Category: Hypertension

Important Nurses throughout History

May 6th marks the beginning of National Nurses Week, commemorating the crucial role of nurses in the healthcare system and raising awareness of the value of nursing. The week-long celebration ends on May 12th – the birthday of the founder of modern nursing, Florence Nightingale. Although perhaps the most well-known, Nightingale was not the only nursing pioneer that made history. The nurses below made significant changes to the field through their discoveries, compassion, dedication, and practice – together forging the profession of modern nursing.

Florence Nightingale (1820-1910)

One of the most famous names in nursing, Florence Nightingale was an English social reformer and founder of modern nursing. Florence Nightingale advocated for patient and human rights, established new standards in healthcare as well as the concept of holistic nursing. She began her career in Egypt, where she underwent her first formal nursing training, with further trainings in Germany and France. Nightingale went on to voluntarily serve as Superintendent at the Institute for the Care of Sick Gentlewomen in London before her most famous contribution came during the Crimean War. Upon reaching the British camps, where she was to tend to military victims, Nightingale discovered the horrific conditions for the wounded and began her reform. She improved sanitation procedures< > as more soldiers were dying from unhygienic conditions than wounds, and drastically improved the hospital survival rate. The focus of her career turned to extending health and survival rates, and she opened the very first nursing school, Nightingale Training School, in 1860.

Dorothea Dix (1802-1887)

A pioneer of mental health advocacy, Dorothea Dix helped to advance the specialty of psychiatric nursing in a time when the mentally ill were neglected. Dix initiated a statewide investigation of the living conditions of the mentally ill in Massachusetts, which revealed that patients were often locked up, abused, and subjected to nearly torturous treatments. Her discoveries led her to create a report of the egregious human rights violations she had witnessed. Dix presented the report to state legislature, thereby leading to the expansion and significant improvement of the state’s mental healthcare system. She performed similar investigations in New Hampshire, Louisiana, North Carolina and other states, increasing awareness across the southern United States and eventually, the entire country. Her work, qualifications as a caregiver, and extensive body of research resulted in the creation of asylums nationwide.

Clara Barton (1821-1912)

Clara Barton’s work and dedication still affect millions today. At the start of her career, Barton organized and delivered medical supplies during the Civil War before moving on to treating wounded soldiers. She was so effective as a nurse that she was later put in charge of the Union hospitals. Barton spoke publicly about her wartime experiences, achieving nationwide recognition as the “Florence Nightingale of America”. After traveling to Europe and working with the Red Cross, she decided to bring the association back to America and was able to establish the American Red Cross  under the administration of President Chester Arthur. Her impact on healthcare can be felt today, as the Red Cross continues to assist victims of natural disasters around the United States.

Mary Eliza Mahoney (1845-1926)

Mary Eliza Mahoney began her groundbreaking nursing career as an untrained practical nurse and janitor at the New England Hospital for Women and Children. She was accepted into the hospital’s graduate nursing program, and graduated as one of the only three students to complete the course, making her the first African American in the U.S. to graduate from nursing school and work as a professional nurse. After graduation, she went on to work as a private care nurse before co-founding the National Association of Colored Graduate Nurses. Largely due to her efforts, the number of African American nurses doubled from 1910 to 1930. Mahoney made history by raising the status of nurses of color in the profession for decades to come.

Hazel Johnson-Brown (1927-2011)

Hazel Johnson-Brown made history as a nurse and educator serving in the United States Army for nearly three decades. Johnson enlisted in the Army in 1955, and began her career as a staff nurse in Japan. Throughout the 1960s, she trained surgical nurses on their way to Vietnam during the war. In 1979, she was serving as chief nurse of the Army hospital in Seoul, South Korea when she was promoted to brigadier general of the U.S. Army Nurse Corps, as the Army’s first African American female general. Her groundbreaking military nursing career paved the way for African American women serving in the military.

Not only did these pioneer nurses save countless lives and reform healthcare standards throughout their careers, but they also helped forge the path of modern nursing for the 4 million registered nurses practicing today. We’re wishing a very happy National Nurses Week to the awe-inspiring nurses dedicated to enhancing patient care each and every day.

Updated Guidelines for Blood Pressure

For many years, hypertension was defined as a blood pressure reading of 140 over 90 mm Hg or higher. Recently updated guidelines from the American Heart Association, however, now classify a BP of 130 over 80 mm Hg or higher as hypertension. As a result, many patients previously considered healthy—with normal or slightly elevated BP readings—now rank in the hypertension stage 1 category.

The updated guidelines are based on the 2017 Systolic Blood Pressure Intervention Trial, which indicated reduced chances of heart attacks, heart failure, and stroke over a three-year period: when targeting a systolic pressure of 120 mm Hg or lower. VA Boston Healthcare System endocrinologist Dr. Paul Conlin explains the lowered classification in Harvard Men’s Health Watch as a preventive measure to help people address high blood pressure and its correlated problems earlier.

Redefined classification categories and guidelines, new treatment suggestions, and pharmacologic recommendations from the AHA’s report are outlined below:

Updated Classification Categories

Beyond the change in definition, the updated hypertension guidelines have also eliminated the prehypertension category: previously defined as a systolic BP reading of 120 to 139 mm Hg or diastolic reading of between 80 to 89 mm Hg. These readings now fall into the categories of elevated blood pressure or Stage 1 hypertension, while Stage 2 hypertension begins at 140/90 mm Hg. Any reading higher than 140 over 90 is currently classified as hypertensive crisis.

New Treatment Guidelines

The AHA’s updated guidelines outline new treatment recommendations for patients with high blood pressure, including lifestyle changes and pharmacologic care. While the DASH diet is still referenced, the report recommends reducing sodium consumption and increasing potassium intake to lower BP. Patients with kidney disease, or those taking certain medications, should avoid excess potassium. Additional lifestyle changes include incorporating 90 to 150 minutes of aerobic or dynamic resistance training per week, and/or 3 sessions of isometric resistance training. Moreover, patients who consume alcohol should limit their intake to 1-2 drinks daily for men, and 1 daily drink for women.

For patients with normal BP, treatment is comprised of yearly evaluations and a focus on healthy lifestyle choices. It is suggested that patients with elevated BP (previously normal BP) implement lifestyle changes and reassess in 3-6 months. Stage 1 hypertension patients should be evaluated for 10-year risk of heart disease and stroke using the ASVCD calculator. If risk is less than 10%, patients should begin to integrate healthy lifestyle recommendations, with a reassessment in 3-6 months. If the risk is greater than 10%–or the patient has known clinical cardiovascular disease, diabetes mellitus, or chronic kidney disease—he/she should be prescribed a BP-lowering medication, coupled with lifestyle change recommendations. These patients should be reexamined in 1 month to ensure efficacy of the medication until control is achieved. Treatment for Stage 2 hypertension patients is similar, with the addition of another BP-lowering medication of a different class.

Pharmacologic Recommendations

New guideline recommendations focus on more aggressive pharmacological treatment of hypertension patients. While a BP-lowering medication is only recommended for those with an ASCVD risk of 10% or greater at stage 1, stage 2 treatment now includes 2 BP-lowering medications.

The updated guide also features recommendations for at-risk populations with higher morbidity and mortality rates associated with hypertension, such as African-American and Hispanic adults. In order to achieve a BP of less than 130/80 mm Hg in these groups, 2 or more BP-lowering medications are suggested.

Currently, the AHA reports that nearly half of American adults have high blood pressure; nearly half of those cases are uncontrolled. With the implementation of the new blood pressure guidelines, patients will receive treatment at earlier stages of hypertension, thus reducing their risk of heart disease, stroke, and other life-threatening illnesses.