Getting the silent killer’ before it gets to patients requires detective work
Stress importance of follow-up
High blood pressure, or hypertension, is referred to as the "silent killer" because it often has no specific symptoms. If it is not properly treated and controlled, it can lead to stroke, heart attack, congestive heart failure, kidney damage, blindness, and other serious conditions.
The only way for people to determine if they have hypertension is to have their blood pressure checked; therefore, screenings could save lives. However, the first step in setting up a public blood pressure screening is creating a plan for follow-up, says Dan Jones, MD, professor of medicine and director of the division of hypertension at the University of Mississippi Medical Center in Jackson. "Otherwise, there is no value in having a screening," he says. The reason is simple — people with elevated blood pressure should be seen by a health care professional.
Therefore, health care professionals who conduct public screenings should include representatives from clinics in the planning stage who agree to treat people with elevated blood pressure, advises Jones. This is especially important when targeting underserved populations who may not have health insurance.
Follow-up is key, agrees Janet Hale, RN, manager of the health information center at the University of Missouri Health Care in Columbia. Health care providers can’t determine whether a person has hypertension by one elevated blood pressure reading; there needs to be evidence of a trend, she explains. That’s why the nurses who conduct the daily complimentary blood pressure screenings the health center provides encourage people to keep a record of their blood pressure and look at the average rather than one reading, or look for a trend.
To aid the nurses in this endeavor, the center, which is located at Columbia Mall, set up a computer program that tracks each person seen, provided permission is given. The nurses enter the person’s name and address, physician information, and a brief history that includes whether the individual is on blood pressure medication and if he or she smokes. Blood pressure readings, plus comments from the nurses regarding any education that took place also are recorded.
In addition the nurses who conduct the blood pressure screenings at the Health Information Center all are trained in the proper technique so that they measure blood pressure exactly the same way each time. They even write down what size cuff they use on each person so that the next time he or she comes to the center for a blood pressure check, the nurse on staff will not deviate in any way from the last screening. Small details create consistency, explains Hale.
The record can be printed at any time if someone wants to take it to his or her next physician visit. Sometimes, physicians refer their patients to the center to have their blood pressure monitored on a regular basis. When people who drop in for a screening have high blood pressure, the nurses strongly recommend that they see a doctor about their condition.
For personal tracking, each person who comes to the center for a blood pressure screening is given a pocket card on which to record his or her blood pressure. "They may be going other places in addition to the center to get their blood pressure checked," explains Hale.
Having patients actively involved in their care, including blood pressure screening is very important, says Carol Maller, RN, MS, CHES, patient education coordinator at the New Mexico Veterans Affairs Health Care System in Albuquerque. Therefore, the health care facility created a program called Patients are Partners where health care professionals coach patients on ways to become involved in their care.
"If patients have high blood pressure, then we encourage them to know their target goal for blood pressure. It’s fine to know what normal is, but often that varies for each individual," says Maller. Once patients know their target blood pressure goal, they are encouraged to monitor it regularly and record the numbers.
There is a blood pressure machine at the learning center that patients can use or they can choose to find a machine at a store, fire station, or senior center in their neighborhood. "For many people who are being managed for hypertension having a home monitoring device is the best method and we provide that at the medical center if the provider orders it," says Maller.
Education another key element
Blood pressure screenings provide a good opportunity to educate people about hypertension and its prevention, says Hale. During the education process, first make sure that people understand what blood pressure is and what the numbers mean, and that your blood pressure can fluctuate on any given day," says Hale. Often during a screening when people are told their blood pressure, they will say "I thought my blood pressure was 120 over 80," she says. They need to know that blood pressure is dynamic and will fluctuate throughout the day. Talking, walking, or eating a meal can elevate blood pressure.
People also need to know the importance of having their blood pressure checked regularly. The National Institutes of Health, based in Bethesda, MD, published blood pressure guidelines that include recommendations for blood pressure measurement, says Jones. (For information on how to obtain the guidelines, see sources at the end of this article.)
People with normal blood pressure need information about the prevention of hypertension, he says. Between 60%-70% of Americans eventually will develop high blood pressure, which is caused by a combination of genetic predisposition and lifestyle exposure. Lifestyle choices that contribute to high blood pressure include being overweight, lack of exercise, a high-sodium diet, and heavy alcohol consumption.
Some people with high blood pressure can manage it with lifestyle changes, such as weight loss, which brings the blood pressure back into normal range. However, the blood pressure must be diligently monitored. "Those people always need to be monitored carefully because they will always be at risk for developing elevated pressures again," says Jones.
When going out into the community to screen, it’s always wise to target a particular group, preferably people who are not routinely having their blood pressure measured in other settings. That’s why health fairs aren’t always the best choice, says Jones. Those who attend usually have a high interest in their health and already are being measured, he explains.
Hale always asks about the environment for the blood pressure screening when accepting an invitation from a business, church, school, or community organization. It’s important that the temperature is not too hot or cold, that the location of the screening is away from loud noise, and there is some privacy. "You don’t want everyone to hear what the person’s blood pressure is and what you say to them," she explains.
Also, get an estimate of how many people will attend the screening, says Hale. In that way, it’s easier to determine how many health care professionals should be on hand to conduct the screenings. On average, it takes about three minutes to conduct a screening depending on the person and their risk, she says.
While blood pressure machines frequently located in stores can help people track their blood pressure, it is not a good initial screening device. It’s important for a health care professional to be involved so there is an opportunity to teach and discuss lifestyle factors that impact blood pressure, says Hale.
Self-monitoring blood pressure machines are not always the answer for tracking either, says Jones. "Machines are reliable with certain types of patients and not as reliable with others. For example, the machines can give an unreliable reading with older people who have stiff vessels," he explains. n
For more information about blood pressure screening, contact:
• Janet Hale, RN, Manager, Health Information Center, University of Missouri Health Care, Columbia Mall, 2300 Bernadette Drive, Columbia, MO 65203. Telephone: (573) 882-4743. E-mail: [email protected].
• Dan Jones, MD, Professor of Medicine and Director, Division of Hypertension, University of Mississippi Medical Center, Jackson, MS. Telephone: (601) 984-1010.
• Carol Maller, RN, MS, CHES, Patient Education Coordinator, New Mexico VA Health Care System, 1501 San Pedro Drive S.E., Albuquerque, NM 87108. Telephone: (505) 265-1711, ext 4656. Fax: (505) 256-2870. E-mail: [email protected].
Blood Pressure Screening Guidelines:
• American Heart Association, National Center, 7272 Greenville Ave., Dallas, TX 75231-4596. Telephone: (214) 706-1397. Fax: (214) 706-5243. Web: www.americanheart.org.• National Heart Lung & Blood Institute [a division of the National Institutes of Health], P.O. Box 30105, Bethesda, MD 20824-0105. Telephone: (301) 592-8573. Web site: www.nhlbi.nih.gov/health/infoctr.
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