Guidelines for monitoring hypertension in LTC:
There are reviews of hypertensive therapy in the elderly which support the concept of continuing therapy into the later years. Recent meta-analysis has shown reductions in stroke incidence in persons older than 80 who were treated for hypertenion. However, there was a non-significant trend toward early death in those treated. Therefore, in the frail elderly, anti-hypertensive therapy should be used cautiously and with adequate monitoring.
There are clinical practice guidelines for the screening and treatment of hypertension but very little written about the ongoing monitoring of the blood pressure. Therefore, these guidelines will offer a common-sense approach to monitoring in residential care.
In office practice we follow-up the blood pressure every three to six months but in residential care, which is staffed by health personnel, a more appropriate plan is to monitor monthly.
1) All newly admitted residents will have their blood pressure (BP) monitored OD x one week to establish a baseline BP. It is recommended that the BP be monitored at the same time of day, each time it is taken (i.e. at 1100, or at 1600 etc.)
2) After this initial assessment, BP is to be monitored monthly.
3) If changes are made to antihypertensive medications, the BP will be q 2 d, x 2 weeks or at the discretion of the physician making the medication changes. If the BP is stable after 2 weeks, previous frequency of monitoring will be resumed.
4) If there is any intercurrent illness, the BP should be monitored more frequently (recommended q 2 d) as there is a potential for hypotension to occur.
5) In the frail elderly who are or maybe susceptible to falls, the monthly BP should be checked in a lying and standing position to assess for an orthostatic drop.
6) Residents who are on diuretics should have their potassium level checked routinely but this frequency can vary from q 3 months to yearly depending on the stability of potassium levels.
Because of the effects of NSAID on the kidney
and the possibility of increasing
BP levels, any resident who has these agents started should have their BP monitored q 2 d, x 2 weeks.
Dr. G. Nemanishen, MD, FCFP
Susan Madlung, RN, BSN, GNC(C)
Sarah Siebert, RN, MSN