Hypertension Blood Pressure Management Facts, Myths & Legends,Jill Bunker Clinical Nurse Specialist Hypertension and Cardiovascular Disease Prevention Peart-Rose Clinic & Clinical Investigation Unit 9th September 2007,Hypertension Control in Europe and North America,13.0%,9.3%,5.7%,7.7%,5.0%,11.6%,26.8%,0%,5%,10%,15%,20%,25%,30%,USA,Canada,England,Finland,Germany,Spain,Italy,Control in %,Wolf-Maier K et al, Hypertension 2004;43:10-17,British Hypertension Society Guidelines for hypertension management (BHS-IV): summary (2004) Bryan Williams, Neil R Poulter, Morris J Brown, Mark Davies, Gordon T McInnes, John F Potter, Peter S Sever, Simon McG Thom; the BHS guidelines working party, for the British Hypertension Society. BMJ 328 634-640. Joint British Societies Guidelines on Prevention of Cardiovascular Disease in Clinical Practice (2006) British Cardiac Society, British Hypertension Society, Diabetes UK. HEART UK, Primary Care Cardiovascular Society, The Stroke Association. 91 Supl. V Hypertension-management of hypertension in adults in primary care (2004 and 2006). NICE. Clinical guideline 18 and 34 www.nice.org.uk,Guidelines,Guidelines,Guidelines,Topics to be covered,Definition, Thresholds for intervention and treatment goals Measurement Evaluation of hypertensive patients Lifestyle measures ABPM and home monitoring,Classification of blood pressure levels of the British Hypertension Society,Hypertension is BP 140 systolic and/or 90 mmHg diastolic.Medication Required if; Sustained raised BP 160 systolic and/or 100 mmHg diastolic (despite non-pharmacological treatment)OR if BP 140 systolic and/or 90 diastolic AND patient has Target Organ Damage, CVD, Diabetes or 10 year CVD risk 20%,When to treat?,Suggested target blood pressures during antihypertensive treatment.,Clinic BP (mmHg)No diabetes Diabetes Optimal treated BP 140/85 130/80 Audit Standard 150/90 140/80,Systolic and diastolic blood pressures should both be attained Target = 140/85 mmHg This means systolic BP is less than 140 and diastolic BP is less than 85 (BHS & JBS Guidelines) NICE- treat to 140/90,BHS Guidelines,Definitions Definition, Thresholds for intervention and treatment goals Measurement Evaluation of hypertensive patients Lifestyle measures ABPM and home monitoring,Mercury Myth Mercury sphygmomanometers have been banned? Fact You can still use mercury. It will eventually be phased out, but not yet, no date set,FACT Inaccurate blood pressure tests could affect millions,The Times, Saturday 13th August, 2005,MHRA Blood pressure measurement recommendations 2005,Auscultation method: e.g Greenlight; mercury Should be available in all clinical areas Taught to healthcare workers Auscultation method used to check oscillometric (automatic) monitors Always used in certain clinical conditions: arrhythmias; pre-eclampsia; certain vascular disorders 2. Non-mercury auscultation method: Available in all clinical areas (e.g. Accoson Greenlight 300) Mercury Spillage kits: Available in all clinical areas if using mercury,MHRA Blood pressure measurement recommendations 2005,Oscillometric monitors (automatic): Dont assume its suitable for use in diagnosis of hypertensionOscillometric (automatic) method not suitable for all: Arrythmias; pre-eclampsia; certain vascular diseasesAneroid monitors: Aneroid dial gauges easily prone to damage from dropping, causing significant errors in zero & calibration7. Calibration/Servicing Calibrate and service all your monitors regularly,Examples of recommended blood pressure monitors.,Mercury sphygmomanometers (gold standard). Greenlight 300 (accoson)Independently validated automated upper arm devicesConsider MANDAUS 11 for community use (available BHS website),Blood pressure measurement Myths, Facts & Legends,what size cuff?,Size does matter,Using too small a cuff/bladder can overestimate the blood pressure Bladder should encircle arm by 80-100%,5,For cuff size follow manufacturers recommendationsGrowing obesity problem-cuffs may not be big enough especially automatic monitors-max large cuff tends to be 42 45cm depending on monitor. Patients arm circ can be 65cm,Too tight clothing,if the sleeves are too tight or bulky they act as a tourniquet giving inaccurate readings,6,MYTH: Mercury sphygmomanometer should be positioned level with the patients heart?,It should be level with the nurses eye,9,MYTH: The position of the arm is immaterial During BP measurement?,FACT: The arm should be well supported at HEART level (both sitting & standing) An unsupported arm is performing isometric exercise thus raising BP,4,At what rate should the cuff be deflatedon a mercury or Greenlight sphygmomanometer?,FACT: 2mm/Hg per second,FACT: BP should be recorded to the nearest 2mm/Hg on mercury or Greenlight sphygmomanometer,LEGEND: Nikolai Korotkoffs sounds (1906),Record readings atK1 as systolic(1st clear tapping sounds heard)K5 as diastolic (when sounds disappear)Use K4 (when sounds muffle) when K5 sounds continue to zero (document in notes - K4 used),