Hypertension Risk Level System Based on Personal and Global Awareness - Term Paper Example

FINAL PAPER Name: Institution: Abstract The aim of this study is to propose the hypertension risk level system based on personal and global awareness. This is in relation to the hypertension management guidelines from multiple studies. The study done is to offer full knowledge of what hypertension is and how it may be prevented or controlled. The goals are to identify regional risk factors for current and future health interventions. It also investigates the awareness, prevalence, control and treatment of hypertension. A hypertension evaluation should involve assessment of organ damage and cardiovascular risk, detection of the causes of secondary hypertension and the confirmation the hypertension diagnosis. Introduction Human health is shaped by very powerful forces: rapid urbanization, unhealthy lifestyles globalization, and demographic ageing. Most countries have the same health issues. Non-communicable diseases have overtaken the infectious diseases in the leading causes of mortality. This includes cancer, chronic lung diseases, cardiovascular diseases, and diabetes. Hypertension is a key risk factor for cardiovascular diseases. It affects billions of people globally, killing nine million people annually by triggering strokes and heart attacks (Diviani et al. 2015). Hypertension can also be prevented hence lowering the risk. Prevention of hypertension is safer for patients and cost efficient than most interventions like dialysis and cardiac bypass surgery that is needed when hypertension goes untreated. Hypertension can be simply described as an invisible, silent killer which rarely causes symptoms. Access to early detection is key as well as public awareness of the disease. The warning signs include raised blood pressure which signifies that lifestyle changes are needed. Reducing salt intake, eating a balanced diet, shunning tobacco, having regular exercise and avoiding excessive use of alcohol supports healthy lifestyles (Sowers et al., 2001). Inexpensive and effective access to quality medicine is vital at primary care level. Countries with high incomes are reducing hypertension by implementing public policies like availing diagnosis and treatment centers and reduction of the amount of salt in processed food. Problem Statement The burden of strokes, heart diseases, premature disability and mortality and kidney failure is majorly contributed to by hypertension. Middle- and low-income populations are disproportionately affected because health systems are weak (Heagerty, 1993). Many people go undiagnosed in the early stages of hypertension because it rarely causes symptoms. The diagnosed patients may not successfully control the illness because they may not have access to treatment. Good control systems, adequate treatment, and early detection have significant economic and health gains (Diviani et al. 2015). Draining individual and government budgets, cardiac bypass surgery, dialysis and carotid artery surgery are the costly interventions of treating the disease. Behavioral risks such as physical inactivity, harmful use of alcohol and unhealthy diets should be addressed to prevent hypertension. The disease increases when no action is taken to reduce exposure. Control and prevention of high blood pressure can be majorly contributed by salt reduction initiatives. Also, a sustainable and affordable way of tackling hypertension in countries is implementing integrated noncommunicable disease programmes (Sowers et al., 2001). Control and prevention are complex since it requires multi-stakeholder collaborations such as academia, civil society, food and beverage industry and the government. Literature Review Approximately 17 million deaths annually are caused by cardiovascular disease globally. Hypertension alone accounts for 9.4 million of these deaths. 45% of the deaths are caused by heart disease and 51% caused by stroke. Because more people live in the mid- and low-income countries, hypertension is more prevalent than in high-income countries. Further, because there is a high number of people are undiagnosed because of weak health systems. Other health risks increase the odds of kidney failure, stroke and heart attack hence compound the consequences of hypertension (Gakumo et al., 2015). Low-income countries have higher current age-standardize mortality rates than those of developed countries. Comprehensive preventative intervention should be initiated in countries with a high mortality rate that occur from heart disease (Heagerty, 1993). With this, multiple positive changes would be observed in the forms of improved hypertension control, smoking reduction and dietary changes. The working-age population’s annual cardiovascular disease mortality rate would see a significant reduction. Actions to tackle hypertension should be taken in order to avoid losses that would outstrip public health spending (Gakumo et al., 2015). The process of measuring blood pressure is recorded as two values in units of millimeters of mercury written one above the other. The lower value indicates the diastolic blood pressure which is the minimum pressure in the blood vessels between heartbeats that occurs when the heart muscle relaxes. The upper value indicates the systolic blood pressure which is the maximum pressure in the blood vessels that occurs when the heart beats or contracts. Normal adult diastolic blood pressure is 80mm Hg, and systolic blood pressure is 120 mm Hg. Cardiovascular benefits of the normal blood pressure extend to lower diastolic pressure levels of 105 mm Hg and lower systolic pressures of 60 mm Hg. With this, it is easy to define hypertension in more technical terms (McNaughton, Jacobson & Kripalani, 2014). Hypertension can be defined as diastolic blood pressure above or equal to 90 mm Hg. Also, it may be defined as systolic blood pressure above or equal to 140 mm Hg. Both diastolic and systolic blood pressures require being at normal levels for the efficient functioning of vital organs and overall health and wellbeing. There are multiple causes of hypertension which collectively include: behavioral risk factors, metabolic factors, and socioeconomic factors among others. Behavioral risk factors include; harmful levels of alcohol usage, poor stress management habits, lack of exercise or physical inactivity, the consumption of food containing excessive levels of fat and salt and, consumption of fewer fruits and vegetables (Gakumo et al., 2015). These risk factors are mainly influenced by the people's living and working conditions. Increased risk of stroke, kidney failure, heart disease among other hypertension complications is caused by metabolic factors. High cholesterol, obesity, and diabetes are the main complications brought about by hypertension. Hypertension and tobacco raise the probability of getting cardiovascular diseases after their interaction. Socioeconomic health determinants include housing, education, and income. These also have an impact on behavioral factors which then trigger hypertension development. High-stress levels that may be brought about by fear of unemployment or unemployment influence high blood pressure (Calhoun et al., 2008). Untimely detection and treatment may occur due to living and working conditions because people may not access diagnostics and treatment hence impending complication prevention. Unhealthy environments encourage sedentary behavior, consumption of fast food, harmful use of alcohol and tobacco brought about by rapid unplanned development which consequently leads to hypertension. The aging population is affected mostly by hypertension. This mainly occurs due to stiffening of blood vessels, which can also be slowed by healthy living. In other instances, there are specific unknown causes of hypertension. At times when hypertension occurs in people under 40 years, it is necessary to exclude causes such as blood vessels malformation, endocrine diseases and kidney diseases which are called secondary causes and investigate the causes in relation to genetic factors (Vernon & Rosenbaum, 2013). Some women have hypertension during pregnancy. This type of hypertension is known as preeclampsia. It occasionally revolves after childbirth and in other cases it has sometimes been observed to linger and in other cases, they experience hypertension later in life (Gakumo et al., 2015). Most hypertension cases do not exhibit symptoms, but the common misconception is that when someone is experiencing hypertension, there are always symptoms. The common hypertension symptoms include shortness of breath, nose bleeds, chest pain, dizziness, headache and palpitation of the heart (Heagerty, 1993). These symptoms however should not be highly relied on when diagnosing hypertension though it can also be dangerous to ignore them. Knowing one's blood pressure level is important because the condition is a silent killer that indicates the need for serious lifestyle changes. Life-threatening complications may be increased by ignoring high blood pressure. There is a higher likelihood to develop harmful consequences to major organs due to ignoring high blood pressure levels (Johnson et al., 2003). Uncontrolled hypertension aids in the development of cardiovascular events due to poor access to medication and health services and low socioeconomic status. There are various ways of diagnosing hypertension. These may include aneroid devices, mercury, and electronic devices. The use of reliable and affordable electronic devices that have optional manual readings are recommended by the World Health Organization. Semi-automatic devices address the common problem involved in resource-constrained settings by offering the option of manual reading even when batteries run down (Gakumo et al., 2015). Electronic devices are favored in comparison to mercury devices because mercury is toxic. Sphygmomanometers are examples of aneroid devices which require calibration after every use (Calhoun et al., 2008). It is necessary to record blood pressure measurements for several days before a diagnostic conclusion can be made. The process involves; taking two consecutive measurements a minute apart with the parson seated twice daily. The average value minus first-day measurements are taken to deliver a hypertension diagnosis (Seanny, 2010). Significant benefits are achieved from self-care, early detection, and treatment of hypertension. The risk of heart failure, heart attack, kidney failure and stroke can be minimized by early detection of hypertension. It is necessary for adults to know their blood pressure levels. In a case where hypertension is detected outside a clinic setting, it is important to consult medical advice (Burt et al., 1995). Certain cases of hypertension require medication prescription when lifestyle changes are not sufficient in the control of blood pressure. Medication works in different ways like slowing the heartbeat, widening and relaxing blood vessels and in the removal of excess fluids and salt in the body. Hypertension management is recommended for patients by self-monitoring of blood pressure because the devices are affordable. Early detection of hypertension can be facilitated by self-care, particularly to those with limited access to health facilities (Jackevicius, 2012). Individuals, families, the private sector, civil societies, academic research communities, health workers, policy-makers, and governments should play a role in prevention and control of hypertension. Testing and treatment technology can only be harnessed with the concerted effort of these parties hence delaying the life-threatening complications of hypertension. The disease burden caused by hypertension is the reason why health policy makers must address it. These interventions require to be effective, sustainable and affordable (Jackevicius, 2012). Sole focus on hypertension by vertical programmes is not recommended. Programmes on cardiovascular risk as an integral part of the strategy for control and prevention of hypertension should be addressed. Universal health coverage has greatly affected the improvement of health and equity services using health systems. Primary care levels targeting social determinants spectrum of health should be promoted; these balance health promotion and balance prevention with curative interventions (Wolf-Maier et al., 2014). First levels of care are emphasized with appropriate coordination mechanisms. It is increasingly difficult to the populations’ ever-growing needs even in countries with affordable and accessible health services. Health-care costs containment should consider hypertension as a critical element. Reducing suffering, increasing health service coverage and strengthening prevention of hypertension is crucial in all countries. Hypertension will be overcome by effectively addressing system strength across health systems components such as service delivery, human resources, information, financing, and governance. Equitable access to curative, rehabilitative and preventative health services should be addressed by the government in order to prevent the development of hypertension and complications. Features of integrated primary care programmes need to be established; this is mostly the weakest level of a health system (Jackevicius, 2012). It is necessary to target populations with a high or medium risk of developing kidney failure, stroke or heart attacks. Cardiovascular risk assessment should be done to patients presenting hypertension which include testing for diabetes mellitus among other risk factors. This should be done because diabetes and hypertension are closely linked, and management cannot be effective without attention to the other (Verdecchia et al., 1994). An integrated programmes' objective is the reduction of total cardiovascular risk. By adopting a comprehensive approach will ensure that those at high and medium risk have drug treatment. Moreover, unnecessary drug treatment is prevented for people with low cardiovascular risk and borderline hypertension. People with inappropriate drug treatment increase the costs of health and unwarranted harmful effects. Further, there are very effective and inexpensive medicines for the control of hypertension and exhibit great safety margins. The required guidelines are openly provided by the World Health Organization. There are charts available, designed to assist in risk assessment with evidence-based guidelines on the management of hypertension patients. With such guidelines, appropriate use of medicines to facilitate costs management to ensure sustainability of programmes (Wolf-Maier et al., 2014). There are gaps in the application of cost-effective interventions, especially in a resource-constrained setting. Quick identification of ways to address these major gaps is essential through operational research. It is a compelling case for action from the benefits achieved from blood pressure control in public health. The average costs of cost-effective interventions scale up in addressing cervical cancer and cardiovascular diseases in mid- and low-income economies are at an estimated value of $9.4 billion annually. The technical approach to management of hypertension is the best way forward. Basic technologies required in addressing hypertension are blood cholesterol tests, fasting blood sugar tests, urine albumin strips, weighing scales and blood pressure measurement devices. Some patients diagnosed with hypertension don’t necessarily require medication (Verdecchia et al., 1994). Those with medium or high-risk hypertension require essential medicines to decrease their cardiovascular risk. The cost of implementing these programmes is relatively low; the values are less than $1 per adult in a low-income nation, $1.5 per adult in a lower middle-income nation and $2.5in an upper middle-income nation. The cost of implementing in relation to the current health spending proportion values at 4% for low-income nations, 2% for lower middle-income nations and below 1% for upper middle-income countries. As the level of a risk factor increases the likelihood of a cardiovascular disease consequently increases without a threshold limit. The population with an average risk level have the most cardiovascular diseases. The population with high-risk factor levels is relatively low although an individual’s chances of cardiovascular disease development increase for those with very high-risk factor level. Reduction of the mean risk is a call for the effective reduction of the rates cardiovascular disease which is termed as a population-based approach. A general change in behavior is predominantly involved in these interventions. Modifying environmental and social determinants should be approached using interventions that target schools, worksites, community and the population at large (Wolf-Maier et al., 2014). Therefore, the implementation of a cost-effective programme is necessary including a population-wide approach to shift the population towards a healthy pattern. The majority of nations have an average value of per-person salt intake at 9-12 grams per day which is considered too high. Studies show that lower blood pressure levels are achieved by hypertension patients with modest salt intake reduction in all ethnic groups and all age groups. This is the most cost effective method at the population level to reduce stroke and heart disease. The adult salt intake recommendation is 5 grams per day. Foods rich in potassium help to reduce blood pressure. Processed foods have high levels of salt and low levels of potassium (Kalichman et al., 2013). The public, health professionals, nongovernmental organizations, the food industry and the government should intervene at all levels to reduce salt intake in the population. Regulation of the salt amount in condiments and prepackaged foods or voluntary reduction should be a modest approach to improving this (Lucy, 2010). The sustained and gradual decrease in salt added to pre-packaged foods is a major contribution the food industry can make to improve the population’s health. Encouraging reduction in salt intake in communities and households via sustained mass-media campaigns is required. A more cost-effective way to control hypertension is a workplace health programmes. It is necessary to control hypertension by promoting and creating an enabling environment among workers for healthy behaviors (Johnson et al., 2003). This can be done by establishing health measures, tobacco-free workplaces and having a healthy working environment. Workplace programmes focus on the promotion of workers' health by reduction of risk-related behavior such as physical inactivity, harmful use of alcohol, unhealthy diet, and tobacco use among others. Different population groups can have raised awareness of hypertension from health workers. Health workers can implement dialogues with policy makers at their workplace and blood pressure measurement campaign. The allied health worker, nursing, and medical curricula should institutionalize the training of health workers. It is possible to manage hypertension at a primary level effectively (Aboumatar et al., 2013). All health workers are required to familiarize themselves with the tools developed to assist in the management of hypertension. Civil societies are necessary for addressing control and prevention of hypertension. This is because they have roles that are uniquely placed for the fulfilment of various agendas (Detection, 1985). They help in the strengthening of the capacity to address hypertension prevention. Civil societies are placed in positions where there can easily mobilize society and garner political support for wide support of agendas. Civil societies are well known for the provision of significant health-care services to both the private and public sectors (Ong et al., 2003). The partnership between academia and NGOs can pool together resources and expertise required to build the skills and workforce of a population. Systematic collection and analysis of data for the purpose of continuous monitoring hypertension disease burden are known as hypertension surveillance. The collection of reliable information concerning determinants and risk factors of illness and disease mortality is a must for monitoring systems (Detection, 1985). It is critical for the data to be accurate for programme and policy development. Development of a global monitoring framework is necessary for application globally. Interventional targeting of a population is needed in the achievement of global targets in relation to hypertension (Lucy, 2010). Prevalence of hypertension can be reduced by reducing the risk factor exposure thus eventually strengthening the wide population approaches. Preventable mortality reduction and high-risk complications will be facilitated by strengthening health systems in order integrated programmes at the primary care level. If countries are supported in setting national targets and baselines, then there can be meaning contribution towards global voluntary targets. Strengthening the capacity for nations to collect, analyze and relay data is a crucial necessity to monitor global targets progress particularly in low- and middle-income nations (Lucy, 2010). Conclusion Hypertension can be briefly summarized as a modifiable risk factor. A careful evaluation would identify those suffering from hypertension at risk of organ damage with microalbinuria and left ventricular hypertrophy which predicts possible renal, cardiovascular events though most patients remain asymptomatic. It is important to emphasize the fundamental importance of measurement of blood pressure in hypertension management. Identification of modifiable risk factors can aid in the reduction of renal and cardiovascular damage and improvement of blood pressure control (Ong et al., 2003). Various medication classes have been identified to have greater beneficial effects in high-risk hypertension patients than the others hence leads to the recommendation of all compelling indications. An individual's health profile should be considered during personalization and tailoring of anti-hypertensive therapy. The burgeoning of therapies adds complexity to the process of therapeutic decision-making. A reasonable cost and less burdensome side effects would be more desirable than specific drug strategy in achieving blood pressure goals. Serum potassium, renal function, orthostatic changes and blood pressure all require monitoring at appropriate intervals. Clinical characteristics should determine and influence the treatment decisions inclusive of cost, personal preference, comorbidities, and tolerance. Various controlled studies have demonstrated the relationship between blood pressure reduction and weight loss. They have proved that in most cases blood pressure can be reduced with weight reduction independent of sodium intake. It is correct to conclude that hypertension is a critical condition but with the right measures it can be controlled or treated. References Aboumatar, H. J., Carson, K. A., Beach, M. C., Roter, D. L., & Cooper, L. A. (2013). The impact of health literacy on desire for participation in healthcare, medical visit communication, and patient reported outcomes among patients with hypertension. Journal of general internal medicine, 28(11), 1469-1476. Burt, V. L., Cutler, J. A., Higgins, M., Horan, M. J., Labarthe, D., Whelton, P., & Roccella, E. J. (1995). Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population data from the health examination surveys, 1960 to 1991. Hypertension, 26(1), 60-69. Burt, V. L., Whelton, P., Roccella, E. J., Brown, C., Cutler, J. A., Higgins, M., & Labarthe, D. (1995). Prevalence of hypertension in the US adult population results from the Third National Health and Nutrition Examination Survey, 1988-1991. Hypertension, 25(3), 305-313. Calhoun, D. A., Jones, D., Textor, S., Goff, D. C., Murphy, T. P., Toto, R. D., ... & Ferdinand, K. (2008). Resistant hypertension: diagnosis, evaluation, and treatment a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension, 51(6), 1403-1419. Detection, H. (1985). Five-year findings of the Hypertension Detection and Follow-up Program: prevention and reversal of left ventricular hypertrophy with antihypertensive drug therapy. Hypertension, 7(1), 105-112. Diviani, N., van den Putte, B., Giani, S., & van Weert, J. C. (2015). Low Health Literacy and Evaluation of Online Health Information: A Systematic Review of the Literature. Journal of medical Internet research, 17(5), e112. Gakumo, C. A., Enah, C. C., Vance, D. E., Sahinoglu, E., & Raper, J. L. (2015). “Keep it simple”: older African Americans’ preferences for a health literacy intervention in HIV management. Patient preference and adherence, 9, 217. Heagerty, A. M., Aalkjaer, C., Bund, S. J., Korsgaard, N., & Mulvany, M. J. (1993). Small artery structure in hypertension. Dual processes of remodeling and growth. Hypertension, 21(4), 391-397. Jackevicius, CA. (2012). ‘Prevalence, predictors, and outcomes of primary nonadherence after acute myocardial infarction.’ Circulation. 117: 1028–1036 Johnson, R. J., Kang, D. H., Feig, D., Kivlighn, S., Kanellis, J., Watanabe, S., & Mazzali, M. (2003). Is there a pathogenetic role for uric acid in hypertension and cardiovascular and renal disease?. Hypertension, 41(6), 1183-1190. Kalichman, S. C., Cherry, C., Kalichman, M. O., Amaral, C., White, D., Grebler, T., & Schinazi, R. F. (2013). Randomized clinical trial of HIV treatment adherence counseling interventions for people living with HIV and limited health literacy. Journal of acquired immune deficiency syndromes (1999), 63(1), 42. Lucy, N. (2010). Health Literacy: A barrier to pharmacist-patient communication and medication adherence. New York: Sage Publications. McNaughton, C. D., Jacobson, T. A., & Kripalani, S. (2014). Low literacy is associated with uncontrolled blood pressure in primary care patients with hypertension and heart disease. Patient education and counseling, 96(2), 165-170. Moser, D. K., Robinson, S., Biddle, M. J., Pelter, M. M., Nesbitt, T., Southard, J., ... & Dracup, K. (2015). Health Literacy Predicts Morbidity and Mortality in Rural Patients with Heart Failure. Journal of cardiac failure. Ong, K. L., Cheung, B. M., Man, Y. B., Lau, C. P., & Lam, K. S. (2007). Prevalence, awareness, treatment, and control of hypertension among United States adults 1999–2004. Hypertension, 49(1), 69-75. Pignone, M. & Lohr, KN. (2014). ‘Interventions to improve health outcomes for patients with low literacy.’ The Journal General Medicine. 20:185-192. Retrieved: http//dx.doi.org/10.1016/j.pec.2015.07.012 Retrieved: http://www.pubfacts.com/author/Thurga+Devi+Balasubramanian Seanny, M. (2010). Health Literacy and Medication Adherence. San Francisco: University of San Francisco Press. Sowers, J. R., Epstein, M., & Frohlich, E. D. (2001). Diabetes, hypertension, and cardiovascular disease an update. Hypertension, 37(4), 1053-1059. Stonbraker, S. Rebecca, S. and Elaine. (2015). Tools to measure health literacy among Spanish speakers: An integrative review of the literature. New York. Verdecchia, P., Porcellati, C., Schillaci, G., Borgioni, C., Ciucci, A., Battistelli, M., ... & Santucci, C. (1994). Ambulatory blood pressure. An independent predictor of prognosis in essential hypertension. Hypertension, 24(6), 793-801. Vernon, JA, & Rosenbaum, S. (2013). Low Health Literacy: Implication for National Health Policy. Retrieved December 13, 2015, from http://www.iom.educ/project.asp:id=3827. Wolf-Maier, K., Cooper, R. S., Kramer, H., Banegas, J. R., Giampaoli, S., Joffres, M. R., ... & Thamm, M. (2004). Hypertension treatment and control in five European countries, Canada, and the United States. Hypertension, 43(1), 10-17. World Health Organization. (2013). Adherence to Long-term therapies: evidence for action. Geneva: WTO Publications. Yu Ko, Thurga Devi Balasubramanian, Lilian Wong, Mui-Ling Tan, Evonne Lee, Wern-Ee Tang, Soo Chung Chan, Audrey S L Tan, Matthias Paul Han Sim Toh. (2013). International journal of cardiology: Health literacy and its association with disease knowledge and control in patients with hypertension in Singapore. Syngapore Read More