36 | Nursing in Practice | Winter 2022
TEN TOP TIPS
Hypertension
diagnosis and management
Cardiovascular specialist nurses Joanne Haws and Michaela Nuttall provide an update on best practice in the diagnosis and management of hypertension in primary care
Diagnosing hypertension and controlling blood pressure ( BP ) is a key area of disease prevention in primary care . Approaches to detecting raised BP are evolving and new monitoring requirements in primary care mean it is important to keep up with evidence-based practice and guidelines . Here are our top tips for ensuring optimal care for patients with hypertension in the community .
Support opportunistic screening
1The first step in managing hypertension is looking for it . Undiagnosed hypertension leads to outcomes such as stroke , heart failure and heart attack . Nurses should look for opportunities to check BP at most if not all clinic appointments ( unless checked recently and found to be normal ). While it can often feel that we are too busy to check everyone ’ s BP , it is always worthwhile .
Blood Pressure UK , which runs the campaign ‘ Know Your Numbers ’, has produced lots of resources on what nurses require to deliver opportunistic screening . 1
Get the technique right
2Measurement of BP is a common and important clinical assessment , but is often done incorrectly . Given the pressures healthcare workers are facing , it ’ s essential to ensure it is done properly to avoid the need for repeat readings and adverse clinical consequences . The environment should be standardised wherever possible , whether in a clinical setting or in the home . The British and Irish Hypertension Society ( BIHS ) has a range of resources that offer a valuable reminder of the correct technique , including monitor choice , cuff size , patient positioning and measurement protocol . 2
BP will usually be measured in the seated position , but it is important to check for any postural drop in patients with symptoms of falls or dizziness . To do this , measure the BP while the patient is seated and again after they have been standing for at least a minute . If the systolic BP ( SBP ) reading falls by more than 20mmHg , use the standing reading for diagnosis and management . 3 high ’. Explain that raised BP on a single occasion does not mean a diagnosis . Then explain the numbers , the potential impact of high BP and the next steps towards diagnosis . While clinicians may assume they have explained this well , there is often miscommunication in healthcare , including what patients recall . Along with the Blood Pressure UK resources , a useful digital tool is Share the Pressure , 4 which can be used in the clinical setting or directly by patients . The NHS Heart Age Test , an online risk calculator , can help people understand the impact of raised BP on their heart , and how reducing it can help . 5
Make sure raised BP is confirmed
4A reading of 140 / 90mmHg is the threshold for concern , and the patient will enter the diagnostic pathway for hypertension . A reading of ≥180 / 120mmHg should prompt urgent , same-day review
Table 2 Stages of hypertension
Michaela Nuttall and Joanne Haws are cardiovascular specialist nurses and members of the Nurses and Allied Health Professionals working party of the British and Irish Hypertension Society . They also run the not-for-profit organisation Learn with Nurses
Table 1 ABPM / HBPM readings required to confirm the diagnosis of hypertension
Method Requirements Diagnosis ABPM
HBPM
At least two measurements per hour during the person ’ s usual waking hours , average of at least 14 measurements
Two consecutive seated measurements , at least one minute apart , blood pressure is recorded twice a day for at least four days and preferably for a week
Average daytime reading
Measurements on the first day are discarded – average value of all remaining is used
Stage Clinic BP ABPM / HBPM reading Stage 1 hypertension ≥140 / 90mmHg ≥135 / 85mmHg
Explain the risks of high BP
3The first step in communicating risk of high BP is to let people know their numbers . All too often , patients says ,‘ oh , the nurse / doctor said it was a bit
Stage 2 hypertension ≥160 / 100mmHg ≥150 / 95mmHg Severe hypertension ≥180 / 110mmHg n / a
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