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The new hypertension guideline lowers the definition of high BP to 130/80 mm Hg. This means that millions of adults will now be diagnosed with hypertension and that many of those taking antihypertensive drugs are not at goal. The challenge is to communicate the change, the strength of evidence behind the change, and the options available to patients. Healthcare providers must be knowledgeable of the new guideline and must be ready to meet this challenge. [ABSTRACT FROM AUTHOR]

Hypertension is a preventable cause of poor health outcomes. This first article in a series about the most commonly billed diagnoses in primary care settings explores the pathophysiology, diagnostic evaluation, and management of hypertension. Relevant billing issues are addressed.

Hypertension, the most prevalent cardiovascular disorder in America, affects over 50% of the older adult population. Management of hypertension in the elder is influenced by numerous age-related factors, including physiological changes, co-morbid conditions, functional or cognitive impairments, and polypharmacy issues. As data on the damaging effects of untreated hypertension increase, practice guidelines are increasingly focused on early detection and successful management of blood pressure in the primary care setting. The primary health care provider, having an advanced knowledge base and excellent communication skills, can make effective management of hypertension a reality. This article presents a comprehensive review of assessment, diagnosis, and treatment of hypertension in the older adult. Lifestyle modification and pharmacologic therapy are discussed. Elements of patient education are described, with special emphasis on promoting adherence to a long-term treatment regimen.

This article reports the results of a correlational study that explored the association between the three factors of pregravid weight, prenatal weight gain at 28 weeks and maternal age, and the subsequent development of pregnancy-induced hypertension (PIH). A significant relationship between low maternal age and PIH development was found. Further data analysis showed that PIH occurred significantly more often when the second trimester mean arterial pressure (MAP) did not drop to a level lower than the first trimester MAP. Clinically, emphasis should be placed on early detection of women at high risk for PIH development. Analysis of the MAP changes could prove to be a low-cost, effective and low-risk predictive test for PIH development.

Knowing a patient's continuous 24-hour blood pressure measurements can be useful to the nurse practitioner in evaluating the hypertensive patient. Recent studies have demonstrated end-organ damage to have a higher degree of correlation with 24-hour blood pressure readings than with more periodic blood pressure readings. Previously, 24-hour ambulatory blood pressure determinations were evaluated primarily in research settings. The ability to obtain these readings for diagnostic information applicable to clinical situations is becoming readily available. The historical background leading to the development of the ambulatory blood pressure monitors for clinical use is reviewed. The indications for obtaining 24-hour ambulatory pressures, interpretation of specific graphs and patient outcome are explained.