Provider Adherence to JNC 8 Pharmacological Guideline Recommendations in African American Adults Diagnosed with Hypertension

Abstract

Background: In the United States, one-third of adults have hypertension (HTN). Among African American (AA) adults, 43% of men and 45.7% of women have HTN. HTN in the AA adult population is more severe and occurs earlier in life compared to Caucasian adults, putting them at increased risk for cardiovascular events and renal disease. The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 8) Guideline Recommendations 7 and 8 were developed to aid in appropriate treatment and management of hypertensive AA adults. Purpose: The purpose of this Doctor of Nursing Practice (DNP) project was to improve the care, management, and outcomes of hypertensive AA adults by identifying current JNC 8 guideline prescribing patterns among a sample of hospitalized patients. The first project aim was to determine provider-prescribing rates of thiazide diuretics (TDs) and calcium channel blockers (CCBs) in newly diagnosed AA adults with HTN. The second project aim was to determine if AA adults previously diagnosed with HTN were currently prescribed TD and/or CCB medications. Methods: A retrospective medical record review of AA adult patients with a new HTN diagnosis or previously diagnosed with HTN was selected for this project. Participants were discharged from Medical City Dallas between 01/01/2017 and 03/31/2017. Results: In newly diagnosed participants with HTN, none were prescribed a TD (0%) and two were prescribed a CCB (40%). In previously diagnosed participants with HTN, 30 participants (16.3%) were prescribed a TD and/or CCB upon admission and 29 participants (15.76%) were prescribed a TD and/or CCB upon discharge. Among prescribing providers, beta blockers and other class hypertensive medications (i.e., furosemide, hydralazine, clonidine, and spironolactone) were most widely ordered for participants. Conclusions: The results of this DNP project display low provider compliance rates to guideline-recommended pharmacological therapy AA adults. This outcome highlights several potential reasons for the low adherence rates, including lack of provider documentation, lack of provider rationale for treatment selections, provider knowledge of HTN CPGs, and data analysis of prescribed medications. These factors present the opportunity for further research to identify the root cause of low compliance.