What is the first contributing factor the nurse should explore for a patient with inadequate BP control?

Inadequate blood pressure control is often significantly influenced by how well a patient adheres to their prescribed medication regimen. Lack of adherence to prescribed drug therapy can prevent the effective management of hypertension, leading to persistent high blood pressure and eventually potential complications. When assessing a patient's inability to control their blood pressure, it is crucial for nurses to initially consider whether the patient is taking their medications as prescribed.

Understanding the patient's adherence is essential because it can provide insight into treatment effectiveness and inform necessary adjustments to the management plan. For instance, patients may miss doses due to various factors such as misunderstanding instructions, experiencing side effects, or having difficulty accessing their medications. Addressing adherence first allows the healthcare team to customize their educational efforts and provide support systems to help the patient manage their hypertension effectively.

Exploring factors like progressive target organ damage or possible substance use, while important in the broader assessment of the condition, are secondary considerations that follow the need to ensure medication adherence is in place. Additionally, medication interactions may impact blood pressure as well, but if a patient is not taking their medications regularly, the potential for these interactions is largely moot. Thus, assessing for adherence is the most immediate and practical step in identifying barriers to achieving adequate blood pressure control.