Quality Improvement Project: Implementing the 2025 AHA Hypertension Guidelines in Rural Primary Care
Degree Name
Nursing Practice, DNP
Publication Date
9-27-2026
First Advisor
Sandy King
Second Advisor
Veronica Arredondo
Abstract
Hypertension contributes to cardiovascular morbidity and mortality, and delayed adoption of updated guidelines can increase therapeutic inertia in rural primary care. This Doctor of Nursing Practice quality improvement project addressed an evidence-to-practice gap at a rural Federally Qualified Health Center where clinicians used 2017 American Heart Association/American College of Cardiology hypertension protocols after release of the 2025 guideline. The purpose was to determine whether structured education and point-of-care visual decision aids improved provider knowledge, attitudes, self-reported practices, and selected clinical adherence metrics over 3 months. Guided by the Iowa Model, Lewin’s Change Management Model, and the Plan-Do-Study-Act framework, a quasi-experimental pre-post design was used with 26 clinicians and nurse managers involved in adult hypertension care. The intervention included guideline education, updated algorithms, visual aids, and patient education resources. Outcomes were measured with an adapted Knowledge, Attitudes, and Practices questionnaire and aggregate Azara DRVS reports. Composite knowledge increased from pre-intervention (M = 2.42, SD = 0.81) to post-intervention (M = 3.96, SD = 0.20), t(25) = 9.53, p < .001. Attitude items showed improved confidence and perceived usefulness of visual aids; self-reported practice items showed increased algorithm use, seated-rest adherence, and DASH diet and exercise education. Azara DRVS reports evaluated 4-week follow-up compliance, medication intensification, and systolic blood pressure reduction after intensification. Clinical metrics showed mixed descriptive trends: intensification peaked in June, blood pressure reduction improved after rollout then returned near baseline, and follow-up compliance remained low. Findings indicate that education improved provider readiness, but sustainable guideline adherence requires workflow redesign, nurse-led follow-up, and ongoing quality monitoring in rural primary care.
Rights Management
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License
Recommended Citation
Alvarez, Johanna M., "Quality Improvement Project: Implementing the 2025 AHA Hypertension Guidelines in Rural Primary Care" (2026). Doctor of Nursing Practice Projects. 378.
https://arch.astate.edu/dnp-projects/378
