Thiazide-like Diuretics as First-line Treatment to Improve Blood Pressure Management
Date of Award
Doctor of Nursing (ND)
Hector R. Morales, DNP, APRN, PMH/CS-BC
Background: Thiazide diuretics are currently the first-line treatment for hypertension (HTN). This class of drugs includes hydrochlorothiazide (HCTZ) and the thiazide-like diuretic, chlorthalidone (CTDN). The quality improvement project began in the fall semester with a 10- day reflective practice log to assess my current practice. A review of the clinical practice log allowed me to evaluate my current practice and identify three opportunities to improve my practice. I developed three potential PICOT questions and selected one for the QI project with the guidance of my Doctor of Nursing Practice (DNP) chairperson. I performed a literature review to gather the best evidence-based intervention to improve my practice. My current practice was to use HCTZ, losartan, or lisinopril as initial treatment for uncontrolled blood pressure (BP). The literature review's new evidence-based intervention was to initiate CTDN 25mg per day as the first line of treatment for HTN in adults 18 to 73 years of age. I presented the QI proposal of the evidence-based intervention to the IRB at The University of Texas at El Paso (UTEP) and my worksite supervisor. Approval from the IRB at UTEP and work supervisor were obtained in letter form before initiation of the QI project. I implemented the evidence-based QI project for six weeks in the Spring semester.
Purpose: This Quality Improvement (QI) project aims to use CTDN as a first-line treatment to achieve effective BP control in patients 18 to 73 years of age within 4 weeks.
Methods: A Plan-Do-Study-Act quality improvement method was used in this QI project. To assess the effectiveness of CTDN treatment, I recorded pre-intervention baseline BP measurements during the initial visit, followed by post-intervention BP measurements two to three weeks after that.
Intervention: Evidence-based CTDN monotherapy was initiated as a first-line treatment for patients 18 to 73 years of age diagnosed with HTN. CTDN was also added as a combination therapy to the drug regimens of known hypertensive patients. Kurt Lewin's three-stage model of change was used as the translational framework for this QI project. This model requires the provider to participate in the steps that include (1) unfreeze (i. e., identifying patients with uncontrolled HTN), (2) change (i. e., beginning treatment with CTDN), and (3) re-freeze (i.e., making the new evidence-base treatment of CTHN permanent).
Results: Twenty-seven patients, eight males, and 19 females, 18 to 73 years of age, were identified for QI improvement. Reductions in SBP (100%) and DBP (81%) were observed in the participants. The average reductions in SBP and DBP were 25 mmHg and 7 mmHg, respectively. Conclusions: The use of CTDN as a first-line treatment in this patient population reduces both SBP and DBP
Okubo, Raquel, "Thiazide-like Diuretics as First-line Treatment to Improve Blood Pressure Management" (2022). Cohort X. 10.
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