Newly diagnosed hypertension: case study
The role of an advanced nurse practitioner encompasses the assessment, diagnosis and treatment of a range of conditions. This case study presents a patient with newly diagnosed hypertension. It demonstrates effective history taking, physical examination, differential diagnoses and the shared decision making which occurred between the patient and the professional. It is widely acknowledged that adherence to medications is poor in long-term conditions, such as hypertension, but using a concordant approach in practice can optimise patient outcomes. This case study outlines a concordant approach to consultations in clinical practice which can enhance adherence in long-term conditions.
Hypertension is a worldwide problem with substantial consequences (Fisher and Curfman, 2018). It is a progressive condition (Jamison, 2006) requiring lifelong management with pharmacological treatments and lifestyle adjustments. However, adopting these lifestyle changes can be notoriously difficult to implement and sustain (Fisher and Curfman, 2018) and non-adherence to chronic medication regimens is extremely common (Abegaz et al, 2017). This is also recognised by the National Institute for Health and Care Excellence (NICE) (2009) which estimates that between 33.3% and 50% of medications are not taken as recommended. Abegaz et al (2017) furthered this by claiming 83.7% of people with uncontrolled hypertension do not take medications as prescribed. However, leaving hypertension untreated or uncontrolled is the single largest cause of cardiovascular disease (Fisher and Curfman, 2018). Therefore, better adherence to medications is associated with better outcomes (World Health Organization, 2003) in terms of reducing the financial burden associated with the disease process on the health service, improving outcomes for patients (Chakrabarti, 2014) and increasing job satisfaction for professionals (McKinnon, 2013). Therefore, at a time when growing numbers of patients are presenting with hypertension, health professionals must adopt a concordant approach from the initial consultation to optimise adherence.
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