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Ambulatory blood pressure monitoring: A nurse practitioner run program
Christine Burke1, Catherine Haut, Kelly Hussong
1Division of Nephrology, Nemours AI duPont Hospital for Children, Wilmington, DE.
Insights
Accurate hypertension diagnosis in children requires consistent guidelines. The 2014 American Heart Association guidelines provide the most accurate ambulatory blood pressure monitoring interpretation for pediatric hypertension.
Area of Science:
- Pediatric Nephrology
- Cardiology
- Hypertension Management
Background:
- Ambulatory blood pressure monitoring (ABPM) is crucial for diagnosing hypertension in all age groups.
- Current guidelines for ABPM interpretation lack consistency, leading to diagnostic confusion.
Purpose of the Study:
- To resolve discrepancies in pediatric hypertension diagnosis at a children's hospital.
- To determine the most accurate ABPM interpretation method between the 2004 National High Blood Pressure Education Program (NHBEP) and 2014 American Heart Association (AHA) guidelines.
Main Methods:
- A quality improvement project led by a nurse practitioner.
- Retrospective chart review comparing ABPM results using both 2004 NHBEP and 2014 AHA guidelines.
- Analysis considered patient height and gender.
Main Results:
- The 2014 AHA guidelines demonstrated superior accuracy for ABPM interpretation.
- Implementing a single guideline ensures consistent hypertension diagnosis.
Conclusions:
- Standardizing ABPM interpretation with the 2014 AHA guidelines improves diagnostic consistency in pediatric hypertension.
- Nurse practitioners can utilize these findings to manage hypertension effectively in various clinical settings, including primary care.
Background:
Ambulatory blood pressure monitoring (ABPM) is a standard screening tool for the diagnosis of hypertension in children, adolescents, and adults. However, there is confusion and misunderstanding about which guidelines can provide the most accurate diagnostic values.
Local Problem:
At a large, free-standing pediatric hospital, ABPM testing was historically being conducted by both nephrology and cardiology departments. The nephrology service was using the American Heart Association (AHA) guidelines, published in 2014 for interpretation of results and for diagnosis of hypertension, whereas the cardiology service depended on the 2004 National High Blood Pressure Education Program (NHBEP) fourth report, which led to discrepancies in diagnosis of hypertension in this patient population.
Methods:
A nurse practitioner-led quality improvement project was designed and implemented to determine the best method of ABPM monitoring and test interpretation based on comparing results of patients using height, gender, and application of either the 2004 NHBEP fourth report or 2014 AHA guidelines.
Interventions:
Using a retrospective chart review, ABPM monitoring results from both cardiology and nephrology services were reviewed and compared to identify the most accurate methods and to recommend changes to practice.
Results:
Accuracy of interpretation for ABPM is best accomplished using the 2014 AHA guidelines.
Conclusions:
Using a single method of interpretation provides consistent diagnosis and treatment of hypertension in children. Nurse practitioners can apply this knowledge in other settings to manage hypertension and provide similar services in different settings, including primary care.
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