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PATIENT CARE PROCESS

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Patient Care Process for the Management of Hypertension

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Collect

  • Patient characteristics (e.g., age, race, sex, pregnant)

  • Patient history (past medical, family, social — dietary habits, tobacco use)

  • Home blood pressure (BP) readings

  • Current medications and prior anti-hypertensive medication use

  • Objective data (see Box 13-1)

    • BP, heart rate (HR), height, weight, and BMI

    • Labs (e.g. serum electrolytes, Scr, BUN)

    • Other diagnostic tests when indicated (e.g. ECG)

Assess

  • Presence of compelling indications (e.g. coronary artery disease, chronic kidney disease; see Figure 13-3)

  • Hypertension-related complications (e.g. albuminuria, retinopathy; see Box 13-1)

  • 10-year Atherosclerotic cardiovascular disease (ASCVD) risk when indicated

  • Current medications that may contribute to or worsen hypertension

  • BP goal and whether goal has been achieved (see Box 13-2)

  • Appropriateness and effectiveness of current antihypertensive regimen

  • For resistant hypertension if taking 3 or more antihypertensive medications (see Table 13-10)

Plan*

  • Tailored lifestyle modifications (e.g. diet, exercise, weight management; see Table 13-4)

  • Drug therapy regimen including specific antihypertensive(s), dose, route, frequency, and duration; specify the continuation and discontinuation of existing therapies (see Tables 13-5, 13-6, 13-7, and 13-9)

  • Monitoring parameters including efficacy (e.g. BP, cardiovascular events, kidney health), safety (medication-specific adverse effects), and timeframe (see Table 13-8)

  • Patient education (e.g. purpose of treatment, dietary and lifestyle modification, drug therapy)

  • Self-monitoring of BP, HR, and weight — where and how to record results

  • Referrals to other providers when appropriate (e.g. physician, dietician)

Implement*

  • Provide patient education regarding all elements of treatment plan

  • Use motivational interviewing and coaching strategies to maximize adherence

  • Schedule follow-up

Follow-up: Monitor and Evaluate

  • Determine BP goal attainment

  • Presence of adverse effects

  • Occurrence of CV events and development/progression of kidney impairment

  • Patient adherence to treatment plan using multiple sources of information

*Collaborate with patient, caregivers, and other health professionals

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CONTENT UPDATE

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Content Update

December 6, 2017

New Guidelines for High Blood Pressure in Adults: The American College of Cardiology, American Heart Association and 9 other organizations published updated guidelines for the prevention, detection, and treatment of high blood pressure (BP). The guidelines recommend lower BP goals than previous guidelines. High BP is now defined as a systolic BP ≥ 130 mmHg or a diastolic BP ≥ 80 mmHg, and the recommended goal is to lower BP to less than 130/80 mmHg while exercising clinical judgment. The new guidelines will result in many more Americans being diagnosed with hypertension, and many will require two or three medications to achieve the <130/80 mmHg BP target.

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CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK

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For the chapter in the Wells Handbook, please go to Chapter 10. Hypertension

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KEY CONCEPTS

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KEY CONCEPTS

  • Image not available. The risk of cardiovascular (CV) morbidity and mortality is directly correlated with blood pressure (BP).

  • Image not available. Evidence from clinical trials has shown that antihypertensive drug therapy substantially reduces the risks of CV events and death in patients with ...

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