Blood pressure

The number of Americans at risk for heart attacks and strokes just got a lot higher. An estimated 103 million U.S. adults have high blood pressure, according to new statistics from the American Heart Association. That’s nearly half of all adults in the United States.

High blood pressure causes the heart to pump harder to move blood through the body. This can weaken blood vessels and damage major organs, such as the brain. People who have high blood pressure have one and a half times the risk of having a stroke compared to those who consistently have optimal blood pressure of 120/80.

Jennifer Geisert

Jennifer Geisert, RN, BSN

“When my in-laws first moved to town, they both had multiple health conditions that needed attention. With me being a nurse, I accompanied them to numerous doctor appointments. During these visits, I noticed errors when their blood pressure was being taken. The most notable was when a staff member took my father-in-law’s blood pressure over his winter coat. I tried to intervene and said, ‘you can’t possibly hear his blood pressure through that coat’. The staff member actually said, “Oh, it is fine!”  Thinking about that experience makes me realize how almost any practice can benefit from a quality improvement process around blood pressure monitoring,” shared Jennifer Geisert, RN, BSN; Quality Improvement Advisor and cardiac health team lead with Great Plains Quality Innovation Network.

Another example of a missed opportunity was my best friend’s mother, Mae, was a recent widow and was relocating to live closer to her children. After suffering a TIA, they realized she had suffered from undiagnosed hypertension. This was extremely unfortunate as she had several doctors’ visits over the years prior to moving. Not once was she told she had high blood pressure. Read Mae’s story.

This makes me wonder why her mother was never given the opportunity to have a blood pressure monitor at home to help the physician diagnose high blood pressure. Or were the blood pressure readings accurate?

Hypertension is the single most important treatable risk factor for stroke. Controlling blood pressure is one of the most important things a person can do to decrease their risk of stroke. This can be done by eating healthy, participating in physical activity, not using tobacco or smoking and taking medications properly. To help improve control, an individual can monitor his/her blood pressure at home.

As healthcare providers, we can be instrumental in making sure our team members and patients are performing blood pressure measurement correctly. It is important to follow evidence-based treatment protocols and partner with patients to help get blood pressure under control. Utilizing a team-based approach, blood pressure improvement solutions can be implemented with minimal disruption to existing work flows. This team-based approach includes Identifying errors performed by staff when measuring blood pressure and providing education to staff that are performing blood pressures.

The American Heart Association and American Stroke Association, along with the CDC, have useful tools to learn how to position a person correctly to ensure accuracy in blood pressure monitoring. The Target BP improvement Program outlines a practical, evidence-based approach by focusing equally on three critical areas:

1. Measure accurately
2. Act rapidly
3. Partner with patients

This infographic shows correct techniques and the potential impact of incorrect positioning.

The benefits of Self Measured Blood Pressure (SMBP) include Improve the accuracy of diagnosing hypertension, better management of patient blood pressure and help patients adhere to treatment. A person with a home self-measure blood pressure cuff can communicate measurements with their doctor on a regular basis to help the physician monitor, assess and prescribe medications. Patients who engage in SMBP are more likely to take action to improve their health in other ways. SMBP monitoring also helps a person know where they can make improvements in their self-care by exercising, participating in stress relieving activities, like meditation and monitoring their diet.

The Great Plains QIN hosted a WebEx in November 2016 with Michael Rakotz, MD, FAHA, FAAFP, Vice President of Chronic Disease Prevention & Management Improving Health Outcomes with the American Medical Association, titled The Importance of Accurate Blood Pressure Monitoring.

As a standard part of many physicians’ office workflows, measuring blood pressure may seem like a normal routine, but seemingly minor issues can impact blood pressure measurement. The Great Plains QIN hosted a webinar that focused on the importance of accuracy in blood pressure measurement in the identification and management of hypertension. The webinar included demonstration of proper blood pressure cuff sizing, how to take a blood pressure and alternate blood pressure measurement sites. Click here to view the recording.