Army Action Plan: Standard Operating Procedures for High Blood Pressure Management

Army Action Plan: Standard Operating Procedures for High Blood Pressure Management at the detainee Hospital at Guantanamo Bay.

Doc_type: 
Non-legal Memo
Doc_date: 
Thursday, October 16, 2003
Doc_rel_date: 
Tuesday, November 29, 2005
Doc_text: 

DETAINEE HOSPITAL GUANTANAMO BAY, CUBA SOP NO: ESS
Title: HIGH BLOOD PRESSURE MANAGEMENT Page I of 5 Effective Date: 16 Oet 03
SCOPE: Deland:le Hooks!
L SNCL: (1) Chronic Disease Medical Flow Sheet
IL REFERENCES

(1)
Joint National Committee on Prevention, Detection, Evolution, and Treatment of High Blood Pressure. The Seventh Report of the JNC on Prevention, Detection. Evaluation, and treatment of High Blood Pressure. JAMA. 2003; 2E9(19)2560-72.

(2)
National Commission on Correctional Health Care Clinical Guideline for Correctional Facilities — Transept of High Blood Presnlre

II. BACKGROUND
High blood pressure is a disease that causes an Increased risk for stroke. heart disease, and renal failure. While traditionally recognized as a problem in the United States, it is a significant cause of morbidity and mortality worldwide that can be reduced by early intervention. It is well established in Western populations, that the risk of stroke, CHD sod other common cardiovascular diseases, have multiple determinants such as age, high blood pressure, hypercholesterot, obesity; and family history. How well these factors predict cardiovascular disease in non-Western populations is less certain, although recent evidence from Eastern Asian populations suggests that blood pressure may have a similar association. However, there is little evidence about these factors in other large populations such as in sub-Saharan Africa, India or South America. The evaluation and vestment of these determinants in a similar manner may be beneficial until fiture research dictates otherwise. This guideline is adapted from the Seventh Report of the Joint National Committee on Prevention. Detection, Evaluation, and Treatment of High Blood Pressure.
III. POLICY
This is the first SOP on high blood pressure management and tide program will be conducted by a medical provider an the JTF staff under the guidance of the Senior Medical Officer (SMO). Scheduled blood pressure monitoring will occur to screen detainees for hypertension and to offer further evaluation and treatment.
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HIGH BLOOD PRESSURE MANAGEMENT SOP: 0S3
Page 2 of S The Delta Medical Clinic is reepounble for providing blood pressure monitoring and medical treatment as clinically indicated for detainees with high blood pressure. The SMO will
enure
that the appropriate randards of care for the medical and administrative management of high
blood pressure are adhered to.
allolliggAkiximnika. The mean of two or more sated blood pressure (BP) readings ontwo or more occasions with a systolic BP gremer than or equal to 140 ora diastolic BP pesterthen or equal to 90 will be considered hypertensive.
IV.. PROCEDURES
A. Correct Measuranent of Blood Pressure:
1. Detainee should be seated for at least five minutes with arm supported at heart level. The BP cuff bladder should encircle at least SO% of the arm. Sy/toile BP measurement should benoted at the point at which the first sound is headand the diastolic meenweelent should be noted at the point just before the
sound disappears.
B. b-proceedsg
1.
Igiddhisix: Upon arrival, detainees will hive a history and physical=ambition recorded on the report of medical examination (see SOP 037).History and symptoms of diabetes, heart Masse, hypertension, hyperlipidemie, and renal disease will be obtained. Current/pea medicationuse inchefing illicit drug, alcohol, and tobacco will be obtained.

2.
firagEdiaminatieg: At least two blood pressure measurements will beobtained using the above-described methods. Elevated measurements will be verified using the contralsteral arm. The weighs and height of each detaineewill be determined with calculation of the body mess index (see SOP 014).Physical examination will include hadoscopic examination, auscultation forcerodd bruitsohyroid exoninistion, thorough cardiovaseada and lung exam,

abdominal examination for bruits, abnormal pulsations, and organffineguly,aerologic examination, and easement of Motel extremities for pulses and
edam.u.
3. Diggingirjuds: As indicated by the historical or physical exam findings, additional Monitory studies may be obtained to amass for identifiable causes of hypertension or for the jetsam of end-orpn damage. .These may include,but are not limited to: complete blood count (CBC), blood chemistries. u

urinalysis, lipid panel, and 12-lad electrocardiogram.
4. All detainees will be reassessed for repeat blood pressure measuranents within one month, which will be recorded in the medical record and • mean blood pressure measuranent determined. Detainees witb.known hypertension '
or abeaml findings by examination will be managed per guidelines listed
below.
C. Classification of Blood Pressure (from .1NC VU)
I. Normal: systolic BP less than 120 and diastolic BP 00
2. Errhyrainr: systolic BP 120-139 Of diastolic BP 11049
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HIGH BLOOD PRESSURE MANAGEMENT SOP: 053 Page 3 of 5
3. Naggljummaks systolic BP 140-159 or diastolic BP 90-994• Agigellungsgika systolic BP 139 or diastolic BP 99
V. MEDICAL EVALUATION AND MANAGEMENT
A. Mougensent of Detainees with Hypertension
1. General Guidelines:
i. All detainees will be educated regsrding lifestyle modification. Please
mew to 90P 014 for guidelines on the weight management program.Weight metal and diary sodium restriction have been Mown to
Weight
ii. The blood pressure goal to mime
the risk of catdomecular disease is
asystolic sed diastolic BP less than 1401'90 mm Hg or less than 13040mm Hg for individuals with diabetes or rand dense.
iii. Cement clinical trials have decionstraled @Mew from severed classes of antiltypertartives including angiotendn-conveeting enzyme • inhibitors, benoblockera. adclurn almond Modem, and thimide diem ca, 2 or move andhypertensim media tines u
be needed to
mach the desired BP goal While thiadde &nudes hove been used in the most trials and have deenonstrated efficacy both as single drug andin oombisetion. providers should be cognisant of the hot weed=elitism Ind de poundal rid for elertrolyte abnormalities and
dehydration.
2. Detainees with Prehypertension:
i.
Unless there b a melded indention fbr medical therapy such as:recurrent stroke, hetet fitilure, &bete; preview myocardial inferedao. or high risk fir coronary dream, no medical tbengay isindicated. himeganeat will include Aare no
lifestyle
modification.
3. Deadness with Hypertension (stage 1) L In addition to lifestyle modificatice, the use of reecfication will likely
be required to meet the gods.
4. Detainees uHypertension (stage 2)
i. Detainees with stage 2 hypertatelon will require anditypertensivemedical therapy in addition to lifestyle modification.
B. Detainees enrolkd in the blood pressure management program will be categorized in the following manner bend on the blood ptessure classification and degree of control
(using NCCHC
1. Imams Includes detainees with hypertension (systolic BP 159
ordiastolic BP 99) or those with signiflatt cardiovaecular comorbidities.
Thee detainees will be monitored at least monthly or more frequent as necessary with BP goal is attained. Once BP goal is net and is stable. visitscan be done every 3-6 months. Visits should include blood premure determirations, amassment of mediation tolerance. and education. Sawn
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u
HIGH BLOOD PRESSURE MANAGEMENT SOF 0S3 Page 4 of 5
creatinine and potassium should be obtained 1-2 times such year. Results will be recorded on the Chronic Dismay Medical Row Sheet (sea enclosure 1).
2. isiEgaug. Includes detainees with systolic BP 140-159 or diastolic BP of
90.99. These detainees will be monitored at least every 2-3 months for blood pressure determinstioa, assessment of medication tolerance, and education. Results will be recorded on the Ckvisk Disease Medical Flow Sheet (seeenclosure 1).
3. Good Control. Includes detainees with a blood pressure less than 140/90. These detainees should be seen initially every 3-4 months and if controlled and stable, this may decrease to twice yearly. Visits should include blood prams determinstioo, medication tolerance, and lifestyle education with the results recorded on the Chromic Disease Medical Flow Sheet (see enclosure1).
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HIGH BLOOD PRESSURE MANAGEMENT SOP: 053 Page 5 405
STANDARD OPERATING PROCEDURES Detention Hospital
J7.••••••
REVIEWED AND APPROVED BY: .,
Officer in Charge
IMPLEMENTED BY:
Director for Administrationu.
Date
Senior Enlisted Advisor
Date
ANNUAL REVIEW LOG:
By: Date:
By: •u• Date:
By: Date:
By:
Date:
By: Date:
By: Date:

SOP REVISION LOG:
Revision to Pap: Date:u.
Revision to Page: Date:
Revision to Page

Date: •
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ENTIRE SOP SUPERSEDED BY:
Title:
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SOP NO: -.
Date:
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Doc_nid: 
2919
Doc_type_num: 
63