Publication Date

Spring 5-2020

Degree Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Tamara McKinnon

Second Advisor

Robert Murad

Third Advisor

Diana Felix

Keywords

Hypertension, High Blood Pressure, White Coat Hypertension, Hypertension Screening

Abstract

Many clinicians continue to diagnose hypertension based on office-based readings, despite the 2015 United States Preventive Services Task Force recommendation for the use of home or ambulatory blood pressure monitoring to confirm the diagnosis of hypertension prior to initiating treatment. Without obtaining blood pressure readings outside of the clinic environment, it is impossible to correctly diagnose hypertension, particularly regarding masked hypertension and white coat hypertension.

Stanford Health Care implemented a quality improvement project that provided patients with a home blood pressure device to monitor out of clinic blood pressure readings. The purpose of the project was to improve clinical care at Stanford Health Care, to assess for treatment control in patients already diagnosed with hypertension, and to verify the diagnosis of hypertension in patients undiagnosed. There were 98 subjects who had elevated or high blood pressure readings in the clinic who agreed to participate in the project. Findings showed that home blood pressure monitoring was effective in assessing for hypertension treatment control and verifying hypertensive phenotype in previously undiagnosed patients. Home blood pressure monitoring also allowed for timely diagnosis and treatment of hypertension. Providing home blood pressure devices to patients has the potential to reduce morbidity and mortality related to hypertension, reduce economic burden, and contribute to national quality initiatives that contribute to the overall health of the nation.

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