Non-pharm interventions for very high blood pressure?

1. Hi everyone. I am a recent grad working in long term care. Many of our patients tend to get “sundowners” and will refuse their PM medications. After refused blood pressure medications I see a lot of very high blood pressures for example 178/86, 192/96 etc. Not yet in the defined hypertensive crisis range of >180 systolic “and” >120 diastolic but high enough to make me worry.
   
   Are there any non-pharmacological interventions I can take to help reduce the patients BP? The only things I can think of are having the patient rest, reducing stressors such as reducing noise and dimming lights, but what else is there?
   
   At what point should I call the doctor? I called for the 192/96 (after several high BP readings in 2.5 hours with no symptoms s/a severe headache, I called) and the doctor seemed completely unconcerned, didn’t give parameters for a call back. Am I worrying when I shouldn’t?
   
   Several of the other nurses told me they raise the foot of the bed and lower the HOB but I thought that was only for hypotension. Wouldn’t that intervention increase blood pressure?
   
   Thanks for any help or advice.

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2. 9 Comments

   Comment
3. 
   Jan 6, '11

   You should discuss the nature of the problem with each patient's doctor to see if there are long-acting medications can help solve the problem.
4. 
   Jan 6, '11

   Dash diet? Can dietary assist with this issue at all?
5. 
   Jan 6, '11

   Change important medication times to something earlier in the day.
6. 
   Jan 6, '11

   This sounds like a bigger problem of patient who aren't competent refusing meds. Can't they get them earlier when they are more with it? Also the answer to your last question is yes. That doesn't make much sense unless they are trying to keep them in bed.
7. 
   Jan 7, '11

   How about discussing their refusal with the physician in order to get the ok on crushing the meds?
8. 
   Jan 7, '11

   With each patient something different might need to be done. For one they may need to get his or her meds earlier in the day while for another it could be just as simple as crushing the meds and putting them in applesauce or pudding. Talk to the doctor and hopefully come up with the solution best for that patient
9. 
   Jan 7, '11

   music and pets are documented non-pharm measures, but I would try the above suggestions first.
10. 
    Jan 7, '11

    If this is a pattern of high BPs and refusals, then the meds need to be given at a different time. Do not raise the foot and lower the HOB, you are right, that is for HYPOtension. And I wouldn't be surprised if the doc didn't immediately call you back for that pressure, you are right, it is not a crisis.
11. 
    Jan 7, '11

    Thanks everyone for the advice, I think I will try to talk to the doctor about changing med times or seeing if there is an extended release medicine that might be an option.

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