The goal of this document is to provide nurses with recommendations, based on the best available evidence, related to nursing interventions for high blood pressure detection, client assessment and development of a collaborative treatment plan, promotion of adherence and ongoing follow-up.
This best practice guideline focuses on assisting nurses working in diverse practice settings in the management of hypertension. This work is being conducted to support the Heart and Stroke Foundation of Ontario’s High Blood Pressure AIM (Areas of Investment in Mission) initiative, which was launched in September 2004, and is comprised of two major streams:
- Improving the management of high blood pressure by doctors, nurses and pharmacists. Working with several key partners, including the Ontario College of Family Physicians, the Registered Nurses’ Association of Ontario, and the Ontario Pharmacists’ Association, the plan creates new educational opportunities that are designed to enhance physician, pharmacist, and nursing approaches to high blood pressure detection, intervention, and follow up measures.
- Research into:
a. the social determinants of hypertension (non-traditional risk factors and conditions that are linked to high blood pressure, such as socioeconomic status or stressful life environments); and
b. the role of systolic blood pressure level (upper number) in high blood pressure. The HBP AIM plan includes a significant investment in a province-wide research competition to better understand this emerging area.
The development of a guideline on the management of high blood pressure by nurses was identified as an appropriate strategy to facilitate nursing interventions in hypertensive management as a component of the first stream of this initiative.
This guideline focuses on:
- the care of adults 18 years of age and older (including the older adult over 80);
- the detection of high blood pressure;
- nursing assessment and interventions for those who have a diagnosis of hypertension.
This is not meant to exclude the pediatric client, but children have special assessment needs related to developmental stages that are beyond the scope of this guideline. This guideline also does not address hypertension in adults related to: pregnancy, transient hypertension, pulmonary hypertension, endocrine hypertension, or hypertension related to secondary causes (i.e., renal disease).
This guideline contains recommendations for Registered Nurses and Registered Practical Nurses on best nursing practices in the care of adults with hypertension. It is intended for nurses who are not necessarily experts in management of hypertension, who work in a variety of practice settings, including both primary care and secondary prevention. It is acknowledged that the individual competencies of nurses varies between nurses and across categories of nursing professionals and are based on knowledge, skills, attitudes, critical analysis and decision making which are enhanced over time by experience and education. It is expected that individual nurses will perform only those aspects of hypertension management for which they have received appropriate education and experience and that they will seek appropriate consultation in instances where the client’s care needs surpass their ability to act independently.