists have to be involved. Can you speak briefly to the you kind of did? I mean, it's a huge impact to communities, to public health, but just in general, do you have anything to add about the impact of how uncontrolled hypertension can add to expenses and to hospital readmissions and you know just things of that nature that are further complicating you know the care of our patients receiving the optimal care.

Speaker 2:

Yeah, well, hypertension and cardiovascular disease in general is a complicated, multifaceted problem, and you know, and we're seeing increasing rates of metabolic disease, increasing rates of obesity Obesity is a risk factor for high blood pressure, coronary artery disease, high cholesterol, diabetes and so I think this is a problem that so far we haven't done great on, and, in fact, I saw some interesting survey data that looked at awareness, treatment and control rates in a survey between 2017 and 2020. And they compared that to awareness, treatment and control rates in 2021 to 2023, and there was no improvement. And so you know we're not headed in the right direction yet and certainly with the rates of metabolic disease, like I mentioned, this problem isn't going away anytime soon.

Speaker 2:

So we're going to talk about a lot of different opportunities, but I think you know some of the low hanging fruit, easy things that we can do to reinforce throughout the health system. Like I just said, something as simple as asking a patient how they're doing with their treatment goal. You know that doesn't take more than five seconds to ask. And it just sort of reinforces in their mind oh yeah, I need to be important.

Speaker 1:

Yeah, yeah.

Speaker 2:

So we're seeing in the cardiovascular clinic too, we're seeing patients are living longer, so they're developing some of the long term complications of high blood pressure, like heart failure, like dementia, alzheimer's disease. Hypertension is a risk factor for all of those things and so you know, I think suffice it to say you know, without getting into some of the specific numbers and statistics, hypertension is a major driver of cost and morbidity and mortality.

Speaker 1:

For sure. Well, you kind of set us up perfectly to move into the next topic that I wanted to touch on, and so that is. You mentioned that asking the quick question, taking a few seconds. You see, the blood pressure med is being dispensed, or you're doing a med rec review at an AmCare clinic or something and you notice that they're on hypertensive treatment review at a NAM care clinic or something, and you notice that they're on hypertensive treatment. But how can we identify those? What are tips and tricks for pharmacists to help identify those that are either untreated or undertreated? So if we're not seeing them being dispensed to hypertensive medication, do we assume that they have been checked and are good to go, or do we assume that they're one of those walking around that don't know that they have hypertension? You know?

Speaker 2:

Yeah, I think because community pharmacists in particular are so accessible and well connected in the community.

Speaker 2:

You know, I think, just from the awareness side of things, having blood pressure monitoring screening available in your pharmacy, whether that's through a health fair or any other community event, just to raise awareness of hypertension as such a common ailment, and then offering those screening services In terms of those patients that have been diagnosed and are undergoing treatment, regularly asking about blood pressure treatment goals, making sure they're following up with their providers and, if pharmacists are so inclined and they have the resources to engage in a more robust hypertension management service.

Speaker 2:

Offering regular, frequent visits, whether that's phone calls or visits in the pharmacy, to help bridge the gaps in the patient visits with their physicians or nurse practitioner and PA providers, because we know that primary care services are in shortage and those clinics are often very busy and overrun, and so you know when patients are diagnosed with hypertension and initiated on treatment. You know, really regular, frequent, monthly follow-up is recommended in the guidelines. It's well supported as a means to get patients to goal and once they're at goal then you can extend to those follow-up intervals to three to six or even 12 months. But I think this is a big deficiency in our healthcare system, and a lot of what we're going to talk about today isn't really any one part of the healthcare system, whether that's awareness and diagnosis or identifying the right treatments or making sure that patients are adherent. It's a systematic issue and it's going to take systematic solutions, and so One quick fix for any of this.

Speaker 1:

So, yeah, exactly, yeah, one thing I wanted to point out you mentioned and I just I always like to try to highlight things when I when I hear opportunities come from the speakers and you'd mentioned, you know, and I just I always like to try to highlight things when I hear opportunities come from the speakers, and you'd mentioned, you know, offering blood pressure screenings, having health fairs. You know, partner with schools in your area. I am 100% sure that there are students who are active in some of the groups at the organizations on campus who need those hours, who need that service, who want to participate, and so there are opportunities there to tap into schools. So, if you're near a school, partner with them and have their students come out and do, you know, health fairs on Saturday or after school hours, you know, or whatever, that's a great opportunity because I know, you know, timing is not always easy to work in something new and to workflow, and I know that we're all overworked in pharmacy practice.

Speaker 1:

So, but you know, tapping into those resources that we have. So I'm sure you would confirm, given that you're at a college of pharmacy, but you know, utilizing the students, for that is a great opportunity as well. Totally agree, yeah, so one of the other things that you have touched on and let's dig a little bit deeper into it is supporting adherence through either education or continued follow-up care, which you mentioned. So anything else in that space that you want to kind of point out as key factors to keeping people adherent and also at goal.

Speaker 2:

Yeah Well, adherence is a complex problem that has any number of different causative factors, and so I think in a patient-centered healthcare model, it really starts with meeting patients where they're at, getting to know them, building trust. So one of the first things I try to do when I meet with patients in our clinic is to simply understand how they feel about taking medications. A number of years ago, I read an article that was talking about some of the low adherence rates. It's estimated that 25% of initial prescriptions for antihypertensive medications aren't even picked up, and at one year, 50% of patients are not adherent, and so there's a number of different reasons for that, and it really starts at a real basic level. And so when I read that article about some of the challenges with adherence and that we should really be talking to patients about how they feel about taking medications, I started experimenting with just asking patients how do you feel?

Speaker 2:

How do you feel about taking medications, and honestly, it felt a little bit awkward at first. We don't often dig into feelings, but I was. It really opened my eyes a lot, because most patients were telling me I hate taking medications, and so you can imagine having that sort of mindset regarding medications and then being told oh, by the way, you have high blood pressure and you're going to have to take medication, probably for the rest of your life.

Speaker 2:

Yeah, and here's your prescription and go and pick it up. Well, we know that I'm kind of oversimplifying things a little bit, but, generally speaking, we know that the system of care that we've been providing has not been working in terms of adherence. And so, at the point of diagnosis and at the point of that initial prescription, we need to have a discussion with patients about how they feel about taking medications and, most importantly, that they understand what the potential benefits are. You know, when I talk to patients, I explain to them all medications have potential risks and we want to balance that against the intended benefits.

Speaker 2:

You know, when I went through school and you did too we got a lot of information on how to counsel patients and what was the emphasis on? In my recollection and experience, it was on what are the side effects of medications. That's certainly important to talk to patients about and make sure they understand, but we need to put equal, if not more, emphasis on the intended benefits and highlighting treatment goals intended benefits and highlighting treatment goals. And so if a patient's prescribed a medication and they don't really understand their overall risk of longstanding hypertension, in terms of all the target organ damage, stroke risk, retinopathy, cardiovascular risk, kidney risk. Peripheral arterial disease, hypertension is a driver of all those things, and most people understand that high blood pressure is bad, but they may not equate what extent.

Speaker 1:

Yeah, what extent.

Speaker 2:

So we really need to make sure patients understand up front what their diagnosis means and what the treatment options are, and that there are potential side effects. And if they experience side effects that doesn't mean that nothing's going to work, especially in the case of hypertension. We have a number of different drug classes and sometimes it takes a little bit of time to find out what works best for each patient. Every patient's different. So I think that's kind of the first step. The second step is you know potential barriers to care, whether that's access to care.

Speaker 2:

You know in Iowa, where I live, a rural state, there's many other areas around the country that have, you know, pharmacy deserts or patients who have difficulty getting to the pharmacy, even if it's not a long ways away. Even if it's not a long ways away, you know we have a tendency sometimes to quote label patients as bad patients because maybe they don't pick up their prescriptions or they don't show up for a clinic visit. But if you really take the time to understand, you know we may have a better appreciation that you know the patient simply can't make it. I'll tell you, I've had a lot of patients who I've noticed in the chart were labeled as frequent no-shows.

Speaker 2:

When you talk to them about it, they say well, I have to take off work.

Speaker 1:

I can't take off work or I rely on someone to bring me, and if they're unavailable, then yeah.

Speaker 2:

Exactly. So those access issues are really important, and then, I think, just encouraging patients that if they do have a side effect or if they do have a concern, we want to maintain frequent follow-up and frequent communication so that we can address those patients' concerns or issues in real time. We see a lot of patients who come back for an annual follow-up and we end up finding out that they stopped their medication nine months ago, and that's something we want to avoid if at all possible. The other thing I think it's worth commenting on is that there are a lot of errors in the medication record, and so it is an all too often occurrence where patients come into clinic and their medication list is filled with inaccuracies or errors, whether that's missing medications, medications that are on the list that have an incorrect dose, or that they're simply not taking.

Speaker 2:

We see a lot of fragmented care, especially at a large academic medical center. You know we have patients who receive care in their local community. They maybe are admitted to their local hospital, they're transferred to our hospital. There's all these transitions of care which we know are a big driver for medication mismanagement and errors, and so I think it's worth pointing out that in all aspects of the healthcare system pharmacists, whether they're in the hospital setting, the clinical setting or in the community setting making sure that we have an accurate medication list and that patients communicate that and have a good understanding throughout those transitions of care.

Speaker 1:

Yeah, yeah. I love one of the things you mentioned the fact that going to an annual visit and finding out that they've not been taking it for nine months, that is again a great place for the pharmacist to insert themselves, because you know we would see it looks like you're not filling. Did you stop this? Were you supposed to stop this? You know, did you get changed to something else? And that kind of thing. So, yeah, so again, and I also love the stress I used to stress the same thing to my students as well is you know, education and counseling is not just what are the potential bad things that might happen and don't worry about them. It's more, more. It's also about what are the benefits of this? Like what, what are we trying to achieve? And if you take it, what's going to happen? And if you don't, what's going to happen? Like that Not scare tactic, but sometimes it's important to show, like you know, what are the risks versus benefits of you actually staying in here and on the medication.

Speaker 2:

So absolutely, you know. You know hypertension is often referred to as the silent killer. For the most part, patients don't feel when their blood pressure is elevated, but if they have a side effect, they may very well feel that. And so you know, one of the things I do try to emphasize, because most patients, when they come in with a hesitancy to take medications, they'll tell you well, I just had a patient yesterday. I got on the internet, you know, and I Googled and I saw all these side effects and I said, yes, you know.

Speaker 2:

And again I go back to what I mentioned earlier is I emphasize to patients all medications have potential side effects or risks, and I think it can also be helpful to really break down possibility versus probability. And so you know, possible side effects are listed in that laundry list, but if you really break it down, the probability of most of those side effects are highly unlikely. And so you have to, again, because our patients have a wide range of health literacy and ability to understand information, you really need to individualize your education and how you break that down for patients. And so you know there's a few different things that I will communicate to patients to try to help them better understand what that really means in real terms for them so that ultimately, they can make informed decisions for them so that, ultimately, they can make informed decisions, yeah, yeah.

Speaker 1:

So one of the things before we run out of time that I also wanted to touch on as far as like an opportunity and I always feel like this is something that we always talk about, but it's not always the case, you know to bring it up and to discuss it, as the pharmacist is addressing lifestyle factors and how big of a role that they play specifically in hypertension, which is what we're talking about. So can you speak to diet, sodium intake, activity, those different things and how they affect how well the medications work in a patient, if we can talk about that for just a few minutes?

Speaker 2:

Dr Yep, what we call the therapeutic lifestyle recommendations, or TLC, is fundamental to all health and really these therapeutic lifestyle recommendations are important, especially for people with high blood pressure, but really anyone, and not just those at risk. So when we address hypertension with patients and they're starting therapy or they're picking up those refills, it's also important to emphasize a therapeutic lifestyle and some little pointers for your audience to remember. Sodium is a big driver for hypertension, so the optimal goal is less than 1.5 grams per day. But even lowering sodium intake by a thousand milligrams or one gram a day can lower blood pressure four to five millimeters of mercury. Weight loss is also important and one kilogram of weight loss can equate to about one millimeter of mercury lowering of blood pressure. So one kilogram or 2.2 pounds Regular physical activity the recommendations are 150 minutes per week.

Speaker 2:

That can lower blood pressure five to 10 millimeters of mercury.

Speaker 2:

And then one of the other, a couple of the other recommendations increasing potassium intake and the recommended range for that is 3.5 to five grams per day.

Speaker 2:

So potassium, emphasizing those potassium rich foods, you know, bananas, oranges, potatoes, tomatoes which should really be part of the next therapeutic lifestyle and that's the DASH diet, so a diet rich in fruits and vegetables, whole grains, low fat dairy and lean meats like fish and poultry. And then the last thing, which maybe is underappreciated, is the impact of alcohol on blood pressure too. So recommending that patients women one or fewer drinks per day and men two or fewer drinks a day can also help. Combined, all of those things, you know, if patients are really successful, you know, can lower blood pressure 10 to 15 millimeters of mercury alone, and they also play an important role in the effectiveness of antihypertensive medications. So you know, if patients are on a thiazide diuretic, for example, and their sodium intake is exceedingly high, you know it's going to negatively impact how effective those medications are. And so so you know this therapeutic lifestyle recommendations really are the foundation of treatment.

Speaker 1:

Yeah, yeah, and you know I think it's important. You mentioned all those little things and even, just even, you know, changing salt intake and changing it by you know, one or two millimeters of mercury. Like you know, sometimes it's that last hump to get over, to get controlled, that people struggle with. So these slight little tweaks can make a difference. You know, like it seems like, oh well, that's nothing, I'm just going to continue to eat my salt. But if you add it all up and if you lose, you know, 10 pounds because you're exercising and you also change your diet, then boom, you've got lots of change in your readings.

Speaker 2:

So, yeah, Absolutely, and you know back to one of my other points how a lot of patients are averse to taking medications. You know, emphasizing the importance of lifestyle in improving blood pressure control can be a strong motivator to either avoiding medications or being able to decrease medication. So we're seeing that a lot now with, you know, GLP-1 agonists having such significant weight loss.

Speaker 2:

You know this is something pharmacists should be monitoring closely, because we may be able to de-intensify antihypertensive medications and you know we don't want to end up in a situation where patients are hypotensive or over-treated.

Speaker 1:

So yeah, yeah, it's a great point. I mean speaking from experience, having lost weight in the last year. You know, and I was teetering on that every time I went to the doctor they were like, eh, you're really close, your blood pressure's not really looking great. You know, we're going to monitor it and whatever. And now you know, of course, all the other things that go with it cholesterol numbers and all of that. But you know, last time, going and seeing that after the weight loss and it completely changed, they're like, yeah, it's not even a concern anymore. So you know, just like you said, that's a great incentive as well to say, hey, okay, you hate taking medication, you hate the, you know the medication altering effects or whatever. Well, let's get your lifestyle under control because sometimes that can prevent you from having to take it. So, yeah, great points as well.

Speaker 2:

So go ahead. I'm sorry, no, go ahead Real quick. I think this is a big opportunity for community pharmacy too. Despite the knowledge that all of these lifestyle recommendations diet, exercise are important, it's often, speaking from the clinical side, often not addressed in a meaningful way and a lot of patients, you know they want that information. They come in asking for it. So I think the more we can do to emphasize each of the things we've talked about today, throughout the continuum of care, you know patients are going to number one feel like they're cared for. They're going to be actively engaged and involved in their health and just be more confident in the process.

Speaker 1:

Yeah, that's great. So, just as a brief recap of things, all the different ways that pharmacists can interject into this management of patients with hypertension. So we've got accurate education on accurate technique. We have counseling and focusing on the benefits and the outcomes of those medications. So counseling on that. We also have making sure that they are taking them. So adherence, we're also double checking to make sure that they are, that they're able to get to their visits and they're able to get to their doctor, and checking for any kind of social determinants of health issues that we're looking for there.

Speaker 1:

And medication costs we didn't even get into that. That could be a whole nother podcast just in and of itself. And the fact of you know, if they're prescribed one thing and the prescriber didn't realize that it was expensive and not covered and there's a generic opportunity or there's another drug that's similar, you know like that's a whole nother place where we can insert ourselves and really impact adherence and people actually filling it for the first time. That number that you mentioned every time I hear that, where 25% of prescriptions are never even picked up, it just baffles me. And you hear the same thing. We had a cholesterol podcast recently and it was know, I think it was even higher like 50% never even get their medication of lower cholesterol. And so just mind blowing, like if there's ways in which we can be in that process to really even help convince I know that that's kind of a bad word, but convince with good reason the patients to pick it up and to take it. You know, that's a great opportunity for us.

Speaker 2:

Yeah, and I think that's one thing we didn't really talk much about today. In terms of optimizing medication regimens and I think you know from a pharmacist on the prescribing clinic side of things that's one of the things I spend a lot of time doing is working with the patients and the prescribers to identify a regimen that will work for them, whether that's to make sure it's covered by insurance or it's a regimen that they can easily fit into their daily schedule. Once a day, twice a day, if we're using a combination medication or if we're using two or more medications, can we get that in a combination pill? There's a lot of things we can do to try to simplify regimens and let that be a driver of adherence and improving patient care.

Speaker 1:

Yeah, for sure. So, again, another opportunity is the collaboration of care with prescribers and making sure that the continuity is there. And, yeah, so many opportunities for pharmacists to really get into this space and to help patients have better control of their hypertension, and we even talked about how they can become aware of hypertension and be aware that that might be something they need to look into. So what would you say? As I always like to end with turning it back around to the title of our session, which is game changers. What would you say, ryan, is the game changer here? Like, what is the game changer? Is it the alarmingly high rate of people who are walking around with hypertension and don't realize it? And we can get involved there? Like, what do you think is the game changer for pharmacists in this space?

Speaker 2:

What do you think is the game changer for pharmacists in this space?

Speaker 2:

Well, I think, because hypertension is such a big driver of cardiovascular morbidity and mortality and because we have well-established treatments that lower cardiovascular morbidity and mortality, the game changer is really, you know, as a healthcare system, as a pharmacy profession, identifying those things in our day-to-day practice where we can move the needle just a little bit, whether that's one patient at a time, one provider at a time, one drug at a time. I think you know it's going to take a concerted effort on all of our parts. I think you know it's going to take a concerted effort on all of our parts and I think you know it really could be a game changer. If we all do that and over time we're going to see significant changes. So I think it's going in the right direction, absolutely, absolutely. And I think you know, if we want to develop public health initiatives, if there's one thing we could do to affect health, because hypertension is so prevalent and such a driver of adverse outcomes you know, go after hypertension, let that be, you know, your initiative.

Speaker 1:

Yeah, I love that. I also love that you almost try to make a new word and not to normalize it, because saying morbidity and mortality over and over, I think we should just call it morbality and just let's normalize that. I think that would be super helpful to hear. You know, the goal of the podcast every week is to say here is something you can do as a pharmacist, and it always just surprises me how many different ways you know we could be involved in the medication use process, and so it's great to have that perspective from such an impactful disease. So again, thank you for your time. We really appreciate it. Thanks for having me. If you're a CE plan subscriber, be sure to claim your CE credit for this episode of Game Changers by logging in at CEimpactcom and, as always, have a great week and keep learning. I can't wait to dig into another game changing topic with you all next week.