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The role of nurses in treating and managing high blood pressure

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Nirmala Markandu, Hypertension Nurse Specialist & Helpline Advisor for Blood Pressure UK and senior research fellow Queen Mary University of London. 

Nurse taking elderly man's blood pressure

Over half of all strokes and heart attacks are caused by high blood pressure and it’s a risk factor for heart disease, kidney disease and vascular dementia.

High blood pressure affects almost 1 in 3 adults in the UK, yet many people are unaware they have raised blood pressure (BP) as it rarely has any symptoms.

Blood pressure is one of the most preventable and treatable conditions. Reducing BP to normal levels reduces the risk of cardiovascular disease to the same level of someone without high blood pressure. It may surprise you, therefore, that many patients are undiagnosed and of those who are diagnosed, many are not treated or not controlled.

“Nurse-led hypertension clinics have become one of the most effective systems in improving BP control in the NHS.”

Over the years, the role of nurses in BP management has changed significantly. There has been a move away from nurses simply measuring, monitoring and charting BP to specialist hypertension nurses who are trained to lead and manage all aspects of BP care for patients, including detection, referral, and prescribing and managing medications.

Practice nurses and nurses on hospital wards and in the community regularly measure BP in patients. It is the single most important physiological measurement made by nurses of all levels, with basic pathophysiology of hypertension included in nurse tutoring.

With appropriate training and regular updates they are best placed to interpret BP readings and act on any abnormal readings.

Multidisciplinary hypertension clinics run by specialist nurses empower patients to measure and monitor their own BP at home and introduce lifestyle changes which together have been shown to lead to better BP control.

“Nurses contribute a great deal towards lowering BP and thereby reducing incidence of stroke and heart attack in UK.”

As a result, nurse-led hypertension clinics have become one of the most effective systems in improving BP control in the NHS.

Training a nurse to be proficient in BP control is challenging, due to the broad area of expertise they must be able to show confidence in:

● How to measure BP accurately, using validated manual and digital machines, use of appropriate cuff sizes and machine maintenance.
● Monitoring and assessing patients, how to act on the findings e.g. escalating unusual measurements to the senior nurse /doctor.
● Knowing the BP targets for different conditions.
● Having a basic knowledge of medications and side effects and appropriately advising patients on discharge.
● Knowing how to manage home BP monitoring and interpret the results.
● Educating and supervising health care assistants on the importance of measuring BP.
● Advising health care professionals and patients on lifestyle changes e.g. reducing salt, eating more fruit and vegetables, maintaining a healthy weight, being more active and limiting alcohol consumption.

Nurses are perfectly placed to detect undiagnosed raised BP and day to day unexplained variabilities of BP, interact with patients and advise on implementing necessary lifestyle changes.

When treating with tablets, nurses should understand the mechanisms of how the drugs work, the importance of tablet compliance and how to recognize and deal with possible side effects.

As research has shown nurses contribute a great deal towards lowering BP and thereby reducing incidence of stroke and heart attack in UK.

Know Your Numbers! Week (18-24 September) is Blood Pressure UK’s flagship awareness campaign.

It encourages adults across the UK to know their numbers and take the necessary action to reach and maintain a healthy blood pressure. Why not encourage your family and others to check their numbers?

Footnote: Blood Pressure UK is the only charity solely dedicated to lowering the nation’s blood pressure to prevent disability and death from stroke and heart disease.

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