A World Under Pressure: The Growing Burden of Hypertension

The global burden of hypertension was estimated at approximately 1.4 billion in 2010, and is projected to exceed 1.6 billion by 2025.1,2 Noncommunicable diseases (NCDs), which include hypertension, caused 40.5 million or 71% of the 56.9 million deaths that occurred globally in 2016.3 The consequences of uncontrolled hypertension include cardiovascular disease, renal disease, morbidity, disability, and shorter life expectancy.  Low- and middle-income countries are disproportionately affected by the hypertension epidemic1, although hypertension control rates are suboptimal in the United States. 4,5

With over 29 million nurses and midwives globally, and almost 4 million nurses in the United States6, nurses have the opportunity to set the tone for ending the hypertension epidemic. The designation of 2020 as the “Year of the Nurse and Midwife” by the World Health Organization, could serve as a fresh stimulus for renewed efforts by nurses to lead and collaborate in global efforts to curb the hypertension epidemic. 

Nurses and nurse practitioners have the opportunity to lead in several areas of hypertension prevention and care. A few of these roles are summarized below.

Patient education and skill-building for therapeutic lifestyle changes

Although there is overwhelming evidence that therapeutic lifestyle changes substantially reduce the risk for hypertension and CVD7, the adoption and maintenance of these behaviors is a persistent challenge for patients. Nurses play a crucial role in assisting patients in improving physical activity, dietary patterns, and reducing excessive alcohol consumption that causes high blood pressure (BP). Patient education should include a combination of teaching strategies to influence behavior, and produce improvement in knowledge, attitudes, and skills to improve hypertension outcomes. PCNA’s Heart Healthy Toolbox has patient fact sheets and provider tools that can assist with this education. Nurses should consider the approach to education, mode of delivery, and dose of education to enhance its effectiveness and ensure that socioeconomic and psychosocial factors, as well as health literacy issues,  are adequately addressed.8 Furthermore, effective behavioral and motivational strategies such as motivational interviewing may be necessary to achieve a healthy lifestyle.

Promoting Self-management/monitoring of Hypertension

The evidence base supporting self-management and monitoring for patients with hypertension is solid.9 As a chronic illness, effective hypertension management requires the engagement of patients in their care plan. This intervention involves self-monitoring/home monitoring of blood pressure with a validated and affordable BP measurement device and complemented with support from clinicians such as nurses. Nurses should train patients to measure their BP accurately and report readings to inform treatment decisions such as initiating therapy or titrating medications.

Utilizing Established Protocols to Manage Hypertension

Several evidence-based protocols can be used to build the capacity of nurses globally to manage hypertension.10 An example is World Health Organization HEARTS Technical Package for Cardiovascular Disease Management in Primary Care 11, which contains evidence-based treatment protocols for hypertension detection and treatment. The hypertension protocols are endorsed by the World Hypertension League and the International Society of Hypertension. Practicing team-based care and allowing nurses with advanced training to adjust medications using evidence-based protocols, either with approval from physicians or independently is more effective than patient education alone.12 Nurses should be trained globally and empowered to manage hypertension to avert the costly complications of uncontrolled hypertension.

Related Resources


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9. Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. Ann Intern Med. 2013;159(3):185-194. 10.7326/0003-4819-159-3-201308060-00008

10. Commodore-Mensah Y, Turkson-Ocran RA, Dennison Himmelfarb CR. Empowering Nurses to Lead Efforts to Reduce Cardiovascular Disease and Stroke Risk: Tools for Global Impact. J Cardiovasc Nurs. 2019;34(5):357-360. 10.1097/JCN.0000000000000606

11. World Health Organization(WHO). HEARTS Technical Package. https://www.who.int/cardiovascular_diseases/hearts/en/. Accessed June, 3, 2019.

12. Proia KK, Thota AB, Njie GJ, et al. Team-based care and improved blood pressure control: a community guide systematic review. Am J Prev Med. 2014;47(1):86-99. 10.1016/j.amepre.2014.03.004 [doi].

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