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BENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENT

BENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENTBENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENTThe purpose of this assignment is to identify a clinical practice guideline in your specialty area. You will be challenged to evaluate this guideline and discuss its use in clinical practice. This assignment is due at the end of Week 8 but can be completed anytime during this course. This assignment requires a considerable amount of time for completion. Do not wait until week 8 to begin this assignment.BENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENTChoose a health problem that you may commonly see in primary care nurse practitioner practice. Describe the health problem and recommended medical management for it. Research published clinical practice guidelines and evaluate the practice guideline you have selected based on the components listed in the Clinical Practice Guideline Template below.BENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENTORDER A PLAGIARISM-FREE PAPER HEREClinical Practice Guideline Prompts:HEALTHCARE PROBLEM IDENTIFIED: Briefly describe the health problem you have identified. Include a discussion of morbidity, mortality, epidemiology and pathophysiology related to this health problemPRACTICE GUIDELINE: Describe the clinical practice guideline used for this problem. Reflect on the questions included. Expand on your answer using support from evidence· Does the clinical practice guideline adequately address the health problem? Describe.BENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENT· Is this practice guideline based on current evidence (within 5 years)? What is the strength of this evidence?· Does this clinical practice guideline adequately direct the healthcare provider in the management of a patient with this problem?· How effective is this clinical guideline in the management of patients with this healthcare problem? Think about how you would assess the effectiveness of patient management.ANALYSIS: Think about future healthcare needs of patients with this problem, changing demographics, and changes in healthcare policies. Address these questions.BENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENT· Does this clinical practice guideline need revision(s)? Please explain your answer in detail.· If you were going to revise this clinical practice guideline, what would you change? What evidence would you use to base your changes on?· How might changes in US demographics and healthcare reform affect this clinical practice guideline?· What strategies would you use to increase the likelihood that a new or modified clinical practice guideline would be adopted and used in clinical practice?BENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENTEVALUATION How would you determine its effectiveness of this revised clinical practice guideline in directing care for patients with the identified health problem? Outline the steps you might employ.LEARNING POINTS (3-5 bullet points outlining key learning in this case.)REFERENCES (APA formatting, current within past 5 years.)BENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENTExpectationsBENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENT· Length: 8 pages minimum, 10 pages maximum not including the title page, abstract, and reference pages· Format: APA formatted paper – you can opt to use the prompts or a version of the prompt for headers, but do not copy the prompts directly into your paper· Research: APA formatting, current within past 5 years.Running head: EVALUATION HYPERTENSION CLINICAL PRACTICE GUIDELINE 1Evaluation of Hypertension Clinical Practice GuidelineCarla J. Aldaz, RN, BSNUnited States University: FNP59106/28/2021Professor: Dr. Mary BoatengEVALUATION HYPERTENSION CLINICAL PRACTICE GUIDELINE 2AbstractHypertension is characterized by chronicly high blood pressure (BP) in a patient’s circulatorysystem. It is highly prevalent in the US, with data from the recent survey data from the CDCsuggesting that 49.6% of US adults aged 20 years and older had hypertension in 2017-2018,while approximately 36,524 individuals died from the condition. Despite its increasedprevalence, its management has been controversial in the US, with the recommendation thatthe threshold for blood pressure treatment being <130/80 mmHg highly criticized. Thisunderscores the possibility of concluding whether the available guideline is trustworthy.Therefore, it needs further revision to direct the delivery of care to hypertension patientseffectively. BENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENT EVALUATION HYPERTENSION CLINICAL PRACTICE GUIDELINE 3Evaluation Hypertension Clinical Practice Guideline1. Healthcare Problemi. Description of HypertensionHypertension is characterized by chronically high blood pressure (BP) in a patient’scirculatory system (Oparil et al., 2018). Majorly, blood pressure is expressed as the ratio ofsystolic blood pressure and diastolic blood pressure. The threshold of BP that defineshypertension depends on the measurement method used, including Office BP, AmbulatoryBP, and Home BP, among other relevant measurement techniques. In addition, variousetiologies potentially underlie the disease. For example, most hypertension patients arecharacterized by a highly heterogeneous primary hypertension comprising a multi-factorialgene-environment etiology (Taddei et al., 2018). Besides, the frequent occurrence of thedisease is also linked to a positive family history of hypertension. Ideally, research studieshave estimated the heritability of the disease to range between 35% and 50% (Oparil et al.,2018). Thus, the condition is regarded as among the most common preventablecardiovascular disease risk factor (Oparil et al., 2018; Taddei et al., 2018). The morbidity datafrom the Centers for Disease Control and Prevention (CDC) provides that 49.6% of US adultsaged 20 years and older had hypertension in 2017-2018 while approximately 36,524individuals died from the condition; providing an estimated 11.1 deaths per 100,000 peopledied from essential hypertension and hypertensive disease (CDC, 2021).BENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENTii. Epidemiology of HypertensionThe definition of hypertension varies depending on guidelines; for instance, Wheltonet al. (2018) note that the American guidelines provide the threshold for the diagnosis of thedisease to values of at least 80 mmHg during diastole and values of at least 130 mmHgduring systole (130/80 mmHg). On the contrary, the 2018 European guideline onhypertension recommended a threshold of 140/90 mmHg (Taddei et al., 2018). Furthermore,BENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENT EVALUATION HYPERTENSION CLINICAL PRACTICE GUIDELINE 4data provides that hypertension-related deaths occur due to ischemic heart disease, ischemicstroke, and hemorrhagic stroke, which according to estimates, account for 4.9 million, 1.5million, and 2 million deaths in that order (Forouzanfar et al., 2017). Beyond the impact ofthe disease on mortality, higher systolic blood pressure is regarded as the leading cause ofdisability globally; accounting for approximately 218 million global disability-adjusted lifeyears (DALYs) (GBD 2017 Risk Factor Collaborators, 2018). Consequently, data alsoprovides that there has been an increasing burden of hypertension-related CVD, which alsoaccounts for a significant increase in the number of disability-adjusted life years. Forinstance, Taddei et al. (2018) demonstrate that between 2007 and 2017, there wasapproximately a 31% increase in the number of DALYs as a result of the increase ofhypertension-related cardiovascular diseases.BENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENTAccording to a survey conducted by the Centers for Disease Control and Prevention(CDC) in 2017/2018, age-adjusted hypertension is 45.4% prevalent among American adults,with the condition highly prevalent among men (51.0%) compared to women (39.7%)(Ostchega et al., 2020). The survey also provided that the condition’s prevalence increasedwith age, where it is slightly less prevalent among the younger adults compared to the elderly.In terms of races, the CDC survey provided that hypertension is highly prevalent among thenon-Hispanic Black (57.1%) compared to the Hispanic white (43.6%) and the Hispanic adults(43.7%). Nonetheless, the survey showed a decrease in the prevalence of hypertension from47% in 1999/2000 to 41.7% in 2013/2014 before an increase to 45.4% in 2017/2018(Ostchega et al., 2020).BENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENTiii. Pathophysiology of Hypertensiona. Blood Pressure RegulationMaintenance of the physiological blood pressure level requires an integrated interplayof several elements of normal physiologic processies, including the sympathetic nervousBENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENT EVALUATION HYPERTENSION CLINICAL PRACTICE GUIDELINE 5system, the endothelium, the immune system, and the renin-angiotensin-aldosterone system(Oparil et al., 2018). Therefore, possible disruption or malfunction of the factors involved inblood pressure hemostasis can increase the mean blood pressure; thereby, leading to apossible target organ damage (Hall & Hall, 2018). The pathophysiological mechanism relatedto hypertension is highly integrated and acts on a genetic foundation, where the geneticpredisposition and various environmental factors risk factors such as high intake of Na+ andsleep apnea contribute to hypertension development (Hall & Hall, 2018). Consequently, theprobability of individual developing hypertension is also linked to aging (Mikael et al., 2017).Besides, immunological factors also play a significant role in an individual developing thecondition, especially rheumatological diseases like rheumatoid arthritis and the backgroundof the disease.BENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENTb. Regulation of Sodium HomeostasisThe function of sodium (Na+) in the human body is to regulate hydration levels; thus,high sodium concentration in the body facilitates the retention of water, which causes anincrease in blood pressure and volume (Oparil et al., 2018). An increase in sodium, especiallyin normotensive people, leads to compensatory hemodynamic changes in the body tomaintain constant blood pressure. The changes include a decrease in peripheral and renalvascular resistance as well as an escalated production of nitric oxide. In the process, if theeffects of the produced nitric oxide are absent or impaired (endothelial dysfunction), anincrease in blood pressure is experienced; thereby, leading to the development ofhypertension and salt sensitivity (Feng et al., 2017). Salt-sensitive individuals manifest anescalated production of the transforming growth factor β (TGF-β) in response to a high saltload (Wilk et al., 2017). This increases their oxidative stress, risk of fibrosis, as well as alimited bioavailable nitric oxide. Consequently, a higher salt intake induces the T helper 17(TH17) cells, thereby driving autoimmunity. Therefore, a moderate intake of salt in humansBENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENT EVALUATION HYPERTENSION CLINICAL PRACTICE GUIDELINE 6helps reduce the survival of Lactobacillus spp in intestines, increase blood pressure and theactivity of T (TH17) cells; thereby, leading to the pathogenesis of hypertension.c. Renin-angiotensin-aldosterone system (RAAS)The RAAS has several effects on BP regulation, including mediation of Na+ retention,salt sensitivity, pressure natriuretic, vascular injury, endothelial dysfunction, andvasoconstriction, all of which are significant in hypertension pathogenesis (Hall & Hall,2018). It is present at the cellular level in organs and aids in regulating pressure-volumehomeostasis in the human kidney. This is achieved by maintaining perfusion in volume worn-out states and is suppressed when there is a volume expanded condition. Renin cleavesangiotensinogen to produce angiotensin I, which is then cleaved to form angiotensin II (existsat the center of the pathogenetic function of the renin-angiotensin-aldosterone system inhypertension) as stated by Dunphy et al. (2019). The process occurs in response to variousstimuli that necessitate the release of renin and its precursor pro-renin from thejuxtaglomerular kidney cells, where they are synthesized and stored. The role of angiotensinII is to enhance the reabsorption of Na+ in the proximal tubule by escalating the activity ofsodium-bicarbonate exchanger, sodium-hydrogen exchanger, and sodium-potassium ATPaseas well as by inducing the release and synthesis of aldosterone from the adrenal glomerulosa(Hall & Hall, 2018).The angiotensin-converting enzyme 2 (ACE2) is a significant modulator inhypertension pathophysiology since it plays a crucial role in metabolizing angiotensin II toangiotensin (1-7), which induces regional and systemic vasodilation, natriuresis, and diuresis,and also exerts antigrowth and antiproliferative effects on the cardiac myocytes, vascularsmooth muscle cells, proximal and glomerular tubular cells as well as the fibroblasts (Oparilet al., 2018). On the other hand, aldosterone binds to the mineralocorticoid receptor andinduces non-genomic effects, including activation of the epithelial sodium channel leading to BENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENTEVALUATION HYPERTENSION CLINICAL PRACTICE GUIDELINE 7the stimulation of the reabsorption of renal Na+ in the cortical collecting duct. Consequently,it also leads to various non-epithelial effects that facilitate vasoconstriction, hypertension, andendothelial dysfunction (Oparil et al., 2018).BENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENTd. Sympathetic Nervous SystemDuring sympathetic stimulation, BP increase, especially in patients with hypertensionand blood pressure. Research has failed to whether the hyperresponsiveness resides in themyocardium, sympathetic nervous system, or the vascular smooth muscle (Bakris, 2021).However, it has been established that a higher resting pulse rate potentially results from anescalated sympathetic nervous activity, which is a common hypertension predictor. Anelevated blood pressure stretches the internal carotid artery, which then sends messagesthrough the nerve bundles projected from the baroreceptors in the carotid sinus to the humanbrain to lower sympathetic outflow of the nerve traffic or the nerve impulse; thereby, leadingto blood pressure (de Leeuw et al., 2017). Many hypertensive patients are in an autonomicimbalance state with low parasympathetic and high sympathetic activity (Oparil et al., 2018).As a result, they experience an escalated severity of hypertension, linked to risingsympathetic activity levels (Dunphy et al., 2019). The sympathetic nervous system has beenproved as highly significant in hypertension pathogenesis since a high increase in the renalsympathetic nerve activity escalates renal sodium reabsorption; thereby, facilitating themaintenance of sustained hypertension.BENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENT2. Clinical Practice GuidelineThe current clinical practice guideline for hypertension recommends diuretics,angiotensin receptor blockers (ARBs) or inhibitors, angiotensin-converting enzyme (ACE),calcium channel blockers (CCB), and beta-blockers as the first-line medications forhypertension treatment, with some patients requiring two or more antihypertensivemedications to achieve their blood pressure clinical target (Dunphy et al., 2019). Despite  EVALUATION HYPERTENSION CLINICAL PRACTICE GUIDELINE 8constant updates and revisions, the available clinical practice guideline for hypertension stillhas various controversial recommendations, especially on salt, dietary, and blood pressurerecommendations. This underscores the possibility of concluding whether the availableguideline is trustworthy. An effective clinical practice guideline aims to set the standard forpractice and should be accepted by the healthcare provider, disease advocacy groups,patients, healthcare stakeholders, and professional organizations (Dunphy et al., 2019). Thismeans that for a clinical practice guideline to be regarded as effective and adequate forclinical practice, it needs to be driven by solid scientific documentation and carefullyappraised high-quality evidence. The guideline provides the standard blood pressuretreatment recommendation of <130/80 mm Hg and <140/90 mm Hg for patients withsignificant comorbidities over 65 years. The supporting evidence for this treatment goal wasderived from a meta-analysis study comprising of 9 trials, and it demonstrated that reducingthe systolic blood pressure to <130 mm Hg led to an absolute reduction of approximately1.1% in adverse cardiovascular events and 0.5% absolute reduction in stroke (Unger et al.,2020). However, this did not have any impacts on heart failure, myocardial infarction, renalevents, as well as cardiovascular deaths, and all-cause mortality.BENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENTFrom this perspective, it is debatable whether supporting evidence and treatmentbenefit is statistically and clinically significant to support medical practice and public policy.Consequently, the systematic review that provided the recommendation for BP 130/80 mmHg did not formally consider the factors that modify evidence quality and the possible harmthat can lead to adverse effects on the benefit-risk trade-off. Besides, it fails to utilize currenthypertensive evidence; therefore, it does not adequately address the need for hypertensiontreatment and management. Moreover, other professional societies such as the EuropeanSociety of Hypertension, the position statement by the American Diabetes Association, theAmerican Academy of Family Physicians, and the American College of Physicians haveBENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENT EVALUATION HYPERTENSION CLINICAL PRACTICE GUIDELINE 9declined to universally endorse the blood pressure recommendation (Messerli & Bangalore,2018).The meta-analysis study used for the guideline evaluated 6 cardiovascular outcomesacross approximately 8 trials (Unger et al., 2020). The results provided about 6 out of 33outcomes to lower the mean blood pressure. 4 of the 6 outcomes were reduced in the SPRINTtrial while stroke was reduced in 1 trial. None of the trials failed to demonstrate a reduction inmyocardial infarction. Therefore, the guideline specifically uses the SPRINT trial as evidenceto support the <130/80 mm Hg blood pressure treatment goal. Nonetheless, the guidelinecomplies with the Institute of Medicine (IOM) standards for developing reliable clinicalpractice guidelines to optimize care. As such, the challenge regarding the quality of evidenceused for the guideline adequately directs the healthcare practitioners in the management ofhypertension.BENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENTThe hypertension clinical practice guideline provides that antihypertensive drugtreatment should be lowered for Diabetes mellitus patients if the patient has ≥140/90 mm Hgand treated at a medical objective of <130/80 mmHg (Unger et al., 2020). In adults withhypertension and diabetes mellitus, all the first-line antihypertensive agents such as ARBsand diuretics are regarded as effective. Nonetheless, for the treatment of stroke patients, theguideline recommends that an immediate lowering of blood pressure to <130/80 mm Hg and<140/90 mm Hg for patients with significant comorbidities over 65 years, which is lesseffective and can even lead to the death of the patient. Furthermore, the benefit of loweringthe systolic blood pressure is not clear. Based on these scenarios, the effectiveness of theguideline in the management of hypertension patients is hard to grade, but it is clear that it isnot entirely adequate.3. Analysis  EVALUATION HYPERTENSION CLINICAL PRACTICE GUIDELINE 10The current clinical practice guidelines for hypertension needs revision to helpadequately optimize patient care. The supporting evidence provided by the guideline for<130/80 mm Hg BP level recommendation and the dietary and salt recommendations for themanagement and treatment of hypertension is insufficient to warrant the change from theprevious <140/90 mm Hg recommendation. Based on the results of the meta-analysis studythat led to the recommendation, the guideline failed to formally consider the factors thatmodify evidence quality and the possible harm that can lead to adverse effects on the benefit-risk trade-off. This means that as it is currently designed, it recommends clinical practicesinadequately supported with evidence for the treatment and management of hypertension. Forinstance, Unger et al. (2020) states that while treating hypertension and previous strokepatients, an immediate lowering of blood pressure >140/90 mm Hg to a target <130/80 mmHg (<140/80 for the elderly patients) is recommended. However, this is less effective and caneven lead to the death of the patient.BENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENTTo make the guideline effective for clinical practice, the methodology of the guidelineshould be revised to include a more rigorous, systematic review of the literature and definethe standards for the assessment of individual scholarly studies. Consequently, other issuesthat need consideration, such as the factors that modify evidence quality and the possibleharm that can lead to adverse effects on the benefit-risk trade-off, should be rigorously,explicitly, and consistently considered in the guideline to refine the evaluation process. Ascurrently designed, the guideline shows important limitations such as the utilization of softendpoints and missing data, which weakens the evidence; thus, downgrading therecommendations. Also, it would be imperative to avoid overreliance on meta-analysis that isfounded on a p-value threshold of <0.05 to determine the statistical and clinical significanceof the guideline. On the contrary, a p-value of 0.01 or lower should be used to reduce false BENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENTEVALUATION HYPERTENSION CLINICAL PRACTICE GUIDELINE 11positives that emerge from multiple comparisons. This should also compensate for theunknown and known factors of risk and potential biases (Lietzan, 2018).Additionally, it would be ideal for providing clarity between the medically significantbenefits and harms to influence the strength of the recommendations in the guideline(Dunphy et al., 2019). Although the current guideline clearly defines the strength of therecommendation criterion based on the benefit-risk trade-off, a standardized and transparentbenefit-risk evaluation is less routinely considered in the recommendation development.Lastly, an effective practice guideline should be user-friendly, efficient, timely, cost-effective,and embedded in the electronic medical record system (Dunphy et al., 2019).BENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENTThe new version of the guideline will provide a justification of whether the <130/80mm Hg BP should be adopted or abolished in practice. This is because, from a health careprovider’s point of view, the guideline provides limited evidence to support the decision toutilize a lower blood pressure, especially in regards to the management of myocardialinfarction, renal adverse events, heart failure, and cardiovascular events. Consequently, theguideline also provides a controversial recommendation on the risk-based treatment for grade1 hypertension, which limits pharmacological therapy to patients with blood pressure 130 to159/85 to 99 mm Hg and a 10-year ASCVD (atherosclerotic cardiovascular disease) risk of>10% (Whelton et al., 2018). The guideline estimated the 10-year risk from a study cohortthat was never used in a medical trial where the blood pressure was lowered to the suggestedvalues of 130 to 159/85 to 99 mm Hg.Changes in healthcare reforms and U.S demographics can potentially have impacts onthe application of the revised hypertension guideline. This is because the US healthcare needsexperience constant evolution, especially in response to the need for quality and advancedcare provision. In the US, various factors and evolving trends constantly impact its healthcaresystem, for instance, the increasing aging population, the increased demand for IT in BENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENTEVALUATION HYPERTENSION CLINICAL PRACTICE GUIDELINE 12healthcare, rising clinical costs, rising number of patients, and the escalating population ofuninsured patients. Based on these demographical factors, the new guideline would needconstant and frequent revisions to keep up with the demand for care in the nation. This is theonly way the guideline would continue to adapt to the US demographics and policy reformsto adequately and effectively provide care to the US hypertension patients.BENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENTFar from being affected by the US demographics and policy reforms, the guidelinewould first need to be adopted and used in clinical practice. According to Farrell et al. (2016),clinical practice guidelines bridge the gap between research and the provision of healthcareservices; thereby, reducing unsuitable practice variability. Successful implementation of therevised hypertension practice guideline hugely relies on the implementation strategies of theguideline and must be grounded on the evidence and knowledge of the intervention as well asbarriers to its suitable utilization. As such, identifying potential barriers to the implementationof the guideline leads to the development of a tailored plan and strategies for itsimplementation, thereby leading to the guideline’s effectiveness (Fischer et al., 2016).This new hypertension guideline will involve a wide range of specialists,methodology experts, clinical professionals, and care consumers to enhance its effectivenessand the possibility of being accepted and used to treat and manage hypertension. They willaid in making relevant contributions and formulating the implementation suitableimplementation strategies for the target audience. Other implementation strategies that will beused to ensure the guideline is accepted and used in the treatment and management ofhypertension include; Utilizing short summaries of the new hypertension guideline in forums. Involving the potential target population in all the stages of the guidelinedevelopment. This will be achieved through consultative and directinvolvement to encourage participation and ownership.BENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENT EVALUATION HYPERTENSION CLINICAL PRACTICE GUIDELINE 13 Utilization of media platforms to publicize the newly revised hypertensionguideline.BENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENT Usage of professional journals and magazines to involve and inform carestakeholders and professionals about the changes made to the newhypertension guideline. Using all the available channels of communication created by the allied carefirms, the state, care research institutes, and regional societies to publicize thechanges. Utilization of academic processes provided by the relevant consumer groupsand institutions such as seminars to inform the world on the new hypertensionclinical practice guidelines.4. EvaluationIt is imperative to assess the effectiveness of a new/revised clinical practice guidelineto determine the extent to which it affects care delivery and the practitioner’s behavior andknowledge and the factors, if any, that contribute to non-compliance. The results from theassessment inform whether the revised clinical practice guideline produced the projected careoutcomes and is effective for the treatment and management of hypertension. Farrell et al.(2016) indicate that changes in care provision will occur when healthcare practitioners areinvolved. However, effective implementation of care guideline strategies directly improvesthe influence of care practitioners on the delivery of care services. Therefore, for thesuccessful implementation of new/revised care guidelines, they need to be embedded in thecare system and be founded on clinical aspects.For the degree of effectiveness, various evaluation processes have been discussed inthe literature to determine the level of acceptance and the extent to which the revised practicestandards aid to care provision. As such, the revised clinical practice guideline is evaluated to  EVALUATION HYPERTENSION CLINICAL PRACTICE GUIDELINE 14determine whether it serves its purpose of improving healthcare outcomes. To determine theeffectiveness of the revised hypertension clinical practice guideline, the strategies below areutilized:BENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENTi. The first step in evaluating the effectiveness of the revised guideline is toassess the possible changes in care delivery and practice caused by the newguideline standards. This is achieved by comparing the transformation inclinical practice and health outcomes in areas with the remarkably highpromotion of the guideline with the transformation in areas with the lowpromotion of the guideline.ii. The next step is to compare healthcare outcomes transformation in areas thatexperienced high intake of the guidelines against those that had a lowguideline intake. This can be achieved by using a focus group to elucidate themain aspects that have influenced the intake of the guideline.5. Learning Points Hypertension is a healthcare problem affecting a larger adult population throughoutthe globe. In the US alone, data shows that 49.6% of US adults aged 20 years andolder had hypertension in 2017-2018 while approximately 36,524 individuals diedfrom the condition; providing an estimated 11.1 deaths per 100,000 people who diedfrom essential hypertension hypertensive disease.BENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENT Why the recommended threshold of <130/80 mm Hg for blood pressure treatment hasbeen considered controversial in the management and treatment of hypertension. The impact of the recommended <130/80 mm Hg and <140/90 mm Hg for patientswith significant comorbidities over 65 years for the treatment of hypertensive strokecases is less effective and can even lead to death. BENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENTEVALUATION HYPERTENSION CLINICAL PRACTICE GUIDELINE 15ReferencesBakris, G. L. (2021). Hypertension. Merck Manuals Professional Edition.https://www.merckmanuals.com/professional/cardiovascular-disorders/hypertension/hypertensionCDC. (2021). FastStats. Centers for Disease Control and Prevention.https://www.cdc.gov/nchs/fastats/hypertension.htmde Leeuw, P. W., Bisognano, J. D., Bakris, G. L., Nadim, M. K., Haller, H., & Kroon, A. A.(2017). Sustained reduction of blood pressure with baroreceptor activation therapy:results of the 6-year open follow-up. Hypertension, 69(5), 836-843.Dunphy, L. M., Winland-Brown, J. E., & Thomas, D. J. (2019). Primary care: The art andscience of advanced practice nursing (5th ed.). F A Davis Company.Farrell, B., Pottie, K., Rojas-Fernandez, C. H., Bjerre, L. M., Thompson, W., & Welch, V.(2016). Methodology for developing deprescribing guidelines: using evidence andGRADE to guide recommendations for deprescribing. PLoS One, 11(8), e0161248.Feng, W., Dell’Italia, L. J., & Sanders, P. W. (2017). Novel paradigms of salt andhypertension. Journal of the American Society of Nephrology, 28(5), 1362-1369.https://doi.org/10.1681/asn.2016080927Fischer, F., Lange, K., Klose, K., Greiner, W., & Kraemer, A. (2016, September). Barriers andstrategies in guideline implementation—a scoping review. In Healthcare (Vol. 4, No.3, p. 36). Multidisciplinary Digital Publishing Institute.Forouzanfar, M. H., Liu, P., Roth, G. A., Ng, M., Biryukov, S., Marczak, L., Alexander, L.,Estep, K., Hassen Abate, K., Akinyemiju, T. F., Ali, R., Alvis-Guzman, N.,Azzopardi, P., Banerjee, A., Bärnighausen, T., Basu, A., Bekele, T., Bennett, D. A.,Biadgilign, S., … Murray, C. J. (2017). Global burden of hypertension and systolicBENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENThttps://www.cdc.gov/nchs/fastats/hypertension.htmhttps://doi.org/10.1681/asn.2016080927BENCHMARK -EVALUATION OF CLINICAL PRACTICE GUIDELINE ASSIGNMENTEVALUATION HYPERTENSION CLINICAL PRACTICE GUIDELINE 16blood pressure of at least 110 to 115 Mm Hg, 1990-2015. JAMA, 317(2), 165.https://doi.org/10.1001/jama.2016.19043GBD 2017 Risk Factor Collaborators. (2018). Global, regional, and national comparative riskassessment of 84 behavioral, environmental and occupational, and metabolic risks orclusters of risks for 195 countries and territories, 1990–2017: a systematic analysis forthe Global Burden of Disease Study 2017. Lancet (London, England), 392(10159),1923. doi: 10.1016/S0140-6736(18)32225-6Hall, M. E., & Hall, J. E. (2018). Pathogenesis of hypertension. Hypertension: A Companionto Braunwald’s Heart Disease, 33-51. https://doi.org/10.1016/b978-0-323-42973-3.00005-6Lietzan, E. (2018). The Drug Innovation Paradox. Mo. L. REv., 83, 39. Retrieved fromhttps://heinonline.org/HOL/LandingPage?handle=hein.journals/molr83&div=6&id=&page=Messerli, F. H., & Bangalore, S. (2018). The blood pressure landscape: schism amongguidelines, confusion among physicians, and anxiety among patients. Retrieved fromhttps://www.jacc.org/doi/10.1016/j.jacc.2018.07.026Mikael, L. D. R., Paiva, A. M. G. D., Gomes, M. M., Sousa, A. L. L., Jardim, P. C. B. V.,Vitorino, P. V. D. O., … & Barroso, W. K. S. (2017). Vascular aging and arterialstiffness. Arquivos brasileiros de cardiologia, 109(3), 253-258.Oparil, S., Acelajado, M. C., Bakris, G. L., Berlowitz, D. R., Cífková, R., Dominiczak, A. F.,Grassi, G., Jordan, J., Poulter, N. R., Rodgers, A., & Whelton, P. K. (2018).Hypertension. 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