High blood pressure may be one of the most common chronic diseases in the adult population. Nurses and doctors need to conduct screenings to catch the disease early and change the patient’s lifestyle to prevent worsening the condition. Ambulatory blood pressure monitoring is the most accurate method. An alternative to ambulatory monitoring is measuring blood pressure by a nurse or patients themselves. The diagnosis of high blood pressure is one of the most straightforward but essential screening procedures.
Description
Blood pressure readings are classified as normal, prehypertensive, first or second hypertensive. Hypertension is diagnosed when systolic blood pressure is higher than 140 mm Hg or diastolic blood pressure is higher than 90 mm Hg (eCQI Resource Center, 2022). The critical stage of hypertension is a hypertensive crisis requiring emergency medical care. A hypertensive crisis is diagnosed when blood pressure is higher than or equal to 180/120 mmHg (American Heart Association, 2021). This diagnostic procedure aims to screen patients for high blood pressure and provide recommended follow-up as indicated.
The specialist informs the patient about the results and makes recommendations regarding the lifestyle and treatment plan based on the procedure performed. The Preventive Services Task Force recommends that most of the tested population should be adults without previously diagnosed hypertension (2021). The primary purpose of testing is to obtain blood pressure measurements outside of the clinical setting to confirm the diagnosis. Blood pressure measurement is carried out using a manual or automated sphygmomanometer (U.S. Preventive Services Task Force, 2021). The correct procedure uses the value of two measurements taken while the patient is sitting, with an interval of about five minutes between entering the clinic and measuring blood pressure (U.S. Preventive Services Task Force, 2021). An appropriately sized wrist cuff placed on the patient’s arm should be used to perform the test. Multiple measurements over time have a better positive predictive value than a single measurement.
The Level of Prevention
Blood pressure screening is classified as secondary prevention because it does not involve pre-existing preventive measures. Secondary prevention involves early diagnosis and prompt treatment of the disease to prevent more severe health problems. Secondary prevention aims to disseminate medical knowledge and educate the patient on self-diagnosis. The earlier hypertension is diagnosed, the greater the likelihood of minimizing unfavorable conditions. Timely treatment and advice on maintaining a proper lifestyle can guarantee a longer life expectancy for patients with hypertension.
The Recommendations for Frequency
Since arterial hypertension affects a significant part of the adult population, frequent diagnostic procedures are necessary. The problem is that not all citizens are aware of the high risks of developing hypertension throughout life. Screening procedures should be performed at least every three months for adults who have not had high blood pressure (U.S. Preventive Services Task Force, 2021). It is necessary to measure the pressure at least once a week for those who have already been diagnosed with high blood pressure. Screening is required for all citizens over 18, but older people are in a separate risk group.
Risk Factors
The risks of developing hypertension include those that can be eliminated and those that cannot. Unremovable risk factors include age, the older the person, the higher the risk; gender, men are more susceptible to hypertension, and genetic predisposition (U.S. Preventive Services Task Force, 2021). Avoidable risk factors include being overweight, smoking, unhealthy diet, stress, and alcohol abuse. People to whom the above factors apply should have their blood pressure checked at least once a month. An exception for such a frequent diagnosis can only be the patient’s age under 18.
Evidence-based Diagnostic Procedure and Treatment
Once abnormal blood pressure readings are identified, tests should be performed to confirm the diagnosis. Laboratory tests, electrocardiograms, blood biochemistry with the mandatory determination of the lipid spectrum, and the study of the level of ions and glucose are used to obtain more accurate results (Kapusta et al., 2018). Treatment of first-degree hypertension should begin with changing the patient’s lifestyle to a healthier one. Hypertension of the second degree and lifestyle modification and diet involves the constant intake of at least two drugs. Treatment of hypertension involves taking several classes of drugs: angiotensin-converting enzyme inhibitors, angiotensin receptor antagonists, beta-blockers, and calcium channel blockers (Cleveland Clinic, 2022). Depending on the results of the examination and the degree of hypertension detected, the doctor prescribes an individual treatment regimen. Often a specific cause of a persistent increase in blood pressure is identified, which can be eliminated. Hypertension of the third degree involves lifelong medication; it is impossible to cure this disease entirely by medication. For the treatment to be effective, the patient must visit the attending physician in a timely and regular manner.
Barriers and Limitations
If the patient is uninsured or underinsured, this can become a barrier to effective treatment of hypertension due to a lack of funds. The solution to this problem can be self-diagnosis when the patient will independently measure blood pressure and know what measures should be taken to reduce it. A key aspect of self-care for such a patient will be self-modification of lifestyle on a doctor’s recommendation. The most important thing in controlling hypertension is a healthy diet and increased physical activity. The first measure that a patient with hypertension should do is to refuse excessive salt intake since excess sodium increases the load on the heart muscle (The DASH Diet Home, 2019). The WHO recommended daily allowance is 5 grams of table salt per day, or one teaspoon (2020). Micronutrients recommended to be increased in hypertension are potassium, calcium, and magnesium (The DASH Diet Home, 2019). Hidden salt contained in prepared meals must also be taken into account.
Consumption of large amounts of trans fats increases cholesterol levels, complicating the disease’s course. With increased body weight, the load on the circulatory system increases. Fresh vegetables and fruits must be present in the diet of a patient with hypertension (The DASH Diet Home, 2019). To maintain normal blood pressure, moderate physical activity is necessary; the universal complex is a simple morning exercise at an accessible pace.
Conclusion
Hypertension is a severe public health problem; frequent blood pressure screening is necessary to detect the disease early. All people over the age of 18 have a reasonably high risk of developing hypertension, so it is recommended that people outside the special risk groups have their blood pressure checked at least once every three months. In the presence of risk factors, the frequency of checks should be at least once a month, and for people with an already identified disease, it is advisable to measure the pressure every week. Treatment of arterial hypertension primarily involves the patient’s transition to a healthier lifestyle. The sooner the diagnosis is made, the more effective the treatment.
References
American Heart Association. (2021). Understanding blood pressure readings. Heart.org. Web.
Cleveland Clinic. (2022). Antihypertensives: What they do and side effect. Web.
eCQI Resource Center. (2022). Preventive care and Screening: Screening for high blood pressure and follow-up documented. Healthit.gov. Web.
Kapusta, J., Kidawa, M., Rynkowska-Kidawa, M., Irzmański, R., & Kowalski, J. (2018).
Evaluation of selected results of laboratory blood tests in the course of hypertension in elderly patients. Polski merkuriusz lekarski: Organ polskiego towarzystwa lekarskiego, 45(270), 232-236. [Evaluation of selected results of laboratory blood tests in the course of hypertension in elderly patients]. – Abstract – Europe PMC
The DASH Diet Home (2019). The DASH Diet and the Mediterranean Diet.
The DASH Diet for Healthy Weight Loss, Lower Blood Pressure & Cholesterol U.S. Preventive Services Task Force. (2021). Screening for high blood pressure in children and adolescents: U.S. Preventive Services Task Force recommendation statement. American Family Physician, 103(4). Web.
World Health Organization. (2020). Salt reduction. Web.