Measurement Madness
How long before a blood pressure measurement should a patient not drink caffeine, smoke tobacco, or exercise?
30 minutes
What percent of adults in the United States have a diagnosis of Hypertension?
48%
Nearly half of adults have HTN. Based on our data at VMG, we are under-diagnosing HTN.
What level of blood pressure is considered pre-hypertension?
120-129/80
Which race has the highest rates of hypertension?
African American
The symptoms of high blood pressure are obvious.
True or False?
False. The majority of patients with HTN do not have any symptoms, unless their levels are critically high.
Which arm most accurately reflects the pressure that is in the heart (What we are trying to measure by checking blood pressure)?
Bonus: What are some reasons we may not be able to check on that arm?
The left arm.
We should always check on the left arm when possible.
Bonus: Recent surgery or wound/injury on that arm. It is now considered a myth that you cannot check blood pressure on the same arm as a mastectomy.
What is VMG's current blood pressure goal for the majority of patients?
Less than 130/80
Name three ways a patient can provide a blood pressure reading without a provider visit.
1. Lobby blood pressure station
2. Home blood pressure readings
3. Nurse visit
Name at least three lifestyle changes a patient can make to lower their blood pressure.
Exercise, low salt diet, decrease alcohol/caffeine, smoking cessation, weight loss if appropriate, decrease/manage stress, 7-8 hours of sleep (and screen for sleep apnea), etc
As long as I do not add salt to my food, I can eat whatever I want.
True or False?
False. Many foods contain high levels of sodium such as deli meats, breakfast meats, bread, pasta, soups, cheese, crackers, processed foods. We have to check these items for sodium content to truly have a low salt diet.
How long should a patient sit before we check blood pressure?
5 minutes
What percent of patients with the diagnosis of hypertension need more than one medication to treat their hypertension to goal?
75%
It is common to need 2-3 medications as each medication reduces blood pressure by on average 10mmHg each.
You see a patient for uncontrolled blood pressure and want to schedule them with the Nurse titration clinic. What do you do to make this happen?
Send the patient to check out with Nurse BP Titration Clinic circled and amount of time (1 week, 1 month, etc). In your note, document the plan using the Nurse BP Titration Clinic macro for the nurses to follow at that visit. A patient case does not need to be sent.
Name three conditions that uncontrolled hypertension can lead to.
Atrial fibrillation, Chronic Kidney Disease, Dementia (vascular and alzheimer's), Myocardial Infarction, Cerebrovascular Disease/stroke, Erectile Dysfunction, eye disease (retinopathy, glaucoma, cataract), Heart Failure, and more!
Caffeine raises blood pressure.
True or False.
Both!
Low levels of caffeine such as 1-2 cups per day have not shown to increase blood pressure levels. Excessive caffeine such as >6 cups per day, soda or energy drinks can raise blood pressure.
Name three ways a patient could be positioned incorrectly that would increase blood pressure readings?
Arm not at rest (they are using muscles to hold the arm up)
Arm below heart level
Feet not flat on floor (use a stool!)
Done right after sitting down
Incorrect cuff size
Patient or MA/Provider talking
Measurement taking over clothing, or pushing up shirt on arm
Back not resting on chair
A patient's blood pressure is high during their visit and you plan to re-check in five minutes. What are a few techniques you can teach to the patient to lower their blood pressure?
1. Box breathing/breathing techniques (Inhale 4 seconds, hold breath four seconds, exhale four seconds - x10)
2. Sensory grounding technique (great when your mind is on many other things!)
And more!
A blood pressure medication comes into the box out of protocol. What should you do before sending it to the provider for consideration of refill?
Schedule an office visit if due
Schedule a lab appointment if due
Ask for a home blood pressure reading if a blood pressure reading is needed
Name at least two over the counter medications/supplements that can increase blood pressure.
NSAIDs - ibuprofen, naproxen
Decongestants
Arnica
Ephedra
Ginseng
Licorice
St John's Wort
Guarana
Bitter orange
Studies have shown wine is good for the heart so it is not a blood pressure risk.
True or False
False.
Cutting back from moderate to heavy drinking can lower blood pressure 5mmHg on average. The recommendation for patients with hypertension is less than 1 alcohol containing beverage per day.
Does a full bladder affect systolic blood pressure, diastolic blood pressure, or both?
Both!
Studies have shown an increase of 10-15mmHg in both systolic and diastolic blood pressure readings.
You see a patient for a HTN medical management visit. They are not currently exercising. How many months does it take for exercise to lower blood pressure throughout the day?
Minimum 1 month, but up to 3 months.
A consult note comes in from a date after you last saw the patient. Which consult notes can you NOT add a blood pressure reading from?
Hospital Admission, Emergency room visit, Procedure/surgery
You CAN add from urgent care, home nurse visits, and consult notes.
Providers adjust medications based on readings in the office and at home. If the readings are high and inaccurate, what are some poor outcomes the patient could experience if we increase blood pressure medications and the patient actually has a normal blood pressure?
Falls, fractures, loss of consciousness, dizziness, dehydration, kidney impairment, electrolyte disturbance, brain injury, increased medication specific side effects, and more!
You to need to lose a lot of weight or get to your goal weight to bring down your blood pressure.
True or False?
False.
Losing 5lbs can bring down the blood pressure nearly 5mmHg on average. Losing 15lbs is more effective than starting a blood pressure medication.