Allen, Angela, Venus Graham, Chenanda Thomas, and Carla Groh
Introduction: Hypertension is a chronic disease that affects 25-30 percent of the adult population, with the vast majority receiving care in primary care settings. Nurse practitioners (NP) offer a viable option in primary care settings and are well positioned to treat chronic hypertension. The JNC-7 are clinical guidelines established by the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and are the recommended guidelines for the management of hypertension. The purpose of this study was to determine, to what extent, nurse practitioners (NP) follow the JNC-7 guidelines for hypertension in a primary care setting.
Method: A retrospective chart review was performed on 55 randomly selected charts at the McAuley Health Center, a nurse managed center in Detroit. Inclusion criteria were that the patient was seen at least three times during 2006, had seen the NP at these visits, and had an ICD-10 code for hypertension. A checklist was created based on the JNC-7 guidelines. Data collected included: age, gender, race/ethnicity, height, weight, BMI, systolic and diastolic readings, creatinine, glucose, and lipid blood values, medications and lifestyle modifications (e.g. nutritional, smoking, exercise counseling).
Results: Of the 55 charts reviewed, almost 80% had elevated systolic readings and 83% had elevated diastolic readings, indicating that the patients were accurately diagnosed with hypertension. In terms of compliance with the JNC-7 guidelines, 100% of the patients were prescribed some form of antihypertensive and 91% had laboratory tests ordered. However, counseling on lifestyle modifications was less well documented: 40% had documentation on nutritional counseling and only 5.5% documented counseling on exercise. There was a trend toward statistical significance in the number of medications prescribed and control of diastolic blood pressure (p= 0.06).
Conclusion: The results suggest that NPs do adhere to the JNC-7 guidelines for medication and laboratory work in the management of Hypertension. However, the NPs in this study did not consistently document teaching on lifestyle modifications as recommended by the JNC-7: smoking cessation, dietary modifications and exercise. Additional research is required to determine if NPs are not counseling hypertensive patients on lifestyle modification or if they are simply not documenting their efforts.