By Kim Maryniak, PhDc, MSN, RNC-NIC, NEA-BC
Hypertension, or high blood pressure (BP), is a significant risk factor for people developing heart disease and stroke, which are leading causes of death. Approximately 75 million adults in the United States have hypertension, and one in three adults have prehypertension. Hypertension is a primary or contributing cause of death for about 1100 deaths per day in the United States (Centers for Disease Control and Prevention, 2016).
The American Heart Association (AHA) and the American College of Cardiology (ACC) review and establish guidelines for blood pressure prevention, detection, evaluation, and management. These guidelines establish criteria for normal values, screening and testing recommendation, and management of hypertension. The latest guidelines were published in 2017, which includes recommendations for systolic blood pressure (SBP) and diastolic blood pressure (DBP) values (Whelton et al., 2017). For adults, categories include normal, elevated, stage 1 hypertension, and stage 2 hypertension. These are as follows:
• Normal: <120 mmHg SBP and <80 mmHg DBP
• Elevated: 120-129 mmHg SBP and <80 mmHg DBP
• Stage 1 hypertension: 130-139 mmHg SBP or 80-89 mmHg DBP
• Stage 2 hypertension: ≥140 mmHg SBP or ≥90 mmHg DBP
(Whelton et al., 2017)
According to the guidelines, patients in the elevated BP category should be treated non-pharmacologically first. The same is true of patients with stage 1 hypertension if they have low risk for cardiovascular disease (CVD). These non-pharmacological treatments combined with prescribing medication to lower blood pressure are recommended for stage 1 hypertension patients with CVD risk and stage 2 hypertension patients. Non-pharmacologic interventions include weight loss, healthy diet low in saturated fat, sodium reduction, increased dietary potassium, physical activity, and moderation in alcohol. Special considerations in blood pressure management include specific comorbidities that are associated with higher risk. These include diabetes mellitus, chronic kidney disease, heart failure and heart disease, stroke, and peripheral artery disease. (Whelton et al., 2017).
It is important for nurses to identify patients that are at risk, and understand current guidelines for hypertension. For more information on stroke, acute coronary syndrome, and heart failure, check out courses available on RN.com.
Centers for Disease Control and Prevention. (2016). High blood pressure fact sheet. Retrieved from https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_bloodpressure.htm
Whelton, P., Carey, R., Aronow, W., Casey, D., Collins, K.,…& Wright, J. (2017). 2017 guideline for the prevention, detection, evaluation, and management of high blood pressure in adults.
Journal of the American College of Cardiology. Retrieved from https://www.acc.org/~/media/Non-Clinical/Files-PDFs-Excel-MS-Word-etc/Guidelines/2017/Guidelines_Made_Simple_2017_HBP.pdf
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