Winston Salem WellnessWinston Salem Wellness – Winston Salem Health Promotion

Appropriate health care or allied health professional trained in measurement of Blood Pressure (BP), referral protocols, and delivering educational messages to attendant delivering Blood Pressure (BP) programs. These programs are needed to follow national ground rules.

• National ground rules for Blood Pressure protocols:
   o Calibration of Blood Pressure (BP) calculating equipment
   be done at least annually.
   o Two or more measurements of participant’s Blood Pressure (BP) must be taken.
   o Referral of participants with high Blood Pressure (BP) readings to personal physician for further evaluation.

• Systolic/Diastolic Follow-Up:
   o Normal:   <130 / <85
      Action: Recheck in 2 years
   o High Normal:   130-139 / 85-90
      Action: Recheck in 1 year

• Hypertension:
   o Stage 1 (Mild):   140-159 / 90-99
      Action: Confirm within 2 Months.
   o Stage 2 (Moderate):   160-179 / 100-109
      Action: Refer to source of care within 1 month.
   o Stage 3 (Severe):   180-209 / 110-119
      Action: Refer to source of care within 1 week.
   o Stage 4 (Very Severe):   >210 / >120
      Action: Refer to source of care immediately.

• Appropriate educational messages:
   o Normal:   <130 systolic and <85 diastolic
      Action: No referral. If on treatment, then inform participant that Blood Pressure (BP) is under great control today and should continue seeing and following treatment program.
   o High Normal:   130-139 systolic and/or 85-89 diastolic
      Action: Recommend that colleague have Blood Pressure (BP) rechecked within 1 year unless under treatment. Advise colleague that the readings are in a high normal range that needs rechecking. In the interim, suggest that one of the most effective means to lower Blood Pressure (BP) is to bring weight into normal range and to exercise.
   o High:   >140 systolic and/or >90 diastolic
      Action: Refer to physician for further assessment within 2 months unless the level is within urgent, emergency, or isolated systolic hypertension levels. If already on treatment, advise participant of readings and need to get Blood Pressure to a goal of 140/90 or less.
   o Isolated Systolic Hypertension:   140-159 systolic and < 90 diastolic in a participant 65 years of age or older.
      Action: Advise attendant to inform physician of readings at next visit and consider advice regarding weight loss and exercise if appropriate.
   o Urgent:   180-209 systolic and/or 110-119 diastolic
      Action: Recommend obtaining medical evaluation within 1 week.
   o Emergency:   >210 systolic and/or >120 diastolic
      Action: Obtain immediate healthcare attention.

• Provides the following:
   o Written results, referral ground rules, and an explanation of Blood Pressure (BP) levels given to each attendant with individualized counseling, including advice about the interval of time recommended when the attendant should be checked again.
   o Utilizes the recommendations in The Fifth Report Of The Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure (BP), March 1994.
   o Written and audiovisual materials that are informative, simple to be aware of, and useful while containing scientifically accurate information.
   o Relationship of elevated Blood Pressure (BP) and other risk factors, such as family history, smoking, high fat and unhealthy diet, lack of exercise, in the development of cardiovascular disease, including stroke, kidney disease, heart attack, and other diseases.
   o Definition and causes of high Blood Pressure (BP).
   o Importance of following prescribed treatment.