Utilizing Antihypertensive Medication Titration Standardized Procedures to Increase Blood Pressure Control in Patients with Uncontrolled Hypertension

Purpose: This work exams the effect of nurse-driven, antihypertensive medication titration (AMT) standardized procedures (SP) on blood pressure (BP) control in patients with uncontrolled hypertension (HTN) at two ambulatory care health centers in a large, safety-net healthcare system in the United States (US). Participants will be able to identify key components of AMT SP’s and determine their impact on patients with uncontrolled HTN.

Description: Hypertension is a major contributor to cardiovascular disease. In 2017, almost half a million deaths in the country were a result of HTN. Nearly half of all adults in the US have HTN. Less than 25% of those with HTN have their BP at goal (CDC, 2019).

The organization worked to change the care approach for patients with HTN. The goal was to increase BP control and reduce the time to goal for these patients. The interdisciplinary practice committee, inclusive of nurses, providers, and leadership, developed AMT SPs, which guide RNs to obtain blood pressure measurements, evaluate medication adherence, and titrate antihypertensive medications remotely without patient-specific physician medication titration orders. HTN nurse-directed clinic (NDC) RNs received extensive training on HTN, the HTN NDC program, and SPs. Nurse practitioners proctored these RNs and checked them off on competency. Patients with uncontrolled HTN, meeting criteria, were referred to the NDC by their primary care provider, then screened by the RNs using the SP to determine appropriateness of the referral. If patients met criteria, they were enrolled into the program. Once patients met BP goal, they graduated from the program.

The following data was analyzed: number of patients referred to the program, patients enrolled, proportion of patients who graduated from the program, average number of patient visits to achieve BP goal, and average number of titrations needed to achieve BP goal.

Outcome: Over a 12-month period, 125 patients (81 [64.8%] center “A”; 44 [35.2%] Center “B”) were referred to the HTN NDC program. Of the 125 patients, 114 (91.2%) (75 [65.8%] center “A”; 39 [34.2%] center “B”) met criteria and were enrolled into the program. The proportion of enrolled center “A” patients who graduated from the program was .627 (n=47) compared to .667 (n=26) at center “B”. The average number of patient visits needed for patients to achieve BP goal was 2. The average number of medication titrations needed to reach BP goal was 1. These results demonstrate effectiveness of the HTN NDC program in helping patients reach BP goal, particularly when comparing the overall percentage (64%) of patients who met their BP goal to the national percentage of