High blood pressure (hypertension) is one of the world’s biggest killers. The World Health Organization estimates that about 1.3 billion adults have it, and that about half do not know. It is a major cause of stroke, heart attack, heart failure and kidney failure, and it is rising fast in Africa and Asia. Nurses diagnose it, monitor it, teach patients to control it, and increasingly prescribe for it through task-sharing programmes. This care plan covers the essentials.
Classification
| Category | Typical threshold (clinic reading) |
|---|---|
| Normal | Below 120/80 mmHg |
| Hypertension (WHO and most guidelines) | 140/90 mmHg or above on repeated readings |
| Severe hypertension | 180/110–120 mmHg or above |
Assessment
Measuring blood pressure correctly
- Patient seated for 5 minutes, back supported, feet flat, legs uncrossed, no talking.
- No caffeine, smoking or exercise for 30 minutes beforehand; empty bladder.
- Arm supported at heart level; correct cuff size.
- Take at least two readings a minute or two apart and record the average. Check both arms at the first visit.
- Confirm the diagnosis with home or ambulatory monitoring where possible, to rule out “white coat” hypertension.
History and examination
- Symptoms (often none), family history, smoking, alcohol, salt intake, physical activity, stress, sleep (snoring may suggest sleep apnoea).
- Medicines that raise BP: NSAIDs, some decongestants, steroids, oral contraceptives, some herbal products.
- Weight, BMI and waist circumference.
- Signs of target organ damage: chest pain, breathlessness, swollen ankles, visual problems, previous stroke.
- Tests as requested: urine for protein, kidney function, blood glucose, cholesterol, ECG.
Nursing diagnoses
- Deficient knowledge related to a new diagnosis and treatment, as evidenced by questions and misconceptions (e.g. “I’ll stop the tablets when I feel well”).
- Risk for decreased cardiac output related to increased afterload.
- Ineffective health management related to cost of medicines, side effects or complex regimens, as evidenced by uncontrolled BP and missed doses.
- Imbalanced nutrition: more than body requirements related to high salt and calorie intake and low activity.
Goals (SMART examples)
- Within 3 months, BP below 140/90 mmHg (or the individual target set by the prescriber; often below 130/80 for people with diabetes or kidney disease).
- By the next visit, the patient can name their medicines, doses and why they take them.
- Within 1 month, the patient reduces added salt and reports at least 30 minutes of brisk walking on 5 days a week.
Interventions
Medication management
Common first-line drug classes include calcium channel blockers (e.g. amlodipine), ACE inhibitors (e.g. lisinopril) or angiotensin receptor blockers (e.g. losartan), and thiazide-like diuretics (e.g. hydrochlorothiazide, indapamide). WHO’s 2021 guideline supports single-pill combinations to make treatment simpler. Teach:
- Take medicines every day, even when you feel well. Hypertension usually has no symptoms.
- Common side effects: ankle swelling (amlodipine), dry cough (ACE inhibitors), passing more urine (diuretics), dizziness on standing.
- Get up slowly from lying or sitting.
- Don’t stop suddenly, and don’t share tablets.
- Avoid NSAIDs such as ibuprofen and diclofenac without advice.
- ACE inhibitors and ARBs must not be used in pregnancy. Women of childbearing age should discuss contraception and pregnancy plans.
Lifestyle
- Cut salt: WHO recommends less than 5 g a day (about a teaspoon). Much salt is hidden in stock cubes, seasoning, processed and street foods.
- Eat more vegetables, fruit, beans and whole grains.
- Be active: at least 150 minutes of moderate activity a week.
- Lose weight if overweight; stop smoking; limit alcohol.
- Sleep and stress management.
Monitoring and follow-up
- Review every 2–4 weeks while adjusting treatment, then every 3–6 months once controlled.
- Teach home BP monitoring with a validated machine where affordable.
- Kidney function and potassium checks after starting ACE inhibitors, ARBs or diuretics.
When high blood pressure is an emergency
A very high reading (often 180/120 or above) with signs of organ damage is a hypertensive emergency: severe headache, confusion, chest pain, breathlessness, vision changes, weakness or speech problems (possible stroke), or reduced urine. Escalate immediately. Blood pressure is usually lowered gradually in hospital, because dropping it too quickly can cause a stroke. In pregnancy, a BP of 160/110 or above is an emergency: see our pre-eclampsia guide.
Evaluation
At each visit, compare BP against the goal, check adherence (ask openly: “Many people find it hard to take tablets every day; how often do you miss a dose?”), and address barriers such as cost, side effects or beliefs. Adjust the plan with the prescriber and patient together.
Related: The nursing process (ADPIE) · Normal vital signs
Based on WHO Guideline for the pharmacological treatment of hypertension in adults (2021), WHO HEARTS technical package and NICE NG136. Educational content: follow your national guideline.