In 2019, there were about seventy-million Americans with uncontrolled high blood pressure (BP) or hypertension (HTN) (Kitt, Fox, Tucker & McManus, 2019). Hypertension is the leading cause of preventable deaths worldwide (Stephen, Halcomb, McInnes, Batterham & Zwar, 2019). Uncontrolled HTN contributes to stroke, myocardial infarction, and renal failure, and is the most modifiable risk factor for heart disease and death (American Academy of Family Physicians [AAFP], 2019; Oparil & Schmider, 2015). Patients living in rural America have an increased prevalence of HTN and their access to preventative health services is lower (Buford, 2016; Caldwell, Ford, Wallace, Wang & Takahashi, 2016). The increased prevalence of HTN in rural communities does not positively correlate with optimized blood pressure control, which poses a gap in care (Buford, 2016). A multidisciplinary collaboration between registered nurses (RNs) and providers may improve patient outcomes (Ford et al., 2018). The implementation of a collaborative HTN Clinic in a rural setting had the potential to improve BP outcomes by increasing access to services. The practice improvement project established a HTN Clinic as a collaborative effort between RNs and providers in a rural community. Providers and RNs were educated via modules regarding the protocol and participants took surveys before and after implementation to determine effectiveness and if the HTN Clinic should continue after conclusion of the practice improvement project. The HTN Clinic intervention implemented education for hypertensive patients with an emphasis on medication compliance and lifestyle modifications, as well as medication adjustments through nurse-led protocols. Despite a short duration of implementation and evaluation, positive results were observed. All HTN Clinic patients had improvement in BP measures and were controlled by the end of the four-week implementation period. Overall, patient access, wait times for appointments, and BP measures for all hypertensive patients improved after implementation. The providers’ and nurses’ knowledge increased through completion of a detailed curriculum. The provider and RN surveys indicated support for continuing the HTN Clinic to improve HTN management and clinic providers felt that the HTN Clinic helped improve their time with patients and quality metrics.

Background: In the United States, one-third of adults have hypertension (HTN). Among African American (AA) adults, 43% of men and 45.7% of women have HTN. HTN in the AA adult population is more severe and occurs earlier in life compared to Caucasian adults, putting them at increased risk for cardiovascular events and renal disease. The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 8) Guideline Recommendations 7 and 8 were developed to aid in appropriate treatment and management of hypertensive AA adults. Purpose: The purpose of this Doctor of Nursing Practice (DNP) project was to improve the care, management, and outcomes of hypertensive AA adults by identifying current JNC 8 guideline prescribing patterns among a sample of hospitalized patients. The first project aim was to determine provider-prescribing rates of thiazide diuretics (TDs) and calcium channel blockers (CCBs) in newly diagnosed AA adults with HTN. The second project aim was to determine if AA adults previously diagnosed with HTN were currently prescribed TD and/or CCB medications. Methods: A retrospective medical record review of AA adult patients with a new HTN diagnosis or previously diagnosed with HTN was selected for this project. Participants were discharged from Medical City Dallas between 01/01/2017 and 03/31/2017. Results: In newly diagnosed participants with HTN, none were prescribed a TD (0%) and two were prescribed a CCB (40%). In previously diagnosed participants with HTN, 30 participants (16.3%) were prescribed a TD and/or CCB upon admission and 29 participants (15.76%) were prescribed a TD and/or CCB upon discharge. Among prescribing providers, beta blockers and other class hypertensive medications (i.e., furosemide, hydralazine, clonidine, and spironolactone) were most widely ordered for participants. Conclusions: The results of this DNP project display low provider compliance rates to guideline-recommended pharmacological therapy AA adults. This outcome highlights several potential reasons for the low adherence rates, including lack of provider documentation, lack of provider rationale for treatment selections, provider knowledge of HTN CPGs, and data analysis of prescribed medications. These factors present the opportunity for further research to identify the root cause of low compliance.