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Blood pressure (BP) measurements with an electronic BP device may be affected by excessive movement, such as what might occur with seizures, tremors, or shivering, and irregular heart rates.
Untreated or poorly controlled hypertension can lead to hypertensive emergencies and result in organ damage (i.e., myocardial infarction, pulmonary edema, acute renal failure, hypertensive encephalopathy, intracerebral hemorrhage). Patients with BP readings greater than 180/120 mm Hg and who have signs and symptoms of organ damage require immediate emergency treatment.undefined#ref4">4
Hypertension occurs when the force of blood pumping through the arteries is too strong. The arteries are the blood vessels that carry blood from the heart throughout the body. Hypertension forces the heart to work harder to pump blood and may cause arteries to become narrow or stiff, making them more susceptible to plaque buildup. Having untreated or uncontrolled hypertension can cause heart attacks, strokes, kidney disease, and other problems.
A number of risk factors are strongly associated with developing hypertension, including age, obesity, family history, race, high-sodium diet, excessive alcohol consumption, and physical inactivity.4 The American College of Cardiology and American Heart Association updated the guidelines recommending using a lower systolic blood pressure (SBP) and diastolic blood pressure (DBP) to define hypertension. As a result, this translated into a significant percentage of adults 20 years old and older in the United States being classified as having hypertension (defined either as taking antihypertensive medication, or having an SBP greater than 130 mm Hg, a DBP greater than 80 mm Hg, or both).1 Among nonpregnant adults in the United States, hypertension is the most common reason patients need care and chronic prescription medications.
BP can be categorized in four ways (Table 1):1,4
If there is a disparity in category between the SBP and DBP, the higher value determines the stage.4
White coat hypertension is a condition that occurs when BP readings taken at a health care facility are higher than readings obtained elsewhere. White coat hypertension impacts many adults but is not always indicative of hypertension.4 The prevalence of white coat hypertension increases with age and requires periodic monitoring because it increases the patient’s risk for developing true hypertension rather than merely reflecting the anxiety a patient may attach to a heath care practitioner visit.4
Treatment of high BP should involve nonpharmacologic interventions, including lifestyle modifications (e.g., sodium restriction, dietary changes, weight loss, exercise, limiting alcohol intake). Not all patients diagnosed with hypertension require pharmacologic treatment. A specific plan of care for hypertension management should reflect an understanding of the modifiable and nonmodifiable determinants of health behaviors, including health literacy and access to health insurance and medication assistance.4
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Rationale: BP measurements may be taken incorrectly if the cuff is too large or too small, leading to abnormally low or high BP readings respectively.
Rationale: Hypertensive emergencies require an immediate reduction of BP to prevent further organ damage. Examples of organ damage include acute ischemic stroke, myocardial infarction, pulmonary edema, dissecting aortic aneurysm, and acute renal failure.
Unger, T. and others. (2020). 2020 International Society of Hypertension global hypertension practice guidelines. Hypertension, 75(6), 1334-1357. doi:10.1161/HYPERTENSIONAHA.120.15026
*In these skills, a “classic” reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice.
Clinical Review: Suzanne M. Casey, MSN-Ed, RN
Published: September 2023
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