U.S. Pharmacist's
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Call for papers

High Blood Pressure and Antidepressant Use

MH, a 57-year-old woman, visits your community pharmacy and tests her blood pressure (BP) while waiting to pick up a few refills. While paying for her prescriptions she asks you how accurate the machine is, as her BP has been running higher than normal during her last several visits to the pharmacy. Today’s visit yields a BP of 148/102 and she reported a similar reading several days prior. Being fairly familiar with MH and her past medical history (hypertension, depression, type 2 diabetes mellitus, osteoarthritis, and hyperlipidemia) you decide to review her medication profile.

MH confirms that she fills all of her prescriptions at your pharmacy: lisinopril 20 mg PO QD; furosemide 20 mg PO QD; potassium chloride 10 mEq QD; atorvastatin 20 mg PO QHS; metformin 1,000 mg PO BID; glimepiride 2 mg PO QAM; venlafaxine 75 mg PO TID; aspirin 81 mg PO QD; fish oil 1,200 mg PO QD.

MH explains that until recently her BP has been well managed for several years on her current regimen, and that she usually presents in the mid “120s-130/90 something.” MH also states that nothing has changed significantly with her diet and that she takes all of her medications as prescribed. As you continue to listen while surveying her refill history, you notice she stopped taking citalopram 2 months ago and was initiated on venlafaxine. When asked about this change, MH explains that the citalopram was not working for her anymore and she was beginning to feel more depressed, but that venlafaxine seems to be helping. MH mentions that her physician chose venlafaxine hoping it would help her symptoms of painful diabetic peripheral neuropathy in addition to her depressive symptoms.

What thoughts and/or recommendations do you have concerning MH’s inquiry about her recent increase in BP?

Brent Dammeier, PharmD Candidate 2013

Joshua J. Neumiller, PharmD, CDE, CGP, FASCP
Assistant Professor

Washington State University
Spokane, Washington

Click here... Send your input to casestudychallenge@uspharmacist.com by November 15, 2012, and include the words "Case Study" and the date of this email in the subject line (or simply use the Click Here button to the left). Please include your last name and first initial along with your pharmacy degrees and city and state, or let us know if you would like to remain anonymous in the event we choose your answer for the follow-up email.