How High! Decreasing Blood Pressure in Men Aged 45-65 in Primary Care: A Quality Improvement Project

Abstract

<p>PURPOSE: Hypertension is a health issue that affects many people worldwide. The Memphis area has many people who have been diagnosed with hypertension and experience poor outcomes. A local Memphis primary care clinic allowed a DNP student to implement a practice change initiative to improve blood pressures in the most at-risk participants. The aim of the hypertension management program was to decrease systolic blood pressure by five percent and diastolic blood pressure by three percent in men aged 45-65 within 15 weeks at a primary care clinic in Memphis, TN. Additional goals of the study were to improve medication compliance, participant knowledge, and incorporate Joint National Commission guidelines 7 and 8.</p> <p>METHODS: In this quality improvement study, a convenience sample of 49 male participants between the ages of 45-65 qualified for the study, with 31 participants completing the project. Provided education to providers, employees, and patients regarding guideline usage. Pharmacologic treatment was initiated in patients age 60 and over with BP > 150/90 and patients 18-59 with BP >140/90 to treat hypertension timely to decrease risk of complications. Medication was adjusted (either by increasing dosage or the current medication or the addition of a new medication) if BP was not at goal within one month after beginning treatment to decrease complications associated with hypertension. Medication therapy was selected based on race and comorbidities. In General, black participants began treatment with thiazide diuretic, CCB, ACEI, or ARB. Chronic kidney disease participants were treated with ACEI or ARB to improve renal functions. Recommended lifestyle modifications per JNC 7 guidelines (diet, exercise, limit alcohol intake, etc.) to all hypertensive patients to assist in improving health. Education was provided before project implementation. At monthly appointments, B/P was monitored, medications were evaluated, and education was reinforced. Pre-intervention and post-intervention blood pressure readings, survey results from the hypertension evaluation of lifestyle and management (HELM) and Hill-Bone Compliance Scale, and pill counts were gathered. Retrospective chart reviews were also used to gather data. Data was analyzed using Fisher’s exact test, t test, and regression analysis.</p> <p>RESULTS: The 31 participants that completed the program had a mean decrease in systolic blood pressure of 3.935%, and diastolic blood pressure of 1.29%. Pill counts and improved blood pressure readings were seen in months one and two. 80% of participants followed Joint National Commission guidelines. 8 of the 14 questions in the HELM knowledge scale showed statistical significance for improvement of participant knowledge. The Hill-Bone Scale showed that there are compliance issues with hypertension management.</p> <p>CONCLUSIONS: Although providing education, aggressively treating hypertension, and pill counts improved hypertension management in participants, ongoing commitment to aggressively addressing hypertension and the barriers that affect care are needed. In this population there is still much to be done. The results show that the program was effective, but better blood pressure readings could have been achieved with more patient cooperation and compliance. Recommendations for future research include to have a more robust sample with greater demographical variance. Also having additional participants that are medication naïve participants will help improve the diversification of the sample.</p> <p>CLINICAL RELEVANCE: This quality improvement study helped to improve blood pressure readings in participants in the practice and can be used to further develop better techniques for hypertension management. This study also helped the investigator better understand patient perspectives, obstacles, and choices as related to hypertension. Better hypertension management can improve quality of life, decrease comorbidities, lessen mortality, and decrease costs related to uncontrolled hypertension.</p>