Heart Health: Positive Impacts on Cardiovascular Health with new Blood Pressure Guidelines

Today’s Nurses have a more prominent role in the prevention of cardiovascular disease

While February is American Heart Month, or Heart Health Month, the nursing profession is turning its attention towards leadership in cardiovascular disease prevention and awareness 12 months a year.

Leading the initiative is the Preventive Cardiovascular Nurses Association (PCNA), an organization headquartered in Madison, WI, with the mission of promoting nurses as leaders in cardiovascular disease prevention and management across the lifespan. PCNA endeavors to accomplish these goals by promoting nurses to both the public and to politicians as critical members of a healthcare team leading the way towards comprehensive cardiovascular risk reduction.

Jo-Ann Eastwood, PhD, RN, CNS, ACNP-BC, FAHA, FPCNA, is an associate professor at the University of California Los Angeles (UCLA) School of Nursing. Dr. Eastwood also serves as the president of PCNA. While talking with ADVANCE, Dr. Eastwood highlighted the advantages nurses possess in becoming leaders in cardiovascular risk management.

“We actualize our mission by providing nurses with resources—tools and education—to not only educate themselves and do their jobs better, but also to empower the community regarding cardiovascular risk factors,” she said.

Truthfully, the fact that February is Heart Health Month has little impact on the day-to-day business of PCNA. The organization is working 365 days a year to promote and further the placement of nurses as leaders in the cardiovascular field. However, Heart Health Month does offer the opportunity for Dr. Eastwood to promote some of the leading roles PCNA has earned in that regard. For example, in the past year two PCNA representatives were part of the team of over 20 authors involved in the rewriting of blood pressure guidelines.

PCNA’s past president, Cheryl Himmelfarb, RN, ANP, PhD, FAHA, FPCNA, FAAN, was one of two PCNA nurses on the writing team for the new blood pressure guidelines that came out in January, leading PCNA to update all relevant materials in time for Heart Health Month.

The guidelines, a combined initiative from the American Heart Association and the American College of Cardiology, took important steps towards determination of a universal guideline for elevated blood pressure and hypertension. Some critics felt in the past that said guidelines were too individualized, making it difficult for patients and healthcare providers alike to determine a fair measuring stick.

The new guidelines, on the other hand, state that ‘normal’ blood pressure is that which is under 120/80, whereas previously anything under 140/90 was defined as normal. The range of potential blood pressure readings in between those two benchmarks have been separated into categories:

  • Elevated blood pressure is now defined as a systolic (top number) reading between 120 and 129
  • Stage 1 high blood pressure is now defined as any reading between 130-139 systolic or 80-89 diastolic (bottom number). These readings are also considered a diagnosis of hypertension
  • Stage 2 high blood pressure is any reading above 140 systolic or 90 diastolic

The guidelines also worked to clarify and emphasize the importance of obtaining at least two careful, accurate blood pressure readings on separate occasions. What does this mean? Picture a patient coming across town for a 5 p.m. doctor’s appointment. They’ve just left their office after a hectic day and battled rush-hour traffic to arrive at your office with minutes to spare. From there, they hurriedly complete some paperwork before being weighed, ushered into an examination room and having the blood pressure cuff wrapped around their arm.

For years, practitioners and patients alike have known this could create an elevated, inaccurate reading. Now such a scenario is documented as the way not to do things, thanks to the new guidelines created in part by PCNA nurses.

As a result of member involvement, PCNA was one of the first—maybe the first—organizations prepared to offer patients education along the new guidelines. “We’ve put on webinars already to educate our nurses,” said Dr. Eastwood, “and we’ve provided handouts to allow our nurses to teach patients and disseminate these new guidelines.”

The lowering of thresholds for hypertension and pre-hypertension came with clarifications of risk factors. The centerpiece of those recommendation is changes to the individual’s lifestyle. Asked to summarize the importance of those lifestyle changes, Dr. Eastwood was succinct. “Increase physical activity, first of all,” she advised, “plus diet and nutrition. Lifestyle changes, ultimately, will be more effective than medications.”

Due to their unique public stature, perhaps no single group of professionals is better equipped to spearhead these changes than nurses. Aside from increasing involvement in creating policy and guidelines—evidenced by PCNA members’ involvement in creating these new guidelines—nurses have the respect and trust of the American public in a way no other profession does.

Dr. Eastwood pointed out a Gallup poll that singled out nurses as the most honest and trustworthy profession. The poll, released at the beginning of 2018, surveyed the opinions of Americans on some 22 different professions, and nursing came out with the highest marks for the 16th consecutive year.

“As nurses, we are, according to their findings, in an exquisite position to teach patients and persuade them to change behavior,” said Dr. Eastwood.

Dr. Eastwood and PCNA have partnered with over 30 different organizations for the common purposes or raising awareness of heart health and furthering disease prevention. These include such prominent organizations as the American Heart Association. “Right now, we’re looking at data from the past two decades,” she summarized. “Heart disease and stroke mortality have only gradually declined, and we think that has to do with [the prevalence of] diabetes. “We’ve also partnered with the European Society of Cardiology and the World Health Federation.

“We’re extending our reach. We want to bring nursing’s voice to the international level.”

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