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Evaluating the Use of the JNC-7 Guidelines for Hypertension Prevention and Management

1 August 2004


Context Hypertension is a common but generally poorly controlled disease. Unfortunately the end results of this poor control are the increased risk of developing cardiovascular disease, stroke, and kidney disease. Objective To assess adherence to The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) guidelines as well as efficacy of care for hypertensive and prehypertensive patients.

Design A retrospective chart review from 5/10/2004 to 6/1012004 was done which measured several parameters regarding the care and treatment of hypeliensive and prehypertensive patients in comparison to the JNC-7 hypertension guidelines.

Setting This study took place at the Maple Street Clinic-- a family practice clinic in Forest Grove, Oregon. The clinic maintains charts for approximately 8000 patients of mainly Caucasian and Hispanic ethnic backgrounds.

Patients and other Participants Ninety seven charts of patients with the diagnosis of Hypertension were reviewed. Another 56 charts were pulled at random to measure prevalence of prehypertension and undiagnosed hypertension. Included subjects were 18 years of age or older. Subjects were seen in the clinic at least two times and had their blood pressure measured with charted documentation on or after 04/2003

Main Outcome Measures Whether or not the patient achieved a goal blood pressure. Patient monitoring regarding follow up, lifestyle modification, medication regimen, and use of a HTN flowsheet.

Results Exactly 49.5% of patients Witll documented hypeliension (HIN) were at goal blood pressure. The mean SBP for the subjects with HTN was 136.5 mmHg (SD 20.51, CI 95% 132-146 mmHg). The prevalence of pre hypertension was 38.3%. Patients who had out-of-goal blood pressure had appropriate follow-up 72.3% of the time. Lifestyle modification education was documented on only 25.7% of the charts reviewed. Also only 25.7% of charts demonstrated appropriate blood pressure monitoring.

Conclusions This study found that the clinicians at the Maple Street Clinic could improve their evaluation and treatment for hypertensive patients in several areas. However, the clinic's hypertensive patients have a goal blood pressure rate fa.r greater then the national average.


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