JNC 8 Guidelines Of Close Monitoring

Blood pressure is a physiological measurement and would need specific measurement for the prescribing of anti-hypertensives

Mr. Hightower is a 52 year old male with a PMH Type 2 DM, Hyperlipidemia, and HTN. He is a new patient to your office stating he stopped his meds several months ago and he cannot remember what he took in the past. His BP is 150/90. HR 88, RR 20 BMI 35. HGB A1C is 9.6, Total chol 225, LDLs 183, HDL 35. CBC, CHem, LFTs are wnl except for glucose of 124. Discuss the focused pertinent physical exam for this patient as well as what further diagnostics are needed in providing evidenced based care. What medications are important to start for this patient to treat his co-morbidities. Include the follow-up for this gentleman along with pertinent diagnostics needed at

JNC 8 has a hypertension guideline algorithm. Patients older than 60 should be placed on pharmacological treatment if SPB is 150 mm Hg or higher and DBP is 90 mm Hg or higher. Target goal is 150/90 Patient less than 60 should be placed on pharmacological treatment if SPB is 140 mm Hg or higher and DBP is 90 mm Hg or higher. Target goal is 140/90. Initial drug of choice for nonblack patients is an ACEI, ARB, thiazide or CCB alone or in combination. Black patients should be started on a thiazide or CCB alone or in combo. It is recommended to start one drug titrate to maximum dose and then add another drug if target goal has not been achieved. Combination therapy is recommended if BP is greater than 20/10 mm Hg from target. I also gives a guideline for all ages if the patient is diabetic without kidney disease or the patient has kidney disease without diabetes (Armstrong, 2014).

The report describes the visits to the primary care physicians made by adult hypertensive adults during 2013-2014, with their demographic, state and regional differences in hypertension control and pharmaceutical treatment. Hypertension is a leading risk factor for cardiovascular disease and stroke in the United States. Hypertension as defined as an elevation of systolic greater or equal 140mmHg and diastolic greater or equal 90 mmHG. 2011- 2014 from the recent study, estimated that 53% of hypertensive adults had their hypertension controlled. The data obtained by National Ambulatory Medical Care Survey (NAMCS) can be utilized to make national, regional and some state based estimates of office –based physician health care utilization. This

In order to assess treatment, I would ask to see the patients’ blood pressure diary. In starting a new medication, I would ask that the patient continue to utilize this tool and consistently obtain a home blood pressure every evening. This would provide for an accurate analysis of diuresis considering I have asked the patient to take this medication every morning. In addition, I would asses for adherence. The initial onset of side effects may cause noncompliance. If the patient is experiencing hypotension upon standing or dizziness, they may be non-compliant with the medication. Reviewing the medications effects and adjustments may alleviate this apprehension of

Mancia G, Omboni S, Parati G. Assessment of anti-hypertensive treatment by ABP. J Hypertens 1997, 15 (Suppl.2): 543-50.

PJ presents with symptoms of chronic angina treated primarily with measures to control precipitating factors and management of high risk comorbidities. He has mild hypertension with diet control and medications to manage his hypertension. He does not report further risk factors such as

Reduction in the rate of cardiovascular events and total mortality has been accomplished by decreasing BP in hypertensive patients with the help of pharmacological treatment, however, it involves ambulatory elderly patients with few comorbidities and few medication use.

The Hill-Bone Compliance for hypertension treatment (Culig & Lapper, 2014) will be utilized project to assess the behaviors of the patients in three significant domains of hypertension treatment (1) taking medication (2) decreasing sodium in the diet (3) keeping of their appointment. This measuring scale questionnaire has fourteen items in three subscales, and each question has four Likert form of answer (Culig & Lapper, 2014). The Hill-Bone compliance This measure has been tested for validity and reliability, and was found to be clinically valuable for identifying noncompliance issues and to envisage blood pressure status (Kim, Hill, Bone, & Levine, 2000).

I was extremely excited to do this chart audit since I am conducting my DNP project on this topic. In my first audit last year our clinic had only 45% compliance with the guidelines and we were still following JNC 6 Guideline. However, after starting the project, the compliance has increased to 80% and care has been improved. This audit had brought in numbers that I could discuss with him in a professional way and it reflects a vast difference in quality improvement. Initially, chart auditing did not seem very appealing to the doctor but now it has become a norm for our clinic to do chart audit periodically. We still have to work hard in the area of patient compliance to the medications to prevent hypertension

(CMP) with the patients’ agreement’. (DOH, 2007) Mr Jones benefits from Supplementary Prescribing as it ensures timely access for review of his condition along with treatment modification and subsequent monitoring with the reassurance that a GP retains the overview of his care.

Home monitoring for hypertension is never to be used in place of external doctor’s visits. However, home monitoring can be extremely beneficial to patients with the following problems: patients starting HBP treatment in order to determine the effectiveness, patients requiring closer monitoring than intermittent office visits (especially higher risk patients, i.e. individuals with coronary heart disease, diabetes of kidney disease), pregnant women whom are susceptible to preeclampsia or pregnancy-induced hypertension, people who have high blood pressure readings in the office in order to rule out white-coat hypertension (false readings), elderly patients, and anyone suspected to have masked hypertension. People who should not turn to home monitoring include: people with atrial fibrillation or other arrhythmias because the home measurements may not be accurate

Methodology: Prescription pattern of 400 hypertensive outpatients were analyzed on basis of age, percentage of male and female patients, anti-hypertensive drug category, most frequently prescribed hypertensive drug and percentage of one/two drug combination.

The teaching plan is an education program designed to help patients who need a review of concepts for managing hypertension. However, hypertension management requires on-going education and nutritional advice with regular review and modification as the disease process progresses and the needs of the patient changes. The teaching will help patients to apply their new found knowledge to their illness. Altogether will help change the patient feeling and attitude towards hypertension, and also encourage the patients to care for themselves more effectively increasing their quality of life. The teaching plan follows the outline (Appendix A) of the lesson content which include (a) general overview of hypertension, (b) ways to control hypertension, (c) importance of blood pressure medications and being compliance, (d) how to measure a blood pressure, (e) Dietary Approaches to Stop Hypertension (DASH) Plan, (f) importance of exercising, and (g) complications seen from uncontrolled hypertension. Handouts (Appendix B) are given to the patient to reinforce instruction. The patient will be taught how to properly take a blood pressure and where blood pressure monitors can be purchase. The patient will then show a return demonstration how to properly monitor his blood pressure with a home machine and what a normal blood pressure should be. The healthcare provider would inform the patient to keep a record of his blood pressure reading and present them at each

High blood pressure (HBP) is amongst one of the most prevalent chronic illnesses in the United States today. The MOC has created the survey to monitor the growing number of patients that can and are facing this issue in the community of Gainesville, as it can lead to other cardiovascular diseases, such as heart attacks, heart failure and strokes.