Quality improvement project for managing elevated blood pressure in a primary care setting

Elevated blood pressure (BP) and prehypertension increase the risk of cardiovascular diseases, a national health concern. This article presents a quality improvement project implemented within a primary care setting that aimed at lowering cardiovascular risk by improving the identification, treatment, and follow-up of patients with elevated BP. This project was designed and implemented to address the identified deficiencies contributing to poor identification and follow-up of patients with elevated BP. The intervention was multi-pronged and comprised a staff educational program, introduction of a new method for measuring BP using the BpTRU™ device, and patient educational intervention. A significant improvement in staff BP knowledge scores was achieved following the intervention (p<0.05). Patient participants also exhibited a significant improvement in post-intervention BP measurements (p<0.05). This project showed that the implementation of a quality improvement project in a primary care setting can lead to significant improvements in staff BP knowledge and patient BP readings. However, future research in this area is required to determine whether particular lifestyle changes are directly associated with the reduction in BP.

The Metabolic Syndrome

This article reviews the criteria for the metabolic syndrome with a focus on the 5 components of the National Cholesterol Education Program definition (increased waist circumference, increased triglycerides, low high-density lipoprotein cholesterol, high blood pressure, and increased fasting glucose). Epidemiologic trends for the disorder and its prevalence are presented. The relation to cardiovascular disease and diabetes is discussed, as are findings from current studies explaining the risk factors. The article reviews the current recommendations for managing the metabolic syndrome including behavioral (weight reduction and increased physical activity) and pharmacological modalities. Relevant population-based studies and clinical trials are discussed with attention drawn to those clinical implications that are important for nurses to understand as they provide care to the growing population of clients expected to develop the metabolic syndrome.