Blood Pressure and Hypertension

Blood Pressure Monitoring of Hypertensive Veterans in Primary Care Hypertension has been identified as one of the major public health issues in the United States. A significant portion of the American population has been diagnosed with this condition and are mostly treated with medications for blood pressure. According to the findings of a study that was conducted in 2008, it is estimated that 13% of active duty service members have been diagnosed with hypertension (The Diagnosis and Management of Hypertension Working Group, 2014).

In addition, its reported that more than 37% of Veterans have hypertension, which makes it the most common chronic health condition among this population. While the control of hypertension has significantly improved among Veterans, there is need for more improvements in blood pressure monitoring of this population in the primary care setting. Healthcare professionals are faced with the need to enhance blood pressure monitoring of hypertensive Veterans in the primary care setting in order to improve patient outcomes.

This paper focuses on examining blood pressure monitoring of hypertensive Veterans in the primary care setting. This discussion also incorporates an evaluation of the obstacles and facilitators to office, ambulatory, and home blood pressure monitoring of this population in the Triple Threat context. Problem Statement Hypertension, which affects a significant portion of the U.S. population, has been identified as one of the most common chronic health conditions affecting Veterans. As compared to other conditions, hypertension affects more than 37% of Veterans (The Diagnosis and Management of Hypertension Working Group, 2014).

Even though the control of this disease among Veterans has significantly improved in the recent past, there are some problems experienced in blood pressure monitoring in the Triple Threat context. According to Andrews (2014), hypertensive Veterans are usually treated through blood pressure medications. While these medications help in controlling the condition, there have been rampant cases of misdiagnosis and over/under medication.

Similar to other patient populations, Veterans blood pressure measurements are usually taken in the office, which is regarded as the standard protocol for diagnosis and management of this chronic medical condition. This is regardless of the fact that 24-hour ambulatory and home blood pressure are the most suitable techniques for measuring hypertension among all populations including Veterans. In the context of the Triple Threat, blood pressure monitoring of Veterans in the primary care setting is characterized by several problems including poor measurement techniques (controllable) rapid deflation of cuff.

The other problems relating to this issue include screener's bias, mental concentration, faulty equipment, using the 4th phase for dialostic reading, misreading the manometer, and impaired hearing. These problems complicate the ability to obtain accurate blood pressure measurements of Veterans in the primary care setting. Moreover, the problems act as barriers towards effective blood pressure monitoring towards enhancing control of hypertension and patient outcomes among this population.

Significance of the Problem The significance of blood pressure monitoring in improving control of hypertension has been the subject of numerous studies relating to this chronic medical condition. According to Andrews (2014), improving the accuracy of blood pressure measurements is a crucial step towards improving hypertension diagnosis and management, which in turn enhances the healthcare quality of many patient populations in the U.S. including Veterans.

This is an important aspect of improving patient outcomes because inaccurate blood pressure measurements have hindered the effective control of hypertension and in turn generated poor patient outcomes. In concurrence, a report by The Diagnosis and Management of Hypertension Working Group (2014) postulates that evidence-based management of hypertension helps to improve the clinical outcomes among patients in the primary care setting. This report further states that effective control of Veterans' blood pressure has significantly improved the control of hypertension among this population to 76.3%.

Therefore, the lack of effective blood pressure monitoring generates tremendous barriers towards controlling hypertension among Veterans in the primary care setting. Blood pressure monitoring through appropriate blood pressure measurements is a facilitator towards controlling hypertension and improving the clinical outcomes of Veterans in the primary care setting (Andrews, 2014; The Diagnosis and Management of Hypertension Working Group, 2014).

Guiliani (2014) argues that argues that one of the reasons for the increased difficulties in controlling hypertension in the primary care setting is the failure by healthcare providers to meet blood pressure goals depending on guideline recommendations for this condition. This failure is attributable to several factors including clinical inertia, disagreement with the guideline recommendations, and lack of awareness.

In addition, healthcare providers in the primary care setting tend to overestimate their patients' blood pressure control rates/levels while patients fail to comply with blood pressure control guidelines offered by these providers. Andrews (2014) concurs by arguing that some of the reasons for inaccurate blood pressure measurements that result in inability to control hypertension include improper techniques, patient behaviors, and observer mistakes.

There are also problems relating to underestimation and overestimation of the actual blood pressure levels, which result in inappropriate blood pressure medications that make it difficult to control hypertension. For nursing practice, it is increasingly important to utilize suitable blood control measurement and monitoring techniques to enhance the clinical outcomes of patients including Veterans in the primary care setting. Gap in Nursing Practice Nurses play a critical role in hypertension management since they are directly involved in monitoring patients in different clinical settings.

Himmelfarb, Commodore-Mensah & Hill (2016) state that nurses play critical roles in hypertension management including detection, follow-up and referral. The other roles include diagnostics and medication management, clinic or office management, patient education, counseling and skill building, population health management, care coordination, and performance assessment and quality improvement. Given the increased challenges in effective control of hypertension, expansion of the nurses' role in managing this condition is considered as one of the most effective initiatives towards enhancing the control of blood pressure (Himmelfarb, Commodore-Mensah & Hill, 2016).

Since nurses play a crucial role in blood pressure control and hypertension management, gaps in nursing practice contributes to poor clinical outcomes of patients in the primary care setting. This study will focus on examining gaps in nursing practice in relation to hypertension management of Veterans in the primary care setting. The gap in nursing.