Hypertension is the most significant risk factor for disability and death worldwide, which affects more than one billion people and causes ∼9.4 million deaths each year. [14] On the basis of a report by the World Health Organization, hypertension is the single most significant risk factor, which accounts for 13% of global mortality. Human hypertension may be the result of lifestyle and genetic factors. [15,16] The current evidence-based treatment for the hypertension is a key intervention measure to reduce the incidence rate and mortality of cardiovascular diseases. Researches have determined a variety of barriers to the control of hypertension in routine care that are composed of factors related to patients, physicians, healthcare system, and healthcare services.
People with lower income and education levels are more likely to be insufficiently physically active, which predisposes them to the risk of complications associated with chronic diseases, particularly the hypertension. [17] In contrast, people with higher educational and economic levels tend to be more effective at controlling the levels of blood pressure. Therefore, it is essential to consider the effect of these variables and then incorporate these variables into the development of nursing planning and educational activities for hypertension patients. Case management can be utilized for this objective by providing a personalized plan based on each person's needs.
Author contributions.
Shiqiang Song designs the protocol. Xianhong Li reviews the protocol. Xueling Ning performs the data collection. Chunjing Song finishes the manuscript. All of the authors approved the submission.
Conceptualization: Xianhong Li.
Data curation: Xianhong Li.
Funding acquisition: Shiqiang Song.
Investigation: Xueling Ning.
Methodology: Xueling Ning.
Writing – original draft: Chunjing Song.
nursing case management; hypertension; blood pressure; protocol
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Four pharmacy cases address high blood pressure.
Case 1: Weight Loss for Controlling High Blood Pressure (HBP)
Q: TA, a 38-year-old man, has a history of HBP and morbid obesity and has been taking a 3-drug combination pill once daily for many years to control his hypertension. TA’s primary care provider recently brought up his eligibility for weight loss surgery to help with blood pressure (BP) control and reduce his risk for other medical complications. However, TA would like to try to lose weight on his own before taking this approach. He has never attempted weight loss before and is not sure where to start. What information can you provide regarding nonpharmacologic and self-care approaches to weight loss?
A: The American College of Cardiology (ACC)/American Heart Association’s (AHA) updated 2017 primary prevention guidelines underscore the importance of weight loss as a nonpharmacologic approach to helping control and reduce BP in patients who are obese or overweight. 1 Weight loss efforts should be multimodal, encompassing both dietary modification and exercise. In terms of dietary modifications, individuals should reduce their sodium intake to less than 1500 mg a day and consume a diet low in saturated and total fat that is full of fruits, vegetables, whole grains, and low-fat dairy, all of which are found in the Dietary Approaches to Stop Hypertension and Mediterranean diet plans, along with reducing their daily caloric consumption. 1 Finally, if TA consumes alcohol, it is recommend that he limit his intake to 2 or fewer drinks each day. Physical activity recommendations include aerobic, dynamic resistance or isometric resistance exercises several times each week. Nonetheless, although dietary and lifestyle modifications are prudent, weight loss surgery may be indicated based on the degree of obesity and presence of underlying medical complications. Encourage TA to try these changes but to follow up with his physician about next steps after a 3- or 6-month trial period.
Case 2: Smoking Cessation for Reducing Cardiovascular Disease (CVD) Risk
Q : WT, a 45-year-old man, recently discharged from the local hospital’s emergency department (ED) after experiencing chest pain, is inquiring about recommendations for smoking cessation. His medical history is significant for dyslipidemia, generalized anxiety, and hypertension, and he says that he takes atorvastatin (Lipitor), escitalopram (Lexapro) with as-needed lorazepam (Ativan), and lisinopril/hydrochlorothiazide for treating these conditions, respectively. WT was ruled out for acute coronary syndrome while in the ED, although the physician there recommended that he stop smoking to improve his BP control and reduce his risk of CVD. WT would like a recommendation for a nonprescription treatment option that he can start immediately to prevent chest pain recurrence and reduce his desire to smoke. He says he has smoked a pack of cigarettes a day for the past 20 years and that he often lights his first cigarette while still in bed each morning. What recommendations can you provide?
A : Cigarette smoking is a known modifiable risk factor for development of CVD, and the effects may manifest as acute increases in BP and arterial stiffening. Beyond the obvious health benefits on pulmonary function and reducing other long-term health consequences, smoking cessation may reduce WT’s CVD risk and his elevated BP. Make sure to provide a recommendation for establishing a quit date, along with education on the symptoms of nicotine withdrawal and how to manage those with pharmacologic approaches. Notably, for WT, who has a comorbid anxiety condition, point out that anxiety, insomnia, and irritability may worsen with the withdrawal of nicotine and this should be monitored accordingly. Additionally, discuss exploration of smoking triggers and the need for other lifestyle modifications to support the cessation effort. In terms of supporting quitting smoking using pharmacologic approaches, drug therapy often works best in conjunction with behavioral support and counseling. Sharing local or regional programs to support smoking cessation may be helpful in this case. Because WT is seeking a nonprescription medication to immediately help support this effort, either the nonprescription nicotine gum, lozenge, or patch could be considered, based on his preference. Make sure to offer education on the dosage, depending on the product selected. Appropriate follow-up should be established with the pharmacist or primary care provider to gauge the success of the effort.
Case 3: Nutrient Depletion Associated with Diuretic Therapy
Q : AA, a 62-year-old man, was recently discharged from the hospital after having palpitations. His physician told him that his potassium level was very low and that, upon discharge, he should continue to take his water pill with a banana each day. AA’s medical history is significant for allergies, diabetes, gout, and hypertension, and he takes allopurinol, amlodipine, atorvastatin, hydrochlorothiazide, an intranasal steroid, metformin, and pioglitazone each day. He was prescribed a potassium supplement. However, the pills are too large to swallow and unpalatable, and AA would like to talk to a pharmacist about alternatives. What information can you provide regarding the need for electrolyte supplementation with concomitant diuretic use?
A : Thiazide diuretics are known to deplete many electrolytes and other nutrients through various pathways, including increasing urinary potassium, sodium, zinc, and thiamine excretion and reducing magnesium reabsorption in the kidneys. 2 Common electrolyte disturbances associated with thiazides include thiazide-induced hyponatremia, hypokalemia, and hypomagnesemia. Additionally, dietary potassium intake, independent of the need for supplementation, has been linked to improvements in BP control and is recommended as long as comorbid kidney disease and the risks of potassium accumulation do not exceed these benefits. 1 In AA’s case, suggest that he consider dissolving the potassium tablets in applesauce or pudding, depending on the formulation, to ensure that he is obtaining the amount of potassium recommended by his physician. If AA’s potassium levels are chronically low upon follow-up, it may be appropriate for him to consider increasing his dietary fruit and vegetable consumption, along with low-fat dairy, some fish and meats, nuts, or soy-containing foods, which are all considered good sources of potassium. 1 Remind him that a medium-size banana contains, on average, about 12 mEq of potassium, as well. 3
Case 4: BP Self-monitoring
Q : KM, a 30-year-old pregnant woman, is looking for a recommendation for a BP cuff. At her 20-week prenatal visit, her obstetrician/gynecologist (OB/GYN) was concerned about her borderline-high BP. After a 24-hour urine collection, KM was instructed to purchase a BP monitor and to record her reading twice daily at home to share at her next follow-up. She has no significant past medical history, had 1 previous pregnancy with no complications, and only takes a prescription prenatal vitamin. What recommendations or education on self-monitoring BP can you offer?
A : BP self-monitoring is commonly recommended for evaluation and medical decision making for patients outside the ambulatory-care office. The ACC/AHA’s 2017 update for detection and management of HBP delineates a 6-step checklist for ensuring patients who are self-monitoring accurately obtain their BP readings to appropriately inform health decisions. 1 Notably, ACC/AHA recommends the following 1 :
A pharmacist is well positioned to help KM select an appropriate BP monitoring device, including a cuff of appropriate size, and reminding the proper technique for using it and recording her readings at home.
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The high-dose dexamethasone suppression test, the CRH stimulation test, imaging studies of the pituitary gland, and sampling of blood from the inferior petrosal sinus are some of the tests that ...
Previous studies have shown that, among older people with a pulse pressure of more than 60 mm Hg or a diastolic blood pressure of less than 60 mm Hg (or both), a very low systolic blood pressure ...
Furthermore, diastolic hypertension is more common among patients under the age of 50 years (62.5% compared with 42% in over 50s). 31. Additionally, there is uncertainty regarding the significance of isolated systolic hypertension in the young (SBP ≥140 mm Hg, DBP <90 mm Hg). Less than 20% of untreated hypertensives below the age of 40 years ...
Definitions used in these clinical case scenarios. Definitions Stage 1 hypertension Clinic blood pressure is 140/90 mmHg or higher and. subsequent ambulatory blood pressure monitoring (ABPM) daytime average or home blood pressure monitoring (HBPM) average blood pressure is 135/85 mmHg or higher. Stage 2 hypertension Clinic blood pressure is 160 ...
High blood pressure (BP), cigarette smoking, diabetes mellitus, and lipid abnormalities are major modifiable risk factors for cardiovascular disease (CVD). Among these, high BP is associated with the strongest evidence for causation and has a high prevalence of exposure. However, there is considerable evidence that a biologically normal level ...
Learn how to apply the new ACC/AHA blood pressure guidelines for patients with prediabetes or diabetes. See examples of BP measurement, classification, and management in two case scenarios.
Introduction. Globally, high blood pressure (BP) is the leading risk factor for cardiovascular disease (CVD) morbidity and mortality. 1 In the United States, high BP ranks first among modifiable risk factors in population attributable CVD risk, accounting for the largest proportion of coronary heart disease (CHD), heart failure (HF) and stroke events. 2 In adults with hypertension, control of ...
NHLBI-supported research has helped reveal how pregnancy complications, including high blood pressure, affect the long-term health of women and their children. One study found that women who have a preterm birth have a greater chance of later developing high blood pressure. The NHLBI continues to fund the nuMoM2b Heart Health Study. external link.
Early hypertension studies showed that treating elevated blood pressure (BP) reduces patients' risk of cardiovascular disease and all-cause mortality. In subsequent research, patients achieved greater improvement in cardiovascular outcomes when their treatment was aimed at a moderate systolic BP target (<150mmHg) than at higher targets.
High blood pressure is the most significant risk factor of cardiovascular and cerebrovascular diseases worldwide. ... Cross-sectional or case-control studies that compare working and non-working ...
Recently, a 528-patient, 26-week study compared the efficacy of eprosartan (200 to 300 mg/twice daily) versus enalapril (5 to 20 mg/daily) in patients with essential hypertension (baseline sitting diastolic blood pressure [DBP] 95 to 114 mm Hg). After 3 to 5 weeks of placebo, patients were randomized to receive either eprosartan or enalapril.
Anecdotal reports include lowering of high blood pressure (BP). Objective: To test such reports, a pilot case history series was undertaken with hypertensive patients in a single physician cardiology practice. Intervention: Patients grounded themselves at home for at least 10 h/d for several mo. Outcome measure: BP was measured at baseline in ...
a further two weeks. Again, his average home blood pressure was found to be 118/80mmHg and his clinic blood pressure 126/83mmHg. Following further discussion, the GP decided to stop his blood pressure lowering medication. Home blood pressure readings after this point indicated that the patient's blood pressure remained at approximately 134 ...
Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation. 2005;111:697-716.
A 17-year-old female presented to the Hypertension and Vascular Evaluation (HAVE) Program for high blood pressure (BP) during multiple office visits in the setting of morbid obesity and type 2 diabetes mellitus. Family history was significant for high blood pressure and high cholesterol. On exam, her weight was 176.9 kg (99th percentile) and her BMI was 60.92 kg/m2 (99.7th percentile).
Case Presentation. The patient was a 17-year-old male who was admitted to our hospital in May 2020 due to uncontrolled hypertension for 6 months and weakness of limbs for 20 days. Six months prior to admission, blood pressure of the patient was found to have increased to 200/120 mmHg during the physical examination.
Diastolic pressure is the pressure against the arteries between heartbeats, as the heart relaxes. The unit of measurement is in millimeters of mercury (mm Hg). Optimal blood pressure is 120/80 mm Hg (referred to as "120 over 80") or below. High blood pressure is defined for adults as systolic pressure above 140 or diastolic pressure above 90.
Hypertension was diagnosed 5 years ago when blood pressure (BP) measured in the office was noted to be consistently elevated in the range of 160/90 mmHg on three occasions. L.N. was initially treated with lisinopril, starting at 10 mg daily and increasing to 20 mg daily, yet her BP control has fluctuated.
This study reveals that In this study the Majority of were having (60%) optimal systolic blood pressure, 15% normal, 11% having high normal, 7% grade I (mild), 4% grade II (moderate), 3% grade III ...
The prevalence of high blood pressure has increased over the past decades. 1 Hypertension is a major risk factor for cardiovascular disease (CVD) 1 and typically coexists with other CVD risk factors and unhealthy lifestyle behaviors, such as smoking, diabetes, dyslipidemia, overweight, physical inactivity, and unhealthy diet. 2 From randomized controlled trials, we have learned that weight ...
Abstract. Objective: To explore the effect of management of nursing case on blood pressure control in hypertension patients. Method: This is a randomized controlled study which will be carried out from May 2021 to May 2022. The experiment was granted through the Research Ethics Committee of the People's Hospital of Chengyang District (03982808).
Hence, we conduct the randomized controlled study protocol to explore the effect of management of nursing case on blood pressure control in hypertension patients. 2 Materials and methods. This is a randomized controlled study which will be carried out from May 2021 to May 2022 at the People's Hospital of Chengyang District.
Issue 2. Four pharmacy cases address high blood pressure. Case 1: Weight Loss for Controlling High Blood Pressure (HBP) Q: TA, a 38-year-old man, has a history of HBP and morbid obesity and has been taking a 3-drug combination pill once daily for many years to control his hypertension. TA's primary care provider recently brought up his ...