Hypertension outcome evaluation

The Health Outcomes Institute has developed and validated several outcome instruments that can be used to 11 evaluate patient outcomes following interventions by pharmacists. These include hypertension/lipids, angina, asthma, chronic obstructive pulmonary disease, chronic sinusitis, hip replacement, hip fracture, depression, low back pain, osteoarthritis, alcohol abuse, stroke, rheumatoid arthritis, and prostatism (Appendix 4). The Health Outcomes Institute is located at 2001 Killebrew Drive, Suite 122, Bloomington, MN 55425 telephone (612) 858-9188. 

Finally, a comprehensive hemodynamic evaluation in IPAH patients should include assessment of pulmonary vasoreactivity with inhaled nitric oxide (10-40 ppm), inhaled iloprost, IV epoprostenol, or adenosine in patients with precapillary hypertension. If with these treatments mPAP decreases by 10 mm Hg to levels <40 mm Hg, IPAH patients are considered responders. This denotes a small but very important population (<15% of IPAH patients) with significantly improved outcomes when treated with high doses of calcium channel blockers (29,30). For the select patients who are deemed responders and are subsequently treated with calcium antagonists, close follow-up to confirm a sustained hemodynamic improvement is essential. 

Epidemiological studies have suggested that an increase of 3 mmHg in blood pressure is associated with a 10-20% increase in congestive heart failure (ALLHAT Collaborative Research Group 2000). Conversely, a 3 mmHg reduction in blood pressure in hypertensive individuals decreases risk of myocardial infarction by 22 % and of stroke by 33 % (Heart Outcomes Prevention Evaluation Study Investigators... 

Weaning failure increases the risk of myocardial ischemia, left ventricular dysfunction, and pulmonary hypertension (27,29). In a prospective cohort study, Epstein et al. (30) evaluated medical outcomes of 42 patients reintubated after an unsuccessful extubation attempt. They noted an increase in mortality, duration of ICU and hospital stay, dependence on ventilatory support, and requirements for long-term care among these patients. Predicting failure to wean has been disappointing (15,27,31), especially among patients with neuromuscular disease who often perform better than expected (13,32). 

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