Enalapril 20 mg should be prescribed as 10 mg twice daily and measures taken to improve patient compliance.

Clinical skills are becoming increasingly important for pharmacists as they take on more patient‐facing roles in primary care. In this article, the authors discuss the clinical skills currently taught to pharmacists during undergraduate and postgraduate training, and how this training could be expanded.

Given the clear evidence that reducing blood pressure decreases the vascular complications of hypertension, loss of efficacy represents the principal complication of noncompliance with antihypertensive therapy. Withdrawal symptoms are also important and occur after abruptly stopping beta-blockers and centrally-acting antihypertensive drugs. Very few studies have been conducted to assess the impact of missing 1 or 2 doses of an antihypertensive agent on short term control of blood pressure. A high trough to peak ratio (> 50%) for a once-daily medication suggests a long duration of action. However, methodological problems in the design of the studies to determine trough to peak ratios make comparisons between various medications very difficult. In general, however, stopping a drug with a low through to peak ratio is more likely to result in loss of antihypertensive effect than a drug with a high ratio. Poor compliance in dose-escalating studies with antihypertensive agents may have resulted in excessively high dose recommendations in clinical trials.

The introduction of rofecoxib and celecoxib has increased prescribing volume of anti-inflammatory agents by 26% in Northern Ireland over the 3-year period. This could pose safety problems in the future as more people are being prescribed anti-inflammatory agents.

Bendrofluazide at doses of 1.25 mg daily or 2.5 mg every other day reduces blood pressure as effectively as does the conventional 2.5 mg daily regimen.