BSN 440 Activity 5 Evidence-Based Practice and Case Management for Hypertension

Student Name

Post University

SIMPATH: BSN440

Professor

August 24th, 2023

Evidence-Based Practice and Case Management for Hypertension

Hypertension is also known as high blood pressure, whereby the pressure of blood inside the arteries remains high for an extended period. They increase the risk of both coronary artery disease, heart attack, stroke, heart failure, and can also harm kidneys. Therefore, proper management of hypertension is very important to prevent the aforementioned adverse health consequences. This paper aims at analyzing the conducted research and the process undertaken in the case management of hypertension and the current trends, evidences, guidelines and pathways in practice.

1. Current Best Evidence-Based Practices

Lifestyle Modifications:

• Diet: The dietary style that has been recommended for use in controlling hypertension is the Dietary Approaches to Stop Hypertension (DASH). This dietary pattern focuses in increasing foods such as fruits and vegetables, fish, whole grains(Carey et al., 2021), and dairy products low in fat while limiting foods that contain saturated fats, cholesterol and sodium. 
• Physical Activity: Diet control including moderate aerobic exercise for at least 150 minutes per week or vigorous exercise at least 75 minutes per week is also advised in order to achieve reduced blood pressure. 
• Weight Reduction: It is critical to focus on weight management as one of the complied factors that affect blood pressure(Carey et al., 2021). Losing 5-10% of body weight is all that is required to lower blood pressure numbers – a breakthrough that the drug companies do not want anyone to know about. 
• Alcohol Intake: Females should avoid more than one standard drink per day while for males should not take more than two standard drinks per day. 
• Smoking Cessation: To the above effects(Carey et al., 2021), quitting smoking is important as tobacco additives raise hypertension and cardiovascular diseases.

Pharmacological Interventions:

Pharmacological therapies are a major component and typical initial treatments for hypertension consist of ACE inhibitors, ARBs, calcium channel blockers and thiazide Diuretics (Price, 2020). Sometimes, a single drug may not be enough, and using two drugs can be required; the choice of drugs should be based on patient characteristics and concomitant diseases, as well as potential side effects.

Monitoring and Self-Management:

It is beneficial to teach patients to check their blood pressure at home and record it to detect uncontrolled hypertension at an early stage and ensure compliance with medication (Price, 2020). Education of the patient regarding hypertension and the need to follow changes in lifestyle and medication is crucial here, where motivational interviewing enhances patient participation in the process.

Importance of Evidence-Based Case Management:

Organizing case management based on best and present evidence allows providing the patient with the best care possible. The utilization of case management results in creating standards of care and practice guidelines across different settings, better quality of care, efficiency in terms of resource allocation, and overall patient care (Price, 2020). It minimizes the unwarranted variations in practice, improves the organization of care, guarantees that the clinical decision-making process is based on evidence.

2. Published Guidelines:

The guidelines involved here are the American College of Cardiology and the American Heart Association whose recommendations embrace the prevention, early identification, assessment, and control of high blood pressure in the adult population (Song et al., 2020). These are evidenced based guidelines which look at the current literature and are revised after a period of time to incorporate new findings.

Recommended Treatment Plans:

• Initial Treatment: In the early stages, the main interventions adopted for most of the patients are changes in dietary practices like the DASH diet alongside physical activity and weight loss (Mayo Clinic, 2024). 
• Pharmacotherapy: If these modifications fail to reduce the level of blood pressure, pharmacotherapy is advised for hypertension (Mayo Clinic, 2024). Medication should be given according to the patient’s condition, presence of other diseases or ailments, and their risk factors. 
• Blood Pressure Targets: Ideal blood pressure for most people is below 130/80 (Mayo Clinic, 2024). But in the case of elder patients or patients with some chronic diseases, it is necessary to set more individual goals for treatment compared to potential complications.

3. Clinical Pathways:

In the management of hypertension, there are clinical pathways that ensure that all clients are offered relevant and standard care as predefined by Song and associates (2020). Hypertension and its approach as described by these pathways entails certain actions that are involved in patient management and follow up in a way that makes practitioners cover all. 

Initial Assessment:

The patient history and physical assessment are crucial in terms of developing approaches when it comes to hypertension (Song et al. , 2020). They should history the family background of the patient especially on hypertension, record the lifestyle of the patient and his/her signs and complications. This practice of assessing the physical status of the patient is important as one tries to establish whether or not there are manifestations of hypertension and its effects. Lipid profile, renal function tests, and ECG are other screening investigations that have to be done to get general physical health status and/or comorbidity that may be an interferer to hypertension control. 

Management and Treatment:

• Lifestyle Modifications: The patient needs to be encouraged on matters concerning; diet modification, physical activity, weight loss and smoking cessation (Leupold et al., 2023). Such processes comprise the foundation of hypertension management and, in terms of appreciable variations, can modify blood pressure by low amounts. 
• Pharmacotherapy: If the lifestyle changes do not work, pharmacological treatment is to be applied (Leupold et al., 2023). The particular anti-hypertensive remedy should be started only in accordance with the certain parameters of the patient, whereas in certain cases, even two or more remedies are to be prescribed – combination therapy. 
• Regular Monitoring: Patients should have followed up with their health care provider to check on the blood pressure level efficacy of the treatment, and to be reminded on the medication (Leupold et al., 2023). Hence, HBPM can be utilized in association with the office visits and help in tracking of blood pressures variations.

Follow-Up and Monitoring:

The patient should see the doctor from time to time to check on their progress, revisit the necessary lifestyle changes and report any issues or complications arising from the medication they are taking (Hodgkinson et al., 2018). These visits can help healthcare providers to build an empowering and enhancing relationship with patients. In these visits, the patients should be also observed for side effects of the antihypertensive drugs like changes in electrolyte levels, renal function and any other reactions. Changes to the treatment course may be made in response to side effects or other factors that impact a patient’s well-being. Patient education and follow-ups are also essential in ensuring that the patient is always in tune with the set treatment plan (Hodgkinson et al., 2018). These patients should understand the need to adjust their diets and exercise habits and to take their medicines as well as have their blood pressure checked regularly.

Conclusion

Monitoring and controlling hypertension following best practices and case management helps in attaining high quality patient care because the processes used are the best evidence-based. Compliance with published guidelines and clinical pathways ensures that all patients presenting to a medical facility receive proper management consistent with their condition. Such measures bear positive effects in hypertension management for better control of blood pressure levels, prevention of complications, and improvement of the wellbeing of hypertensive clients.