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Introduction
In the nursing field, answering research questions and papers requires an evidence-based approach framework that is generated from an adequately structured PICO(T) question. A PICO(T) framework is a helpful approach stemming from the aspects of a clinical research study- Patient or population, intervention, comparison, and outcome. In some instances, a time frame element is applicable while developing a research question. Deriving points of discussion from secondary studies, this paper will address the intervention of daily blood pressure monitoring and management among septuagenarians.
Hypertension refers to blood pressure that is higher than the normal standard. That is a systolic reading of 140 mm Hg or more or a diastolic reading of 90 mm Hg or more. Some risk factors causing hypertension are unhealthy diets through excessive salt consumption, a diet high in saturated fat and trans fats, low intake of fruits and vegetables, being overweight or obese, physical inactivity, and tobacco consumption and alcohol. Based on clinical studies, the rate and the risk of hypertension increase with age, affecting roughly two-thirds of the elderly population. However, the approaches to managing hypertension among the elderly population have proved more challenging than among the younger population.
The question being explored in this paper is: is daily blood pressure monitoring consequential in addressing the triggers of hypertension in the elderly population over the age of 75 years? Regarding the PICO(T) framework structure, the population in this question is the elderly population above 75 years. The intervention is the daily monitoring, the comparison is the potential of pharmacologic interventions, and the outcome is hypertension triggers.
Sources of Evidence
In order to carry out daily blood pressure effectively, accurate, reliable, and clinically certified blood pressure monitors are necessary. Experts and healthcare professionals recommend either an electric or an atomic device. While selecting these devices, the most important features to consider are the cuff size, mode, display quality, and cost. In general, blood pressure monitors have similar essential parts: Inflatable cuffs and gauges for readouts.
Home Blood Pressure Monitoring
Home blood pressure monitoring, specifically among septuagenarians, is beneficial in blood pressure control. This benefit is more rewarding to those old adults already suffering from hypertension or other chronic health issues. Inferring from a report by the University of Michigan on the topic of home blood pressure monitoring among older adults, doctor suggestion plays a crucial role in encouraging daily blood pressure monitoring.
Over half of old adults in the United States of America suffering from blood pressure-related health issues adhere to their health providers suggestion of periodic blood pressure monitoring. Only a quarter of the population carries out home blood pressure monitoring from their health requirement awareness without their health providers intervention. However, from the report, two-thirds of the population carry out home BP monitoring to remain as healthy as possible. In contrast, half of the population performs this exercise due to their doctors suggestion.
Two-thirds of the population who share their home BP monitoring report with their health doctors are likely to carry out daily monitoring compared to those who do not. As such, healthcare providers should encourage regular BP monitoring to improve blood pressure control and avert the risk of heart diseases, kidney diseases and stroke (Malani et al., 2021). Since many older adults are motivated to monitor blood pressure as healthily as possible, healthcare providers must educate their patients on the significance of blood pressure control. This contribution will enhance the efforts to lower the risks of cardiovascular occurrences, heart failure, and kidney disease development. It would also enable the provision of feedback on home BP monitor analysis.
Intensive Hypertension Treatment and Daily Monitoring
Hypertension treatment and control are very beneficial in older adults. Several studies across Europe have documented evidence of hypertension treatment benefits on cardiac mortality in addition to other cardiovascular health issues in octogenarians. The 2013 European Society of Hypertension/European Society of Cardiology Guidelines99 for the management of arterial hypertension points out that in the elderly, there is undeniable evidence annotating the benefits of antihypertensive management. The treatment of an elderly population with preliminary SBP of greater than160 mm Hg, whose SBP is lowered to values less than150 mm Hg, further provides supporting insights to this observation (Benetos et al., 2019). Intensive hypertension treatment enables quality and interventions to improve the quality of a patients life.
However, more intensive hypertension treatment interventions, combined with daily self-monitoring of BP, yield better results (Tucker et al., 2019). Daily self-monitoring is helpful as it reduces clinician workload and promotes patient engagement, despite the observation that it is not a complete mode of BP control.
As an intervention in hypertension management, daily blood pressure monitoring requires an all-inclusive decision-making process. In instances where hypertension patients under treatment are not adequately consulted, treatment follow-up becomes a challenge. In the case of elderly patients who might be experiencing a decline in cognitive function, understanding and agreeing to a suggested mode of BP treatment and control is paramount. This approach makes the entire BP monitoring, control, treatment and management process more collective, smoother and more effective.
Relevance of the Findings
Among the referenced studies in this paper is the report on the findings of home blood pressure monitoring among older adults. This report is based on the University of Michigans national poll on healthy ageing carried out in 2021. Its findings focus on a national sample of older adults with health conditions who benefit from blood pressure control. These findings also encompass these adults experiences with daily and regular BP monitoring.
To better assess the impacts of daily and self-BP monitoring on BP control, this paper also referenced Tucker et al. 2019. This studys findings are significant as they are based on a systematic literature search identifying all studies that entail self-monitoring of blood pressure in people living with high BP. It is among the first studies to analyze self-monitoring of BP using Individual Patient Data from a wide range of self-monitoring trials carried out in North America, Australia, and Europe and encompassing both specialist and primary care settings.
Conclusion
By applying the PICO framework, daily monitoring of BP is an evidence-based and practical approach to managing hypertension in an elderly population. Daily blood pressure monitoring can aid in early diagnosis, tracking a patients treatment, encouraging better control, and reducing healthcare costs. This approach can be further reinforced with proper guidance and an informed choice of self-monitoring clinical equipment. Patient engagement and an all-inclusive decision-making process are critical in ensuring the optimal benefits of this approach. However, drawing from the referenced studies, healthcare providers and doctors recommendation of daily BP monitoring to their patients plays a primary role in ensuring the success of this approach.
Reference
Benetos, A., Petrovic, M., & Strandberg, T. (2019). Hypertension management in older and frail older patients. Circulation Research, 124(7), 1045-1060. Web.
Malani, P., Kullgren, J., Solway, E., Levine, D., Springer, M., Singer, D., & Kirch, M. (2021). Home blood pressure monitoring among older adults. National Poll on Healthy Aging. Web.
Muntner, P., Shimbo, D., Carey, R. M., Charleston, J. B., Gaillard, T., Misra, S., & & Wright Jr, J. T. (2019). Measurement of blood pressure in humans: A scientific statement from the American Heart Association. Hypertension, 73(5), e35-e66. Web.
Tucker, K. L., Sheppard, J. P., Stevens, R., Bosworth, H. B., Bove, A., Bray, E. P.,& & McManus, R. J. (2017). Self-monitoring of blood pressure in hypertension: A systematic review and individual patient data meta-analysis. PLoS Medicine, 14(9), e1002389. Web.
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