To help primary care physicians focus on details essential to optimal BP control, we summarize checklists from Target: BP, a new AHA/AMA initiative.
Estimates are that close to half of US adults have elevated blood pressure and that approximately 45% of those with high blood pressure are not at target levels, putting them at increased risk for heart attack, stroke, and death.
To help clinicians improve BP control rates, the American Heart Association and American Medical Association collaborated to create Target: BP -- a comprehensive national initiative that provides a modular, evidence-based QI program for healthcare organizations, care teams, and practices.
Target: BP resources are extensive and ideal for primary care physicians and their patients. In the short slide show below, we combine elements of the program’s BP Practice Assessment checklist and Pre-BP Assessment checklist. See how your practice checks out.
What BP measurement devices do you use in your practice? Manual devices (portable aneroid); manual devices (mounted aneroid); semi-automated devices (take only 1 reading; require observer to be present during measurement)
What measurement devcies are used and which specifically for initial BP measurment? Do you have multiple adult cuff sizes available for each device?
How well do you and your staff measure BP, ie, do you follow guideline recommendations? Have a nurse or medical assistant take BP? Use validated, automated upper-arm device? Measure BP in a setting that supports appropriate patient positioning? Properly prepare patients* (checklist on forthcoming slide)? Take repeat or “confirmatory” measurement if initial BP is high?
What device/procedure is used to take confirmatory BP measurement? Do you perform 1 or 2 additional measurements? Wait 1 or 2 minutes between measurements? Leave the room if using an automated office BP?
How quickly do you/staff respond to an elevated BP? Is the provider notified if patient has high BP? Is the EHR flagged? Do you follow a hypertension treatment protocol? Use EHR to identify patients not at BP goal? Identify clinical inertia and take steps to resolve and move ahead with treatment?
How well do you partner with patients? Do you engage them in their care by using evidence-based collaborative communication strategies, eg, motivational interviewing (see upcoming slide)? Encourage self management with SMBP? Direct patients/families to resources that support medication adherence? Foster specific lifestyle changes that can prevent/help manage hypertension?
How well do you use self-management of blood pressure (SMBP?) Do you train staff on correct use of techniques? Identify patients who would benefit and train them in correct technique and reporting of results? Do you average and interpret SMBP results?
2017 AHA/ACC blood pressure classification. Guidelines published in 2017 lower the target for BP treatment from 140/80 mmHg to 130/80 mmHg, focusin attention on early prevention, detection and treatment. For most adults who meet the new definition of hypertension, the new guidelines recommend nondrug treatment (ie, lifestyle changes).
Check your BP measurement environment details. Avoiding errors commonly made during routine office BP measurement can significantly improve CVD risk estimation and eliminate delay in treatment. For example, placing the cuff over patient's clothing can lead to a reading being off by 5 to 50 mmHg.