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Dec.17.2019

Hypertension Comorbidity (Adult Inpatient)

Clinical Description

  • Care of the hospitalized patient with a known diagnosis of hypertension.

Key Information

  • Patients with hypertension rarely have signs or symptoms, even when pressures are dangerously high. For this reason, they may interpret medication or risk factor modification unnecessary.
  • Systolic and diastolic values that reflect classifications of hypertension vary depending on international guidelines used.

Clinical Goals

By transition of care

A. The patient will achieve the following goals:
  • Blood Pressure in Desired Range

B. Patient, family or significant other will teach back or demonstrate education topics and points:
  • Education: Self-Management

Correlate Health Status

  • Correlate health status to:

    • history, comorbidity
    • age, developmental level
    • sex, gender identity
    • baseline assessment data
    • physiologic status
    • response to medication and interventions
    • psychosocial status, social determinants of health
    • barriers to accessing care and services
    • health literacy
    • cultural and spiritual preferences
    • safety risks
    • family interaction
    • plan for transition of care

Hypertension Comorbidity

Signs/Symptoms/Presentation

  • known history of hypertension
  • maintenance medication use

Problem Intervention

Maintain Blood Pressure Management

  • Evaluate adherence to home antihypertensive regimen (e.g., exercise and activity, diet modification, medication).
  • Provide scheduled antihypertensive medication; consider administration time and effects (e.g., avoid giving diuretic prior to bedtime).
  • Monitor response to antihypertensive medication therapy (e.g., blood pressure, electrolyte levels, medication effects).
  • Minimize risk of orthostatic hypotension; encourage caution with position changes, particularly if elderly.

Associated Documentation

  • Medication Review/Management
  • Syncope Management

Education

CPG-Specific Education Topics

Self-Management

  • adherence to disease management plan

  • when to seek medical attention

General Education Topics

General Education

  • admission, transition of care

  • orientation to care setting, routine

  • advance care planning

  • diagnostic tests/procedures

  • diet modification

  • opioid medication management

  • oral health

  • medication management

  • pain assessment process

  • safe medication disposal

  • tobacco use, smoke exposure

  • treatment plan

Safety Education

  • call light use

  • equipment/home supplies

  • fall prevention

  • harm prevention

  • infection prevention

  • MDRO (multidrug-resistant organism) care

  • personal health information

  • resources for support

References

  • Abegaz, T. M.; Shehab, A.; Gebreyohannes, E. A.; Bhagavathula, A. S.; Elnour, A. A. Nonadherence to antihypertensive drugs:  A systematic review and meta-analysis. Medicine. 2017, January;96(4), e5641. doi:10.1097/MD.0000000000005641 [Metasynthesis,Meta-analysis,Systematic Review]
  • Centers for Disease Control and Prevention (CDC). (2016, October). Blood Pressure Control. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Graudal, N.; Jurgens, G.; Baslund, B.; Alderman, M. H. Compared with usual sodium intake, low- and excessive-sodium diets are associated with increased mortality: A meta-analysis. American Journal of Hypertension. 2014;27(9), 1129-1137. doi:10.1093/ajh/hpu028 [Metasynthesis,Meta-analysis,Systematic Review]
  • Ignatavicius, D. D.; Workman, M. L.; Rebar, C. R. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Langan, R.; Jones, K. Common questions about the initial management of hypertension. American Family Physician. 2015, February;91(3), 172-177. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Leung, A. A.; Nerenberg, K.; Daskalopoulou, S. S.; McBrien, K.; Zarnke, K. B.; Dasgupta, K.; Cloutier, L.; Gelfer, M.; Lamarre-Cliche, M.; Milot, A.; Bolli, P.; Tremblay, G.; McLean, D.; Tobe, S. W.; Ruzicka, M.; Burns, K. D.; Vallée, M.; Prasad, G. V.; Lebel, M.; Feldman, R. D.; Selby, P.; Pipe, A.; Schiffrin, E. L.; McFarlane, P. A.; Oh, P.; Hegele, R. A.; Khara, M.; Wilson, T. W.; Penner, S. B.; Burgess, E.; Herman, R. J.; Bacon, S. L.; Rabkin, S. W.; Gilbert, R. E.; Campbell, T. S.; Grover, S.; Honos, G.; Lindsay, P.; Hill, M. D.; Coutts, S. B.; Gubitz, G.; Campbell, N. R.; Moe, G. W.; Howlett, J. G.; Boulanger, J. M.; Prebtani, A.; Larochelle, P.; Leiter, L. A.; Jones, C.; Ogilvie, R. I.; Woo, V.; Kaczorowski, J.; Trudeau, L.; Petrella, R. J.; Hiremath, S.; Drouin, D.; Lavoie, K. L.; Hamet, P.; Fodor, G.; Grégoire, J. C.; Lewanczuk, R.; Dresser, G. K.; Sharma, M.; Reid, D.; Lear, S. A.; Moullec, G.; Gupta, M.; Magee, L. A.; Logan, A. G.; Harris, K. C.; Dionne, J.; Fournier, A.; Benoit, G.; Feber, J.; Poirier, L.; Padwal, R. S.; Rabi, D. M.; CHEP Guidelines Task Force. Hypertension Canada’s 2016 canadian hypertension education program guidelines for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Canadian Journal of Cardiology. 2016;32(5), 569-588. doi:10.1016/j.cjca.2016.02.066 [Quality Measures,Clinical Practice Guidelines]
  • Liu, L-S.; Wu, Z.; Wang, J.; Wang, W. 2018 Chinese guidelines for prevention and treatment of hypertension a report of the revision committee of Chinese guidelines for prevention and treatment of hypertension. Journal of Geriatric Cardiology. 2019;16, 182-241. [Quality Measures,Clinical Practice Guidelines]
  • National Committee for Quality Assurance. (2017). NQF 0018. Controlling high blood pressure. Source[Quality Measures,Clinical Practice Guidelines]
  • National Heart Foundation of Australia. (2016). Guideline for the diagnosis and management of hypertension in adults. Melbourne: National Heart Foundation of Australia. [Quality Measures,Clinical Practice Guidelines]
  • National Institute for Health and Care Excellence (NICE). (2019). Hypertension in adults; Diagnosis and management. NICE guideline [NG136]. Source[Quality Measures,Clinical Practice Guidelines]
  • Nerenberg, K. A.; Zarnke, K. B.; Leung, A. A.; Dasgupta, K.; Butalia, S.; McBrien, K.; Lamarre-Cliche, M. Hypertension Canada's 2018 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults and children. Canadian Journal of Cardiology. 2018;34(5), 506-525. [Quality Measures,Clinical Practice Guidelines]
  • Nettina, S. M. (2019). Lippincott manual of nursing practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Reboussin, D. M.; Allen, N. B.; Griswold, M. E.; Guallar, E.; Hong, Y.; Lackland, D. T.; Miller, E. R.; Polonsky, T.; Thompson-Paul, A. M.; Vupputuri, S. Systematic review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71, e116-e135. doi:10.1161/HYP.0000000000000067 [Metasynthesis,Meta-analysis,Systematic Review]
  • Weiss, J.; Kerfoot, A.; Freeman, M.; Motu'apuaka, M.; Fu, R.; Low, A.; Paynter, R.; Kondo, K.; Kansagara, D. (2015). Benefits and harms of treating blood pressure in older adults:  A systematic review and meta-analysis. Washington, D. C.: Department of Veterans Affairs; Health Services Research & Development Service. [Metasynthesis,Meta-analysis,Systematic Review]
  • Whelton, P. K.; Carey, R. M.; Aronow, W. S.; Casey, D. E.; Collins, K. J.; Dennison Himmelfarb, C.; DePalma, S. M.; Gidding, S.; Jamerson, K. A.; Jones, D. W.; MacLaughlin, E. J.; Muntner, P.; Ovbiagele, B.; Smith, S. C.; Spencer, C. C.; Stafford, R. S.; Taler, S. J.; Thomas, R. J.; Williams Sr., K. A.; Williamson, J. D.; Wright, J. T. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2017; doi:https://doi.org/10.1016/j.jacc.2017.11.006 [Quality Measures,Clinical Practice Guidelines]
  • Williams, B.; Mancia, G.; Spiering, W.; Rosei, E. A.; Azizi, M.; Burnier, M.; . . . Desormais, I. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension.. Journal of Hypertenison. 2018;36(10), 1953-2041. doi:10.1097/HJH.0000000000001940 [Quality Measures,Clinical Practice Guidelines]

Disclaimer

Clinical Practice Guidelines represent a consistent/standardized approach to the care of patients with specific diagnoses. Care should always be individualized by adding patient specific information to the Plan of Care.