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Hypertension Best Practice Session 2 Blood Pressure Measurement and Management

Hypertension Best Practice Session 2 Blood Pressure Measurement and Management. Hypertension Best Practice Elements. Blood pressure (BP) measurement: including two BP readings if first is high (≥140/90 mmHg) Timely follow-up: monthly visits until BP controlled

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Hypertension Best Practice Session 2 Blood Pressure Measurement and Management

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  1. Hypertension Best PracticeSession 2 Blood Pressure Measurement and Management

  2. Hypertension Best Practice Elements Blood pressure (BP) measurement: including two BP readings if first is high (≥140/90 mmHg) Timely follow-up: monthly visits until BP controlled Treatment algorithm: low-cost, once-daily meds Communication: building trusting relationships Outreach: using a registry

  3. A Model for Quality Improvement What are we trying to accomplish? (AIM) How will we know that a change is an improvement? (MEASURE) What change can we make that will result in improvement? (CHANGE OPPORTUNITIES) ACT PLAN Testing ideas before implementing change STUDY DO Langley et al. , The Improvement Guide, 1996

  4. Accurate Blood Pressure Measurement

  5. Hypertension Measurement Video Click here for a short video on proper techniques for taking a blood pressure from New England Journal of Medicine.

  6. Knowledge Check CLICK HERE forBlood Pressure Measurement Post-Test

  7. What are the errors in this picture?

  8. Common Errors in Blood Pressure Measurement Wrong cuff size Placement of cuff over sleeve OR pulling up sleeve Feet crossed (NOT flat on the floor) Patient sitting without back support Arm in incorrect position (NOT at the heart level) Talking during BP measurement Eyes not level with manometer Patient has a full bladder Over-inflation of cuff

  9. Repeat Blood Pressure Measurement

  10. Why Wait and Repeat Blood Pressure Studies show changes of 10 mmHg in SBP by waiting 5-10 minutes after the patient sits down for BP check. Major trials evaluating the effects of blood pressure control on heart attack and death have patients wait 5 minutes. At one health system, we found that 30% of patients with initial BP > 140/90 had a normal BP (<140/90) after re-check. Repeating the BP helps providers know if they really need to intensify BP medication and avoids overtreatment.

  11. Study: Alerting reaction and rise in blood pressure during measurement by physician & nurse Alerting reaction and rise in blood pressure during measurement by physician and nurse. Mancia G, Parati G, Pomidossi G, Grassi G, Casadei R, Zanchetti A. Hypertension. 1987 Feb; 9(2):209-15.

  12. Hypertensive Adults with Elevated Blood Pressure

  13. Two BP Readings When 1st Elevated

  14. Two BP Readings When 1st Elevated • What is the current process? • How is it working? • How could it be enhanced? • Develop a goal for repeat BP readings. • Ideas from other clinics • EHR alert reminder when 1st BP is elevated • Reminder poster at computer station • BP notification magnet

  15. Treatment Algorithm

  16. Hypertension Treatment Algorithm Initial therapy with a low dose ACE/diuretic or ARB/diuretic combination IS BLOOD PRESSURE CONTROLLED? Yes No Continue with Current therapy Up-titration of combination therapy successively to the highest dose Yes No Add calcium channel blocker and up-titrate Continue with current therapy Yes No Continue with current therapy Add an -blocker,  blocker or spironolactone Feldman R D et al. Hypertension 2009; 53 646-653

  17. Next Steps Repeat BP measurement Finalize treatment algorithm Timely follow-up will be discussed in session 3

  18. Disclaimer Use of these slides alone will not improve blood pressure control within your practice. Blood pressure control will be achieved through active quality improvement efforts in conjunction with these slides. Practice coach consultation is available to assist you in improving outcomes.

  19. Acknowledgements This work was made possible with funding from: The Mount Sinai Health Care Foundation U.S. Centers for Disease Control and Prevention Special thanks to: Better Health Partnership participating clinics Health Improvement Partnership-Cuyahoga (HIP-Cuyahoga)

  20. Contact Info For questions about the online toolkit or assistance with implementation, please contact our coaching team: info@betterhealthpartnership.org.

  21. Thank You! Discussion/Questions?

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