Year of Publication

2019

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Sharon Lock

Clinical Mentor

Dr. Judith Daniels

Committee Member

Dr. Michelle Pendleton

Committee Member

Dr. Stacy Jensen

Abstract

BACKGROUND: White coat hypertension (WCH) is described as an anxiety-provoked, elevated in-office blood pressure reading, combined with a normal blood pressure reading outside of the clinic setting. This condition is often misdiagnosed as hypertension and can result in unnecessary antihypertensive treatment. PURPOSE: The purpose of this project was to determine provider adherence to the 2017 American College of Cardiology/American Heart Association hypertension guidelines for appropriate diagnosis and treatment of patients with white coat hypertension. METHODS: A retrospective chart review was performed on 100 randomly selected medical records of patients from an urban primary care practice diagnosed with an elevated blood pressure from January 1, 2018 to November 30, 2018. The use of blood pressure logs was evaluated before a diagnosis of hypertension was made. Overall blood pressure management was also evaluated. RESULTS: In this sample blood pressure logs were requested 50% of the time and 24% were then diagnosed with hypertension. Of the 24% of patients who were diagnosed with hypertension, no logs were used for the diagnosis. Medication was prescribed in 13% who had an elevated blood pressure without a diagnosis of hypertension. Nonpharmacologic management was documented in 56% of the sample. CONCLUSION: In this study, providers did not consistently adhere to the guideline for prescribing antihypertensive medication and nonpharmacologic management for elevated blood pressure. Findings did not indicate that home blood pressure monitoring was used for decision-making related to white coat hypertension. Home blood pressure monitoring is underutilized, and medications may be prescribed unnecessarily.

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