Hypertension: the Pressure of the Blood - Research Paper Example

? Hypertension of Introduction Hypertension, often referred to as high blood pressure, is a health condition in which the arterial blood pressure is constantly elevated. That is, the pressure of the blood as it pushes on the walls of blood vessels is chronically high making the heart to be forced to pump even harder, a situation that could lead to organ damage, illnesses such as heart failure, renal failure, aneurysm, heart attack, stroke, and/or death (Falvo, 2009).These are among the adverse consequences of elevated blood pressure, characteristic of hypertension. Blood pressure is considered abnormally high if it exceeds the normal level of 120/80. The 120 represents the systolic/peak measurement of blood pressure while the 80 stands for the diastolic/minimum blood pressure measurement in the arteries. If the blood pressure falls in the 120/80-139/89, a person is said to be in a pre-hypertension state, implying an increased risk of developing hypertension. Should the blood pressure hit 140/90 and above, one is considered to have hypertension. The two major classifications of hypertension are secondary and essential hypertension. Whereas essential hypertension refers to a high blood pressure case whose cause is unknown, secondary hypertension refers to high blood pressure caused by tumors, kidney disease, and birth control pills (Falvo, 2009). The essential type of hypertension has been identified to cause about 95% of all hypertension cases. That is, among the about 73 million adults in the United States suffering from hypertension, 69.35% have the essential hypertension (Falvo, 2009). Although the exact causes of hypertension are generally unknown, several risk factors have been associated with hypertension. These factors include diabetes, sedentary lifestyle, and lack of physical activity, smoking, vitamin D deficiency, stress, aging, excessive alcohol consumption, genetics, and medications such as birth control pills, obesity, and excessive consumption of salt. Others are chronic kidney disease and insufficient consumption of minerals such as calcium, potassium, and magnesium. The symptoms of the condition are rather hard to identify and quite a big percentage of hypertension victims do not know that they have the condition. Because this ignorance about one’s hypertension status could last years and endanger lives, it is recommended that people continually go for screenings. Included in these symptoms are problems with vision, breathing problems severe headaches, fatigue or confusion, nausea, blood in the urine, dizziness, irregular heartbeat, and chest pains (Falvo, 2009). This paper explores the subject of hypertension with regards to its statistics, prevalence, psycho-social challenges, lifestyles, treatment, researches, and community programs. Statistics on Hypertension That hypertension is a major health concern in the United States is evidenced by the statistics made available by federal, state, and local government agents as well as private citizens, community-based groups, and non-governmental organizations. For instance, that as many as one in three American adults are at risk of contracting chronic kidney disease, stroke, and heart attack/heart failure makes them highly likely to develop hypertension as well. Evidently, hypertension prevalence is rather alarming. It has also been noted that more than half of hypertension patients have not managed to put it under control, resulting in severe health and psycho-social problems, reduced control rates, and high prevalence across the population. According to the American Society of Hypertension (ASH), more should be done regarding the establishment of educational, prevention, treatment, management and research programs to address hypertension, which has been a national health concern for quite some tine. These programs should specifically target hypertension prevention, treatment, awareness, and the reduction of hypertension’s consequences. To meet these objectives, these programs will have to initiate and support patient outcome improvement, translational research and participate in provide hypertension awareness campaigns, education and services not only to patients but also to health care professionals. According to the American Society of Hypertension, about a third of U.S adults have hypertension, thus at risk of developing life-threatening conditions such as stroke, congestive, kidney disease, heart disease, and heart failure. In fact, in 2006, hypertension resulted in about 320, 000 deaths, costing the government about $76.6 billion in medications, health care services, and missed days of work (Centers for Disease Control and Prevention, 2012). Although about 70% of hypertension patients reportedly take medication and seek to have their high blood pressure controlled, only a insignificant 46.6% of hypertensive patients managed to have their blood pressure controlled in 2010 (Centers for Disease Control and Prevention, 2012). Statistics also indicates that about 25% of adult Americans have pre-hypertension-blood pressure levels. As mentioned earlier, this group is yet to fully develop hypertension. According to the Centers for Disease Control and Prevention (CDC), for the 2009-2010 period morbidity data for hypertension, 31.9% of non-institutionalized hypertension patients were adults aged 20 years (Centers for Disease Control and Prevention, 2012). Concerning health care usage, about 46.3 million hypertension patients undertook ambulatory care visits to hospital outpatient, emergency departments, and physician offices. It should be noted that this number includes those who undertook these visits with hypertension as their primary diagnosis but may not have been positively diagnosed with hypertension. Furthermore, in nursing home care, about 790,300 were reported to have hypertension, representing 53% of all nursing home residents. In the same period, mortality stood at about 25,734, representing 8.4 deaths per a population of 100,000. Psychosocial Challenges There are several psychosocial factors that pose serious challenges to hypertension prevention and treatment. These are psychological and social factors that influence peoples’ health including cultural and religious background, socioeconomic status, interpersonal relationships, peer pressure, and parental support, all of which influence peoples’ lives and personalities, in the process shaping how they respond to diseases (Beydoun & Wang, 2008). The psychosocial factors identified in a study entitled “Psychosocial Factors and Risk of Hypertension: The Coronary Artery Risk Development in Young Adults (CARDIA) were hostility, aggression, cynicism, social withdrawal, anxiety, and depression. The components of depression identified in the study were helplessness, hopelessness, and feelings of guilt, depressed mood, and worthlessness. The challenges posed by psychosocial factors to development of hypertension could be linked to peoples’ socioeconomic, demographic, and behavioral traits. For instance, in the CARDIA study, younger people, women, blacks, and less educated people recorded higher levels of measured psychosocial attributes. Nonetheless, there was only a slight variation in risk of hypertension related to daily alcohol consumption, physical activity, and BMI (Beydoun & Wang, 2008). The role of psychological factors in increasing risk of hypertension could also be explained biologically. For instance, the sympathetic nervous system may be stimulated by acute stress, causing increased cardiac output, pressure elevation, vasoconstriction, and arterial impaired endothelial faction, all of which may contribute to high blood pressure. Psychosocial factors such as peer pressure have prevented hypertension patients and healthy people from living healthy lifestyles and adhering to medication. Programs and Researches From these statistics, it is quite apparent that a lot of improvements must be done as far as delivering health care to hypertension patients is concerned. Health care stakeholders should therefore advocate for better health services and community programs for hypertension patients and health care practitioners to help in addressing the hypertension menace. First, to improve health care for hypertension patients, it is mandatory that sufficient funds are raised through both individuals and institutional initiatives to give support to various hypertension-related initiatives and programs (Sacks et al., 2001). These programs should however be in line with the guidelines and goals of the “Healthy 2020” initiative started by the Department of Health and Human Services (DHHS), which seeks to reduce hypertension among US adults BY 10% in the next decade. These programs should encompass outreach initiatives targeting the hypertension community, more so those communities that face a lot of socioeconomic and cultural disparities. Importantly, the recommended programs should develop and disseminate education and awareness materials to hypertension patients through print and electronic media and public forums. The other essential elements of these programs are effective treatment strategies, practice-based research, community-based clinics, in-service training for health care personnel, and residency programs in hypertension (Sacks et al., 2001). Fortunately, a lot of researches and programs on hypertension are currently underway, indicating there is hope for improved health care for hypertension patients. Researches One of the researches so far done on hypertension was entitled “Reducing Disparities in Hypertension Control: A Community-Based Hypertension Control Project (CHIP) for an Ethnically Diverse Population.” This study was conducted by Donald E. Morisky, Nancy B. Lees, Behjat A. Sharif, Kenn Y. Liu, and Harry J. Ward. The study sought to research the psychological, social, medical, and environmental factors that affect the adherence to hypertension treatment. Second, the study intended to establish the effectiveness of three interventions used to improve adherence to hypertension treatment among vulnerable populations, which are often ethnically diverse and underserved. The study participants were 1,367 Blacks, constituting 76%, while Hispanics constituted 21%. The study took four years during which the participants were randomized to use whatever care they always used and to use one of the three interventions, which included home visits or focus group discussions, individualized counseling by community health workers, and a computerized appointment tracking system. The results of the study indicted that those assigned to the computerized patient tracking systems recorded the most significant improvement in treatment adherence (Sacks et al., 2002). This group actually managed to keep and control their blood pressure at six months. Nevertheless, more significant sustained improvement was recorded for those under individualized counseling at twelve months. Generally, about 35% of all participants had their blood pressure under control while 33% of them had co-morbidities besides hypertension. Just like the outpatient clinics, which participated in this study, it is highly recommended that other clinics integrate these findings into their hypertension care delivery systems (Sacks et al., 2002). Dietary Approaches to Stop Hypertension (DASH Study) A combined study and program on hypertension was the DASH (Dietary Approaches to Stop Hypertension) study, which was sponsored by the National Institutes of health (NIH). It was promoted by the National Heart, Lung, and Blood Institute, which is part of the NIH. After the successful completion of the study, it was recommended by the US Department of Agriculture as the best eating plan for all Americans. The study, an outpatient feeding program for hypertension victims, was controlled across many centers. It evaluated the effectiveness of three diet plans in a diverse population for eight weeks. It had 459 adult participants of systolic blood pressure less than 160?mm?Hg and diastolic BP of 80–95?mm?Hg. One of the feeding plans was that regularly eaten by many Americans. The second eating plan was similar to the first but had more fruits and vegetable while the third was the DASH plan, which normally includes whole grains, nuts, vegetables, fruits, poultry, fish, and low-fat dairy products (Sacks et al., 2002). The other components of the Dash diet were small quantities of cholesterol, saturated fat red meat, sweets. Those enrolled in the DASH diet and the diet of more fruits and vegetables recorded a greater reduction in blood pressure, more so in participants who had higher blood pressure at the start of the study. In fact, even those without high blood pressure recorded reduced blood pressure on the DASH diet (Sacks et al., 2002). However, social cultural factors contributed to vulnerable group’s adherence to DASH diet, thus interfering with their outcomes. Interventions to minimize impact of HTN Several interventions to affectively address hypertension and its consequences are available. The most obvious intervention is prevention, which however, will require strategies that target entire populations to reduce the occurrences and consequences of hypertension (Centers for Disease Control and Prevention, 2012). Second, lifestyle changes are essential for reduced need for antihypertensive drug therapies and hypertension treatment. Other primary hypertension prevention interventions are maintenance of normal body weight to a body mass index of 20–25 kg/m2, reducing sodium intake to less than 100 mmol/day (less than 6 g of sodium chloride per day), and regular aerobic exercises such as brisk walking (Beydoun & Wang, 2008). Furthermore, one should avoid excessive consumption of alcohol but consume diets rich in vegetables and fruits. Once diagnosed with hypertension, people should also take medications or antihypertensive drugs seriously. Among the factors critical during prescription are risk of cardiovascular attack, blood pressure readings, and other health complications, which might be worsened by certain prescriptions. Thus, besides monitoring medication response in patients, physicians should evaluate any adverse reactions to medication (Sacks et al., 2002). Generally, antihypertensive therapy is intended to reduce blood pressure to less than 140/90 mmHg for most individuals, and even lower for diabetics or kidney disease cases. There are cases in which a hypertensive patient may require a combination of medication during which it is recommended that medication starts with two drugs, especially when blood pressure is more than 20mmHg above systolic or more than 10 mmHg above diastolic targets (Centers for Disease Control and Prevention, 2012). Recommended combinations include beta-blockers and diuretics, renin–angiotensin system inhibitors and diuretics, renin–angiotensin system inhibitors and calcium channel blockers, dihydropyridine calcium channel blockers and beta-blockers, and calcium channel blockers and diuretics. Conclusion and Future Recommendations Hypertension continues to be a major health challenge despite many years of intense efforts to prevent, treat, and manage it. For instance, community-based programs and researches have been conducted to prevent, raise awareness and increase knowledge on hypertension, and to encourage lifestyle changes that would improve blood pressure control. Since hypertension is difficult to detect in early stages, healthy lifestyle is its most recommended and effective preventive strategy. However, if diagnosed, adherence to medication and healthy living could combine well to help treat and manage the disease and related complications. Among the challenges encountered in addressing hypertension are psychosocial factors such as religious beliefs, culture, and socioeconomic status, which affect peoples’ perceptions and reactions to hypertension. References Beydoun, M. A., and Wang, Y. (2008). “How Do Socio-Economic Status, Perceived Economic Barriers and Nutritional Benefits Affect Quality of Dietary Intake Among US Adults?” European Journal of Clinical of Nutrition, 62(3): 313. Centers for Disease Control and Prevention (CDC). (2012). “Hypertension: Data are for the U.S.” Retrieved on September 10, 2012 from http://www.cdc.gov/nchs/fastats/hyprtens.htm Falvo, D. (2009). Medical and psychosocial aspects of chronic illness and disability. Sudbury, MA: Jones and Bartlett Publishers. Morbidity & Mortality Weekly Report (2008). “Vital Signs: Prevalence, Treatment, and Control of Hypertension --- United States, 1999--2002 And 2005--2008. (2011).” MMWR: Morbidity & Mortality Weekly Report, 60(4), 103-108. Sacks, F. M., Svetkey, L., Vollmer, W., Appel, L., Bray, G., Harsha, D., Obarzanek, E., Conlin, P. (2002). "Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet". New England Journal of Medicine, 344 (1): 3–10. Read More