Question: As an advance practice nurse, it is important to examine and evaluate different clinical guidelines for a particular condition that you…

Question Answered step-by-step Question: As an advance practice nurse, it is important to examineand evaluate different clinical guidelines for a particular condition that you will encounter in practice. You may find there is more than one for a particular disease or condition. You must be aware of these and be able to evaluate these using evidence based practice in your advanced practice role. For example, if you have been diagnosed with allergic rhinitis, there are guidelines for prescribing. Paper : I chose to discuss hypertension and its guidelines for treatment with this discussion board activity. I have primarily worked in cardiac intensive care units and managed patients with diseases related to uncontrolled hypertension. It is interesting to read the guideline set forth by well-established medical associations on approaching the beginning stages of these diseases. Basil and Bloch (2021) inform readers in an up-to-date meta-analysis that treatment for hypertension is one of the most common reasons for primary care visits and the use of long-term prescription treatment. Hypertension is often referred to as the “silent killer” because it lacks symptoms in the early stages. The importance of regulating blood pressure is well studied in the medical community to minimize premature death and prevent or slow the progression of chronic disease. Uncontrolled hypertension can lead to adverse cardiovascular diseases such as left ventricular hypertrophy (LVH), heart failure with preserved/reduced ejection fraction, ischemic/hemorrhagic stroke, myocardial infarction, chronic kidney disease, and end-stage kidney disease (Basil & Bloch, 2021). The American College of Cardiology (ACC) and American Heart Association (AHA) have guidelines defining/staging hypertension. They are as follows: Normal blood pressure – Systolic < 120 mmHg and diastolic <80mmHgElevated blood pressure- Systolic 120 to 129 mmHg and diastolic <80 mmHg Stage 1 hypertension- Systolic 130 to 139 mmHg or diastolic 80 to 89 mmHgStage 2 hypertension- Systolic at least 140 mmHg or diastolic at least 90 mmHg (Whelton et al., 2017).A meta-analysis from the ACC, AHA, and other medical associations concluded: “the amount of blood pressure reduction is the major determinant of reduction in cardiovascular risk in both younger and older patients with hypertension, not the choice of antihypertensive drug (assuming that the patient does not have an indication for a particular drug, such as diltiazem, verapamil, or beta-blocker for rate control in atrial fibrillation)” (Mann, 2021, p. 2). The guidelines by the ACC/AHA written by Dr. Whelton et al. (2017) recommend nonpharmacological interventions for “elevated blood pressure” and reassessment of blood pressure in three to six months (p.65). Nonpharmacological interventions include limiting excess sodium intake, weight loss, exercise, decreasing alcohol consumption, and tobacco cessation. Pharmacologic treatment is individualized, considering all risk factors and existing comorbidities before initiating drug treatment. Whelton et al. (2017) recommend using thiazides or thiazide-type diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and calcium channel blockers (CCB) as primary agents to combat hypertension. Chlorthalidone, a thiazide-type diuretic, is preferred by both the ACC/AHA guideline and up-to-date guidelines. Primary agents are usually started with stage 1 and 2 hypertension and can progress to combination therapy if target blood pressure is not obtained. Secondary agents recommended are loop diuretics, potassium-sparing diuretics, aldosterone antagonist diuretics, beta-blockers, alpha-1& Alpha-2 blockers, direct renin inhibitor, and direct vasodilators (Whelton, et al., 2017). All medications used have risks of adverse reactions when taken in combination or monotherapy.  The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) research, including 41,000 participants, was used to determine optimal first therapy in hypertension to decrease morbidity and mortality. ALLHAT was a randomized, double-blind study conducted over eight years using chlorthalidone (thiazide-type diuretic), amlodipine (CCB), and lisinopril (ACE inhibitor). Chlorthalidone was associated with significantly lower rates of heart failure and cardiovascular disease when compared to amlodipine and lisinopril (Mann, 2021). I could see this impacting my clinical practice as an advanced practice nurse in several ways. I believe I would use these guidelines more often in a cardiac care unit or cardiac surgery unit. Otherwise, initial therapy is usually started in the primary care setting. However, there are many instances where patients with undiagnosed hypertension and cardiovascular disease are initiated on medicines after being admitted as inpatient. Examples of this would be a patient without a formal diagnosis of hypertension or cardiovascular disease that is treated after myocardial infarction. In those cases, I would feel comfortable using the guidelines set forth by the ACC/AHA in my clinical practice to initiate therapy.  I have learned through this activity that prescribing the correct drug at the right time to certain patients is crucial to their therapy. It is also an immense amount of information to analyze to ensure the safety of our patients. It is no wonder to me now why there are so many different specialties in medicine. We may learn how to begin specific therapies, but even then, a specialist might be the best choice for complex cases. For example, the blood pressure treatment guidelines I discussed branch out even further for the individualized treatment of patients with specific comorbidities. I felt this topic was a good match for me to start with, given my nursing background in cardiac health. Overall, I enjoy the literature and look forward to learning more about pharmacology in general.  ReferencesBasil, J., Block, M. (2021) Overview of hypertension in adults. In J. P. Forman (Ed.), UpToDate. Retrieved September 8, 2021, from https://www.uptodate.com/contents/overview-of-hypertension-in-adults?search=hypertension&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 Mann, J. (2021). Choice of drug therapy in primary (essential) hypertension. In J. P. Forman (Ed.), UpToDate.Retrieved September 8, 2021, from https://www.uptodate.com/contents/choice-of-drug-therapy-in-primary-essential-hypertension?search=hypertension&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H2 Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Jr, Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., MacLaughlin, E. J., Muntner, P., Ovbiagele, B., Smith, S. C., Jr, Spencer, C. C., Stafford, R. S., Taler, S. J., Thomas, R. J., Williams, K. A., Sr, Williamson, J. D., … Wright, J. T., Jr (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension (Dallas, Tex.: 1979), 71(6), 1269-1324. https://doi.org/10.1161/HYP.0000000000000066Answer – need a constructive comment on above paper with at least one evidence based support with its reference cite.  Health Science Science Nursing PHAR 5018 Share QuestionEmailCopy link Comments (0)