This new section was officially launched on Nov. 2, 2010.

Overview of Hypertension:

Chronic conditions represent the bulk of home healthcare visits. Our most common chronic conditions are merely extensions of our most common cardiovascular risk factors. With an ever-growing population of Medicare patients at high risk for developing heart failure due to longstanding hypertension, diabetes mellitus, tobacco abuse and/or obesity, it is important for all healthcare professionals to do their part to reduce cardiovascular risk.

Hypertension is a primary risk factor for heart failure. A new standard of care recently published by the American Heart Association, the American Society of Hypertension and the Preventative Cardiovascular Nurses Association* states the importance of aggressive lifestyle change, risk reduction and public awareness of heart failure as it relates to those risk factors.

Home healthcare professionals are in a unique position not only to help increase public awareness but also to directly intervene upon the risk factors of their patient population. The importance of treating hypertension and diabetes in order to achieve glucose and blood pressure (BP) goals are part of the routine self-care measures instituted into a home healthcare plan. Similarly, it is now recommended that the use of home blood pressure monitors can be effective in helping a patient reach target goals. The purpose of this resource Website is to provide patients and clinicians with monitoring and education tools as well as an update on the standard guidelines for blood pressure management.

Although the most prevalent form of cardiovascular disease (CVD) is hypertension, the majority of cardiovascular disease deaths are attributed to coronary artery disease (CAD). The prevalence and incidence of coronary artery disease increase dramatically with age and coronary artery disease is the leading cause of death in the elderly with 84% of all coronary artery disease deaths in those 65 years of age or older (American Heart Association [AHA], 2001, 2009). Angina pectoris, a major manifestation of myocardial ischemia, is found in 13.7% of women and 21% of men 65-69 years old (Mittlemark et al., 1993). In women 70-84 years old, the prevalence is 19% and 24.7% in those aged 85 years and older. In men aged 70 years and older, the prevalence of angina is 27.3%. Thus, chronic stable angina represents an important problem in the elderly population.

Although angina usually indicates the presence of underlying coronary heart disease (CHD), myocardial ischemia can result from a variety of conditions that lead to an imbalance between oxygen supply and demand, for example, left ventricular hypertrophy and aortic valve stenosis. However, myocardial ischemia occurs frequently in the absence of angina or its equivalents (jaw pain, numbness, dyspnea, fatigue or nonspecific symptoms related to transient left ventricular dysfunction). This is particularly true in the elderly and in those with diabetes. Therefore, angina is neither a reliable nor a sensitive marker of myocardial ischemia.

Despite the limitation of using angina as a sole marker of coronary artery disease, the presence of angina supports the diagnosis of coronary artery disease and is useful in assessing disease progression and efficacy of medical management. Although heart failure may result from valvular dysfunction and other conditions, the majority of cases of heart failure are attributable to coronary artery disease in men and hypertension in women. Both coronary artery disease and subsequent myocardial infarction are potentially preventable conditions. The 2007 ACC/AHA Update for the Management of Patients with Stable Angina helps provide guidelines for translation into homecare practice.

The home healthcare nurse is again in a unique position to ensure patients at risk for the development of angina receive the information necessary for the prevention of coronary artery disease. The purpose of this resource Website is to provide patients and clinicians with monitoring and education tools as well as an update on the standard guidelines for the management of chronic stable angina and hypertension.