Incorporating Blood Pressure Self Monitoring into Clinical Practice

Tuesday, 13 July 2010

Elizabeth L. Finley, MSN, RN, FNP-BC
Nurse Practitioner, Veterans Administration Outpatient Clinic, South Bend, IN

Learning Objective 1: The learner will be able to identify the appropriate use and method of blood pressure self monitoring for diagnosis and improved treatment of hypertension

Learning Objective 2: The learner will be able to interpret and apply the information obtained from self blood pressure monitoring to clinical treatment decisions for improved hypertension management.

Hypertension (HTN) is a challenging condition for clinicians to control.  A potential aid in HTN control is the addition of a home blood pressure (BP) measurement device, allowing patients to self-monitor BP outside the clinic.  While use of home BP devices is common by patients, how this information should be used by clinicians treating HTN is unclear.  Clinicians question the usefulness of BP measurements obtained outside the clinic setting.

Diabetic patients, particularly, will benefit from control of HTN by lowering cardiovascular risk.  This project, currently in the beginning stages, provided BP cuffs to diabetic patients who attended an Midwestern indigent clinic.  Participants were given instructed to measure BPs in the home twice daily.  A registered nurse will contact each participant by telephone on a weekly basis to obtain the readings.  Participants who are identified as having BPs above the goal of 130mmHg systolic and 80mmHg diastolic will be referred to their primary provider.  The PICO question is: for adults with diabetes and uncontrolled HTN, does the use of self BP monitoring reduce the future risk of uncontrolled HTN compared with standard treatment and no self BP monitoring?
 This project will attempt to answer the PICO question by using guidelines created by this author based on the available evidence.  Evaluation will be completed by comparing baseline BPs to BP readings of each participant at the end of the project.  The number of referrals made to providers and of medication adjustments made during the course of the project by the patient’s providers will also be recorded. It is hoped that proper, systematic use of home BP cuffs in a manner that produces maximum sensitivity and specificity will provide a useful adjunct in obtaining BP control in a high risk population.