Correlation between Blood Pressure MEASUREMENTS and Adjustment of Hypertensive THERAPY in Elderly Nursing Home Residents

Introduction: Recent reports of the JNC VII emphasizes the importance of treatment in elderly hypertensives, however, practice for blood pressure monitoring in the nursing home is not standardized. Our aim is to study the correlation between blood pressure measurements and therapeutic interventions in hypertensive nursing home residents.

Methods: A retrospective chart review of the medication administration record (MAR) of all hypertensive subjects in a 672 bed skilled nursing facility between July 1, 2007 and September 30, 2007. Demographic data and systolic and diastolic measurement data was collected.

Results: In the 68 subjects, average age was 83 years (range:65-100). Over the 3 month study, each resident had an average of 25.2 measurements (range:7-147)for a sum of 1,692 for the cohort. There were only 22 recorded measures of uncontrolled blood pressure. Average systolic measurement was 124 (average range:113-138, maximum systolic:168 mmHg) and diastolic was 71 (average range:65-80, maximum diastolic: 98 mmHg). Average MAP was 89 (range: 83-95). Analysis showed a weak & statistically insignificant correlation between total number of blood pressure measurements & number of uncontrolled blood pressure measurements (r=0.113, p=.364). There was no change in the hypertensive management of any of these 68 residents, regardless of the recorded blood pressure.

Conclusion: A lack of consensus between blood pressure measurements & hypertensive therapeutic adjustments in long term stable hypertensive residents was discovered. Since recording blood pressure is a time consuming/burdensome task for clinical staff, with residents unavailable or uncooperative on nursing units, clinical guidelines should be developed in order to maximize efficiency.