Hypertension and Treatment Modalities: what does the current evidence say?

Author

Luis R. Tellez, The University of Texas at El Paso

Date of Award

5-2024

Degree Type

DNP Project

Degree Name

Doctor of Nursing (ND)

Department

Nursing

Chair

Hector Morales

Abstract

Background/Problem Statement: The significantly elevated rates of cardiovascular (CV) disease observed among individuals with mental health conditions might stem from suboptimal handling of cardiovascular risk factors. In this project, I sought to address one aspect of cardiovascular risk: hypertension in patients 18-74 years of age, marked with a blood pressure >140/90 mmHg in a psychiatric inpatient setting. A tenday review of patient care revealed that hypertension management provided to patients under our service was inadequate and might be improved by adopting and implementing more consistent and systematic protocols for medication administration.

Aims/Methods: At the onset of my project, I undertook a detailed examination of approximately 30 patient cases each day within our service. The selection criteria focused on patients aged between 18 & 74 years who exhibited a blood pressure reading exceeding 140/90 mmHg. Those who met these specifications were then introduced to a novel intervention regimen, which entailed administering 10 mg of oral hydralazine every 6 hours on an as-needed basis. This approach was designed to evaluate management of hypertension managing elevated among the identified patient group.

Results: In this quality improvement initiative, I delved into the strategic use of as needed (PRN) antihypertensive medications within a targeted group of patients. The findings documented 40 cases of PRN antihypertensive use, with oral hydralazine standing out for its efficacy. Remarkably, in approximately 80% of these instances, hydralazine successfully reduced blood pressure to levels below 140/90 mmHg within a two-hour window following administration. The remaining 20% of cases required a second dose of PRN hydralazine, which achieved the target blood pressure reduction to below 140/90 mmHg within 8 hours from the initial dose. This evidence underscores the significant potential of oral PRN hydralazine.

Conclusion: Hydralazine demonstrated rapid and effective action in managing acute instances of hypertension with blood pressure readings exceeding 140/90 mmHg. By customizing treatment plans to cater to the unique requirements of each patient, diligently observing the outcomes of these treatments, and modifying the approach when needed, one can significantly enhance the likelihood of reaching the best possible results.

Implications for practice: My findings align with general hypertension treatment guidelines, which recommend aiming for a blood pressure of less than 140/90 mmHg to reduce the risk of cardiovascular disease. In a psychiatric population, managing acute hypertension episodes swiftly with oral hydralazine can be particularly important because psychiatric medications can affect blood pressure, and psychiatric conditions may themselves influence cardiovascular risk.

Recommended Citation

Tellez, Luis R., "Hypertension and Treatment Modalities: what does the current evidence say?" (2024). Cohort XII. 7.
https://scholarworks.utep.edu/cohort_12/7