HYPERTENSION

1. Reduce the incidence of strokes and congestive cardiac failure and renal failure.

2. Reduce the prevalence of overweight and obese clients.

3. The majority of patients are compliant and on continuous treatment.

1.1 Patients health learning materials available on hypertension diet, exercise and weight reduction.

2.1 Sphygmomanometer with different size cuffs
2.2 Urine test strips (blood, protein and glucose)

3.1

4.1 All adults entering clinic have blood pressure measured routinely every five years.
4.2 All patients with high normal values (135-139/85-89mm Hg) or previous high reading have blood pressure measured yearly.
4.3 At least two measurements of blood pressure are made at each of several visits to determine blood pressure.
4.4 Staff measure blood pressure seated but standing if patient elderly or diabetic.
4.5 Referral is made to a doctor for the start of treatment for all people with sustained systolic blood pressure 160mm Hg or sustained diastolic blood pressure > 100mm Hg.
4.6 Patients with a systolic pressure between 140-159mm Hg or sustained diastolic pressure between 90-99 are referred if they are obese, diabetic or have a strong family history.
4.7 The stepwise treatment outlined in the Standard Guidelines and Essential Drug list is followed.
4.8 Target blood pressure during anti-hypertensive treatment is less than 140 systolic and less than 85mm diastolic and is maintained with minimal side effects.
4.9 Combinations of drugs are prescribed by the hospital or visiting doctors.
4.10 Staff identify hypertensive emergencies (neurological signs, pulmonary oedema) and treat with oral nifedipine 5mg and refer.
4.11 Staff check compliance and ensure continuity.

5.1 Patients on treatment are referred if there is no therapeutic response.
5.2 All pregnant women are referred.
5.3 All children with hypertension are referred.
5.4 All hypertensive emergencies are referred.

6.1 All hypertensive or obese patients or those with a family history of hypertension are given non-pharmacological advice :

6.1.1 Weight reduction via reduced fat and total caloric intake, regular brisk physical exercise and limited alcohol consumption.
6.1.2 Reduced intake of salt.
6.1.3 Increased consumption of fruit and vegetables.
6.1.4 Stopping smoking.

7.1 Blood pressure and weight recorded regularly.
7.2 A chronic disease register maintained showing patient’s dates and monitoring monthly returns.

8.1 Community-based education programmes are initiated in all areas with high levels of obesity.
8.2 Community-based life-style improvement programmes are carried out with youth groups.

9.1 Staff collaborate with NGO or CBO dealing with obesity, diabetes and heart disease.