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Closing the hypertension gap with ABPM: a primary care quality-improvement study
S Bhat1,2,3, W Cullen4, T Heffernan5
1School of Medicine, University of Limerick, Limerick, Ireland. shivani.bhat@usask.ca.
BMC Primary Care
|July 15, 2026
Summary
A nurse-led protocol significantly improved hypertension diagnosis and treatment in rural Ireland using ambulatory blood pressure monitoring (ABPM). This approach enhanced diagnosis rates and medication management, showing sustained benefits.
Area of Science:
- Primary Care Medicine
- Cardiovascular Health
- Nursing Practice
Background:
- Hypertension is underdiagnosed and undertreated globally.
- Ambulatory blood pressure monitoring (ABPM) is underutilized in primary care.
- Evidence from rural Irish general practice is limited.
Purpose of the Study:
- To assess the impact of a nurse-led protocol on hypertension diagnosis and management in rural Irish general practice.
- To evaluate the effectiveness of integrating ABPM into primary care through a nurse-led pathway.
Main Methods:
- Retrospective audit of 706 adult patient records in a rural Irish general practice.
- Implementation of a nurse-led pathway empowering nurses to initiate ABPM, provide counseling, and coordinate follow-up.
- Comparison of hypertension diagnosis and management metrics pre- and post-protocol implementation (November 2017-2022).
Main Results:
- Ambulatory blood pressure monitoring (ABPM) utilization increased by over 10% (57.1% to 69.0%).
- Hypertension diagnoses rose from 78.9% to 83.9%, with improved achievement of BP targets (37.7% to 44.1%).
- Antihypertensive therapy intensified, with increased prescribing of ACEi/ARB and calcium channel blockers.
Conclusions:
- A nurse-led protocol integrating ABPM significantly improved hypertension diagnosis and treatment in rural primary care.
- The positive effects were sustained throughout the COVID-19 pandemic.
- Supports wider evaluation of nurse-led, ABPM-integrated models to address the hypertension treatment gap.
Related Concept Videos
01:25Errors occurring during blood pressure monitoring
Blood pressure monitoring is a crucial clinical procedure in diagnosing and managing various cardiovascular conditions. Despite its significance, the accuracy of blood pressure measurements can be compromised by multiple factors, potentially leading to either falsely high or low readings. These inaccuracies are critical as they can significantly impact patient care. So, it is vital to understand these challenges deeply and adopt strategic approaches to minimize errors.
Several factors...
Several factors...
01:28Special considerations while measuring blood pressure
When assessing blood pressure (BP), healthcare professionals must consider various factors and potential unexpected outcomes to ensure accurate readings and provide proper patient care. Adhering to these guidelines is essential to achieving the most reliable results.
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
Accurate blood pressure assessment is crucial for diagnosing and managing various health conditions. To ensure the reliability of these measurements, healthcare professionals must adhere to standardized pre-procedural guidelines. These guidelines enhance patient safety and improve the overall quality of healthcare. The following steps are essential for obtaining accurate and consistent blood pressure readings, from using the appropriate tools to ensuring effective communication with the patient.
01:17Measurement of Blood Pressure
Assessing blood pressure is a standard procedure executed in virtually all medical environments. The method utilized today was established over a hundred years ago by an innovative Russian doctor, Dr. Nikolai Korotkoff. The soft ticking noise, known as Korotkoff sounds, heard while taking blood pressure readings results from turbulent blood flow within the vessels. The apparatus required for this procedure includes a sphygmomanometer, a blood pressure cuff attached to a gauge, and a stethoscope.
01:15Assessment of blood pressure in brachial artery(one-step method)
This procedural guide systematically measures blood pressure using an oscillometric digital sphygmomanometer, emphasizing accuracy, patient safety, and comfort.
Prepare for the Procedure:
Prepare for the Procedure:
01:21Sites for measuring blood pressure
Blood pressure measurement is a fundamental clinical procedure, providing crucial data for assessing cardiovascular health. Among the various sites for this measurement, the brachial and popliteal arteries are predominantly utilized due to their accessibility and the reliability of their readings. This lesson delves into the anatomical significance, methodology, and considerations of measuring blood pressure at these locations.
The Brachial Artery: Primary Site for Blood Pressure Measurement
The Brachial Artery: Primary Site for Blood Pressure Measurement