Practice Recommendations

RECOMMENDATION                                                                                      *LEVEL OF EVIDENCE

Practice Recommendations

Detection

and Diagnosis

1.1   Nurses will take every appropriate opportunity to assess the blood pressure of adults in order to facilitate early detection of hypertension.

IV

1.2   Nurses will utilize correct technique, appropriate cuff size and properly maintained/calibrated equipment when assessing clients’ blood pressure.

IV

1.3   Nurses will be knowledgeable regarding the process involved in the diagnosis of hypertension.

IV

1.4   Nurses will educate clients about self/home blood pressure monitoring techniques and appropriate equipment to assist in potential diagnosis and the monitoring of hypertension.

IV

1.5   Nurses will educate clients on their target blood pressure and the importance of achieving and maintaining this target.

IV

Assessment and Development of a Treatment Plan

Lifestyle Interventions

2.1   Nurses will work with clients to identify lifestyle factors that may influence hypertension management, recognize potential areas for change and create a collaborative management plan to assist in reaching client goals, which may prevent secondary complications.

IV

Diet

2.2   Nurses will assess for and educate clients about dietary risk factors as part of management of hypertension, in collaboration with dietitians and other members of the healthcare team.

IV

2.3   Nurses will counsel clients with hypertension to consume the DASH Diet (Dietary Approaches to Stop Hypertension), in collaboration with dietitians and other members of the healthcare team.

Ib

2.4   Nurses will counsel clients with hypertension to limit their dietary intake

of sodium to the recommended quantity of 65-100 mmol/day, in collaboration with dietitians and other members of the healthcare team.

Ia

Healthy Weight

2.5   Nurses will assess clients’ weight, Body Mass Index (BMI) and waist circumference.

IV

2.6   Nurses will advocate that clients with a BMI greater than or equal to 25

and a waist circumference over 102 cm (men) and 88 cm (women) consider weight reduction strategies.

IV

Exercise

2.7   Nurses will assess clients’ current physical activity level.

IV

2.8   Nurses will counsel clients, in collaboration with the healthcare team, to engage in moderate intensity dynamic exercise to be carried out for

30-60 minutes, 4 to 7 times a week.

Ia

Alcohol

2.9   Nurses will assess clients’ use of alcohol, including quantity and frequency, using a validated tool.

Ib

2.10 Nurses will routinely discuss alcohol consumption with clients and recommend limiting alcohol use, as appropriate to a maximum of:

•  Two standard  drinks per day or 14 drinks per week for men;
•   One standard drink per day or 9 drinks per week for women and lighter weight men.

III

Smoking

2.11 Nurses will be knowledgeable about the relationship between smoking and the risk of cardiovascular disease.

IV

2.12 Nurses will establish clients’ tobacco use status and implement Brief Tobacco Interventions at each appropriate visit, in order to facilitate smoking cessation.

Ia

Stress

2.13 Nurses will assist clients diagnosed with hypertension to understand how they react to stressful events and to learn how to cope with and manage stress effectively.

IV

Medications

3.1   Nurses will obtain clients’ medication history, which will include prescribed, over-the-counter, herbal and illicit drug use.

IV

3.2   Nurses will be knowledgeable about the classes of medications that may be prescribed for clients diagnosed with hypertension.

IV

3.3   Nurses will provide education regarding the pharmacological management of hypertension, in collaboration with physicians and pharmacists.

IV

Assessment

of Adherence

4.1   Nurses will endeavour to establish therapeutic relationships with clients.

IV

4.2   Nurses will explore clients’ expectations and beliefs regarding their hypertension management.

III

4.3   Nurses will assess clients’ adherence to the treatment plan at each appropriate visit.

III

Promotion of

Adherence

4.4   Nurses will provide the information needed for clients with hypertension to make educated choices related to their treatment plan.

III

4.5   Nurses will work with prescribers to simplify clients’ dosing regimens.

Ia

4.6   Nurses will encourage routine and reminders to facilitate adherence.

Ia

4.7   Nurses will ensure that clients who miss appointments receive follow-up telephone calls in order to keep them in care.

IV

Monitoring and

Follow-up

5.1   Nurses will advocate that clients who are on antihypertensive treatment receive appropriate follow-up, in collaboration with the healthcare team.

IV

Documentation

6.1   Nurses will document and share comprehensive information regarding hypertension management with the client and healthcare team.

IV