Category: Hypertension

Introduction

When the pressure in the blood vessels otherwise known as arteries increase, it leads to a medical condition called hypertension. The condition is long term and comes with a range of challenges. Although the challenges do not appear due to the condition, the symptoms come in because of other problems.

Screening and diagnosis of the disease can take place when one visits a medical facility with the intention of addressing another ailment, which may not have a relationship with high blood pressure. It is imperative to explain that the condition is on the rise especially in the light of the changing lifestyles and poor eating habits demonstrated by modern societies. While the condition affects older people in society, younger individuals are also becoming victims due to the use of supplements and birth control pills. It is within this context that the paper examines the various nutritional support strategies for patients with hypertension.

Causes and Effects of Hypertension

Hypertension also is known as high blood pressure can be a result of primary or secondary causes. While primary causes concern unhealthy lifestyles and poor eating habits, secondary causes comprise known factors such as kidney problems and the use of birth control pills. Reddy and Katan (2004) elucidate that consumption of excess salt and fats are some of the factors, which contribute to the contraction of the disease.

On the other hand, too much consumption of alcohol can also increase the chances of contracting the ailment. It is vital to allude that the effects associated with the condition are dire, a factor that calls for timely redress. Loss of sight, cardiovascular complications, and stroke are some of the effects linked to the disease. In contemporary societies, the ailment has led to the death of a number of individuals, and hence, there is need to institute measures that provide timely redress.

While the condition is manageable and can be treated successfully, medical practitioners encourage its prevention. Individuals at risk are usually the subjects of regular education on the various causes and effects associated with the disease. By creating awareness among the risk individuals in a particular society, the practitioners as well as the state incur minimal costs linked to contraction and treatment of the disease. Moreover, the society experiences minimal challenges associated with loss of lives due to the ailment.

According to Appel (2009), prevention of the disease is one of the steps that lead to its management. As such, it is very crucial for medical practitioners to focus on prevention of the condition so that the challenges related to its treatment decrease. Conversely, patients suffering from the disease should receive expert attention from qualified medical practitioners, who have relevant skills in the respective field.

Intake of Potassium and Minimal Intake of Sodium

Potassium is one of the best nutritional components that patients suffering from hypertension need to look for in foodstuffs that they consume. The relevance of potassium in management and treatment of high blood pressure emanates from its ability to control the levels of sodium in the body. Apparently, by controlling the amount of sodium in the body, potassium helps in management of the condition.

Moreover, control of sodium implies that the amount of fluids stored by the body reduces an aspect that is advantageous in the journey of managing hypertension. Tomatoes, broccoli, and vegetables contain potassium and by taking them, one can successfully address the condition. In the perspective of Reddy and Katan (2004), individuals who have hypertension need to consume food that contain potassium as it plays an important role in the overall treatment of the condition. The statement coins the relevance of potassium in treatment and management of high blood pressure among individuals.

Consequently, individuals suffering from high blood pressure need to avoid excess consumption of sodium. While sodium is good for healthy lifestyles, it leads to storage of fluids in the body. When fluids remain in the body, people gain weight and their chances of contracting hypertension rises. Moreover, in the case of those individuals suffering from high blood pressure, intake of salt complicates the condition and hampers its management and treatment. Appel (2009) explains that individuals suffering from hypertension should stay away from foods that contain high amounts of salt or sodium. In effect, they should try to minimize the rate of salt that they consume. Medical practitioners usually encourage individuals to consume one teaspoonful of salt every day for healthy lives. The translation of the teaspoonful is an average of 1,500mg of salt especially for individuals, who have high blood pressure.

Consumption of Whole Grains and Dairy Products

Bread, pasta, and rice are some of the grains that people who have hypertension need to consume. In the quest to treat and manage the level of pressure in the blood, people suffering from hypertension need to take grains that contain little amounts fat. On the other hand, these people should consume food that is full of fiber. Reddy and Katan (2004) elaborate that while most processed grains have little fiber, majority of whole grains contain lots of fiber and are good in management of the condition.

Whole grain bread, brown rice, and whole-wheat pasta are among the grains that contain high amounts of fiber as opposed to those that have been refined. Besides their high content of fiber, which helps the digestive system, the grains are also good because they contain low amount of fat. Therefore, by consuming grains, individuals improve their digestive system and lower the overall amount of fat in their bodies. Low amount of fat in the body translates to effective management of blood pressure.

While some dairy products contain a lot of fat and are not good for healthy living, those that contain little fat are helpful in management of high blood pressure. Appel (2009) asserts that low fat yoghurt and skimmed milk are some of the dairy products that are useful in treatment of hypertension. It is important for people suffering from high blood pressure to look for dairy products that are low in fat. These individuals need to seek medical advice before consuming any dairy product. The essence of consuming these foods is because of their high contents of calcium and proteins. Moreover, the dairy products contain vitamins such as vitamin D. It is practical to elucidate that when individuals consume dairy products that have low amounts of fat their level of calcium amplifies, a phenomenon that facilitates effective recovery from high blood pressure.

Consumption of Fruits, Vegetables, and Seeds

In the quest to treat and manage the level of blood pressure, people need to consume high amounts of fruits and vegetables. Apparently, fruits and vegetables contain high levels of potassium useful in management of the condition. Moreover, fruits and vegetables contain vitamins, which are essential in the overall health of the body.

Therefore, when people suffering from hypertension consume fruits and vegetables, body immunity improves and their attempt to manage the condition augments. Fruits such as citrus, grapes, and apples are among the best fruits that people suffering from high blood pressure need to consume. Besides containing high amount of potassium, fruits and vegetables also contain magnesium, vitamins, and fiber. Therefore, when people consume them, they eventually improve the functionality of their digestive system. As such, people suffering from hypertension cannot downplay the role played by fruits and vegetables in management of the condition.

Besides consuming vegetables and fruits, one also needs to take a reasonable amount of seeds. The minerals present in various seeds are very instrumental in management of high blood pressure as well as treatment of some cardiovascular complications. It is vital to allude that vitamins such as omega 3 present in seeds like nuts are among the healthy types of fat, which are required for health bodies. Additionally seeds like lentils, sunflower seeds, beans, and almonds have minerals like proteins, fiber, potassium, phytochemicals, and magnesium.

In effect, these minerals are very important in addressing issues related to high blood pressure. Besides helping individuals manage their blood pressure, the seeds also help them attain the much-desired lean and healthy body. According to Appel (2009), consumption of seeds reduces the amount of sodium in the body and facilitates successful management of high blood pressure. Notably, consumption of seeds requires moderation because some of them contain high amount of calories that may be detrimental when consumed excessively.

Relevance of Nutritional Support for Patients with Hypertension

Currently hypertension has diverse ways of management and treatment. Some of the ways adopted by individuals to treat and manage the condition include use of supplements and nutritional systems. It is imperative to explain that the other systems or ways of addressing the condition have a range of side effects that come along with their utilization. On the other hand, following the provisions of nutritional support and consuming the right food is a method that manages the condition without side effects (Reddy & Katan, 2004).

The method also facilitates management of other challenges that affect modern individuals. When one consumes the right food after receiving advice from medical experts, the body acquires the right amount of calories. After acquiring the right amount of calories, issues associated with obesity, cardiovascular complications, and other lifestyle diseases diminish. Therefore, it is wise to recommend that nutritional support is the best method that individuals suffering from hypertension can employ to address the condition.

Conclusion

Hypertension is a problem that affects several individuals in modern societies. Due to poor eating habits and changes in lifestyles, several people have contracted the disease through primary or secondary causes. To curb the rising cases of high blood pressure, there is need to devise a strategy that not only manages present instances but also prevents future recurrence of the disease.

While medical practitioners have various methods that they use to manage the condition, nutritional procedure is the best because it has minimal side effects. In effect, the strategy, which utilizes consumption of particular food, has several benefits that outweigh the demerits. Therefore, scholars and medical practitioners should encourage individuals suffering from hypertension to utilize the provisions espoused in nutritional support programs.

References

Appel, L. (2009). ASH position paper: Dietary approaches to lower blood pressure. The journal of clinical hypertension, 11(7), 358-368.

Reddy, K., & Katan, M. (2004). Diet, nutrition and the prevention of hypertension and cardiovascular diseases. Public health nutrition, 7(1), 167-186.

Is there a better medication than a Thiazide, and if so what dose should you initiate this medication?

Although Thiazide diuretics are among the drugs that have been used for a long time to address issues relating to hypertension, it is not recommended for the elderly. To address the issue presented before my clinic concerning Elliot, I will need to use several other drugs that, unlike Thiazide, work well with elderly individuals and display minimal side effects. Some of the drugs that I can utilize in the management of Elliots case include Calcium Channel Blockers (CCB), Angiotensin-Converting Enzyme Inhibitor (ACEI), as well as Angiotension Receptor Blocker (ARB).

Precisely, the classification of drugs that I will use includes Lisinopril (ACEI), Nifedipine (CCB), and Losartan in the class of ARBs. These drugs work well and can be useful in the management of hypertension among the elderly especially those who are older than 60. In the words of Allan, Ivers, and Padwal (2012), the effectiveness of Thiazide diuretics among the elderly is a matter that scholars and stakeholders in the medical sector are researching. The drugs are subjected to research due to the side effects that they cause.

Due to the controversy surrounding the use of Thiazide in the treatment of hypertension among the elderly, I will utilize drugs such as CCBs, ACEIs, and ARBs. Notably, CCBs are very effective as they lower the blood pressure by relaxing blood vessels through minimization of the stiffness common in large vessels. It is fundamental to explain that by curbing the issue of stiffness in large vessels, the drug reduces systolic BP.

On the other hand, ACEI is very vital in the treatment of hypertension especially among people who have a high susceptibility to diabetes mellitus (Wan, Ma, & Zhang, 2014). As such, it is very important in Elliots case. The functionality of the drug lies in its ability to render Renin Angiotensin Aldosterone System (RAAS) ineffective, thereby reducing the instances of hypertension among individuals suffering from diabetes mellitus. I will also use ARBs alongside a small dosage of Thiazide in the treatment and management of Elliots high blood pressure.

How would you proceed and how you would monitor for efficacy and toxicity?

The progress of my treatment will follow a systematic format. Remarkably, the essence of my systematic format emanates from the effectiveness and side effects associated with drugs used such as Thiazide. To ensure that the treatment yields productive results and becomes practical in the management of Elliots case, I will tabulate his results and monitor any changes in his sugar levels and blood pressure.

The relevance of closely monitoring the changes emanates from the use of drugs like Thiazide that have side effects. Notably, Thiazide can trigger a reduction in the amount of sodium and magnesium and an increase in the levels of calcium. An increase in the amounts of calcium and reduced levels of magnesium and sodium has side effects that include confusion and weakness. Moreover, the drug can also lead to the development of gout, a factor that has limited its efficiency in the treatment of hypertension among the elderly.

Consequently, other drugs that comprise CCBs, ACEIs, and ARBs also require scrutiny and follow-up in the aftermath of their use. Wan, Ma, and Zhang (2014) explain that CCBs can lead to side effects such as irregular heartbeat, dizziness, and constipation. Besides, ACEIs and ARBs are associated with complications that include hypotension, renal impairment, and dizziness. Therefore, to ensure that the prescription yields positive outcomes, there is a need to follow up closely on the progress of the medication. It is also paramount to encourage Elliot to engage in regular exercises and a healthy diet so that the effectiveness of the drugs augments.

References

Allan, G., Ivers, N., & Padwal, R. (2012). Best thiazide diuretic for hypertension. Canadian Family Physician, 58(6), 653-653.

Wan, X., Ma, P., & Zhang, X. (2014). A promising choice in hypertension treatment: Fixed-dose combinations. Asian Journal of Pharmaceutical Sciences, 9(1), 1-7.

Introduction

Healthy blood pressure is presented by physicians as 120/80; however, there are numerous incidences whereby the blood pressure level rises to 140/90 especially in stressful situations. If blood pressure persists at this level, then physicians diagnose the patient with hypertension.

Studies show that a majority of americans experience a rise in blood pressure with age due to their poor diets and lack of physical activity (Cooper, Rotimi, & Ward, 1999). 25% of these Americans reach the level for hypertension diagnosis. This accounts for about half a million fatalities per year due to kidney failure, heart disease and stroke (Cooper, Rotimi, & Ward, 1999).

Studies show that black americans are more likely to suffer hypertension, with the prevalence rate at 35% (Cooper, Rotimi, & Ward, 1999). Additionally, high blood pressure contributes to the death of over 20% of black americans in the united states. Studies show that people from African descent are highly inclined to hypertension due to their genetic makeup.

Cooper, Rotimi, & Ward (1999) claims that this argument is biased because public health research tends to attribute health challenges to racial or genetic features with little or no consideration of other factors such as socioeconomic status. The study by Cooper, Rotimi, & Ward (1999) explores other causes of the disparity between blacks and whites by focusing on other variables with the exception of genetics.

Research Questions

Is the high susceptibility of African Americans to hypertension caused by other factors besides genetics? Does aging increase the susceptibility of African Americans to hypertension? Is it possible to avoid rising blood pressure in the modern life for people of all skin colors? How do environmental and biological risk factors interact to produce hypertension?

Hypothesis

Hypertension is caused by intricate interactions among external factors (such as stress or diet), internal physiology (the biological systems that regulate blood pressure) and the genes involved in controlling blood pressure (Cooper, Rotimi, & Ward, 1999).

Higher levels of angiotensinogen in the RAAS correspond to high blood pressure.

Study design

• Establishment of research stations in various communities in West Africa, South America and North America. The countries selected were Nigeria, Cameroon, Zimbabwe, St. Lucia, Barbados, Jamaica and the U.S.
• Focus of the project on Nigeria, Jamaica and the US: these three countries were selected due to the assumed genetic ties since the Americans in the US and Jamaica are believed to have migrated from West Africa between the seventeenth and nineteenth centuries due to slave trade.
• Black people from different locations were randomly selected for testing to check for hypertension and its common risk factors (e.g. poor diet, obesity and physical inactivity).

Findings

The Nigerian community selected was rural, with complex family structures. The residents engaged in strenuous physical activity due to farming activities. Their diet comprised conventional foods like rice, tubers and fruits (Cooper, Rotimi, & Ward, 1999). In addition, the community did not have formal records of mortality and life expectancy.

It was observed that malaria is the primary killer in the region, with an adult mortality risk of 2%. Adults who survived to old age were healthy, and it was noted that death due to hypertension was rare. The study also revealed that blood pressure did not rise with age for the blacks in Nigeria (Cooper, Rotimi, & Ward, 1999).

The community selected in Jamaica was a representation of an industrial economy. The community was a former colonial city with a population of close to 100,000 people. The risk of infectious diseases was low, but the prevalence of chronic disease was higher than that of Nigeria. While the family structure in Nigeria was mainly polygamous, that of Jamaica had numerous incidences where women were the providers.

This is because their high poverty levels led to high unemployment rate that caused the marginalization of men; hence, lowering their position in society. The people also engaged in laborious activities, and their diet comprised mostly local foods and modern commercial products. The study revealed that the Nigerian community experiences few cases of heart disease and cancer, with a life expectancy of six more years compared to that of blacks in the US (Cooper, Rotimi, & Ward, 1999).

The US study was conducted in a region of Chicago that comprises mostly African Americans. Most of the older adults were migrants from lower sections of the US. It is possible that their migration to the north enhanced their health and income level due to the job opportunities in the heavily industrialized region. Both genders contribute to the household income. Their diet comprised foods that are high in fat and salt, which are some of the risk factors for cardiovascular disease (Cooper, Rotimi, & Ward, 1999).

Analysis

The study group shared a common genetic composition with 75% of the US and Jamaican study population sharing their genetic heritage with the Nigerians (Cooper, Rotimi, & Ward, 1999). From the study population, it was noted that about 7% of the Nigerian sample population had high blood pressure. Higher levels of hypertension were noted in the Nigerian urban towns. The study also revealed that 26% of black Jamaicans and 33% of black Americans had high blood pressure or were under medication (Cooper, Rotimi, & Ward, 1999).

This regional increase was due to a variety of reasons including the steady increase in body mass index from Nigeria to Jamaica to the US. The same increment across various regions was observed in average salt intake. Hence, about 50% of the increased risk of hypertension in American Americans compared with Nigerians was due to their lack of physical activity and poor diet causing them to be overweight (Cooper, Rotimi, & Ward, 1999).

Description

Based on the increasing susceptibility to hypertension as the geographical setting changed, it can be said that the human cardiovascular system has evolved from the rural setting in Africa, where the diet was low in fat, and there was a lot of physical activity. For people who have maintained this lifestyle, there was no increase in hypertension with age, as seen in rural Nigeria.

This provided a suitable control group for comparison in the study of the risk of African Americans to hypertension based on living conditions (environment). Living conditions also accounted for variation in blood sugar level between rural and urban Nigeria, whereby the risk was higher in Nigerian towns.

Environmental and biological causes of hypertension

The role of kidneys in the human body is to regulate the level of sodium ions in the blood stream, which controls blood pressure. The kidneys can hold up to 98% of sodium; however, they also release it back into the blood causing blood pressure.

Absorbing too much sodium also destroys the kidneys filtering mechanism, preventing them from adequately regulating the blood sugar levels. To identify the efficiency of the organs in regulating body sodium, an experiment was conducted to evaluate the activity of rennin-angiotensin-aldosterone system (RAAS), which is a vital pathway in the regulation of blood pressure.

RAAS controls the level of protein angiotensin II present in the bloodstream, whose role is to constrict blood vessels causing the pressure to rise. It also promotes the release of aldosterone, which enhances the ability of kidneys to absorb sodium from the blood. To evaluate the activity of RAAS, the experiment assessed the level of angiotensinogen-one in blood, which remains fairly constant.

The study revealed that higher angiotensinogen levels correspond to higher blood pressure. This was supported by the increase in average level of angiotensinogen for the sample population from Nigeria to Jamaica to the US, just as the rate of hypertension increased. The higher level of angiotensinogen was attributed to the risk factors such as excessive body fat and obesity (Cooper, Rotimi, & Ward, 1999).

Increased vulnerability due to genes

Studies show that the 235T gene variant is twice as common in African Americans as it is among the European Americans. This was supported by the fact that 90% of the sample population in Nigeria had the gene variant. However, the presence of the gene did not suggest an increased risk of hypertension since only 7% of the sample was diagnosed with high blood pressure. Hence, the deduction that hypertension is not induced by angiotensinogen levels, but rather physiologic or environmental factors (Cooper, Rotimi, & Ward, 1999).

Conclusion

The assessment of the impact of the environment on the rate of blood pressure on Africans in Diaspora was effective, due to the stability of the gene of the sample population. More studies should be conducted to identify the role psychological and social stress in increasing the rate of high blood pressure across various cultures. Such a study could explore the risk posed by racial discrimination on blood pressure. More research should also be conducted on isolated genetic and environmental effects on hypertension (Cooper, Rotimi, & Ward, 1999).

Reference

Cooper, R. S., Rotimi, C. N., & Ward, R. (1999). The Puzzle of Hypertension in African-Americans. Scientific American, 56-62.

Abstract

The incidence of hypertension among Africans- Americans is high. Although many researchers report that genetics play an imperative role in the occurrence of hypertension among Africans-Americans, the prevalence of high blood pressure is low in Africans. Cooper et al., (1999) conducted studies to explore the reasons behind the high incidence of hypertension in Africans-Americans.

They conducted three studies before concluding that genetics and environmental factors are imperative for the occurrence of hypertension in Africans and Americans. This paper will analyze the three studies about the prevalence of hypertension.

Introduction

The incidence of hypertension among Africans- Americans is high. Although many researchers report that genetics play an imperative role in the occurrence of hypertension among Africans-Americans, the prevalence of high blood pressure is low in Africans. Therefore, there is a possibility that, a positive correlation exist between genetic makeup of an individual, environment and occurrence of hypertension.

Cooper et al., (1999) conducted a study to explore the reasons behind the high incidence of hypertension in Africans-Americans. They used a variety of research designs before making conclusions. The hypothesis of the studies was; hypertension occurs because of the interaction between external factors, internal physiology and genes (Cooper et al., 1999). External factors include things like stress and diet while internal factor is the physiology of blood pressure.

The Studies

Cooper et al., (1999) conducted a retrospective study in some parts of the world to determine the cause of hypertension. The study population was rural communities in Nigeria, Cameroon, Zimbabwe, St. Lucia, Barbados, Jamaica and the United States. They reviewed medical records about mortality as well as expectancy rate and interviewed patients with hypertension.

They found out that the prevalence of hypertension was low in Nigeria and high in Barbados. Besides, the risk of hypertension was overweight, inadequate exercise and poor diet. On the other hand, there was no relationship between hypertension, increase in age and atherosclerosis.

In another study, Cooper et al., (1999) examined how environmental factors interact with a persons physiological functions to produce hypertension. The assumption was that the ability of a persons body to process and regulate salt would determine if that person is susceptible to hypertension.

The study was experimental and Cooper et al., (1999) measured the levels of angiotensinogen in blood. They found out that the higher the levels of angiotensinogen in blood, the higher the blood pressure and vice versa. Additionally, environmental factors like a diet rich in fats triggers the production of angiotensinogen. On the other hand, some people have genes that trigger the production of angiotensinogen and as a result, they have high blood pressure regardless of environmental factors.

Cooper et al., (1999) reviewed published literature to investigate the relationship between high blood pressure and slavery. They found out that hypertension was prevalent among Africans who had migrated to Europe than among the whites. Cooper et al., (1999) concluded that, genes and race are imperative for the development of hypertension in a person.

The Critique of Methodology

Cooper et al., (1999) conducted a retrospective study design by reviewing medical records. The advantage of this method is that the results are valid because it is supported by written documents. On the other hand, some communities did not have a clear record of mortality and morbidity and this interfered with validity and reliability of the findings. Secondly, the researchers interviewed people with hypertension.

This kind of data collection is usually biased because an interviewee can lie about the kind of diet that he takes and the activities that he does. Secondly, the selected sample was not a true representative of Africa and America. This is because most of the countries that were involved in the study were in Africa yet hypertension is prevalent among Africans and Americans.

In the second study, Cooper et al., (1999) used the experimental design. The strength of this method is that it is reliable and researchers can repeat in different parts of the world. Therefore, different researchers can use this method to investigate more about the issue of the prevalence of hypertension in Africans and Americans.

On the contrary, people may have a hidden factor that can interfere with the levels of angiotensinogen in the body. For instance, obesity, high salt diet and genes can trigger the production of angiotensinogen yet some researcher may not consider it. Additionally, the researcher can easily manipulate the reagents, hence, interfering with the findings. As a result, the findings will be erroneous. Secondly, the selected subjects were few and thus, the findings of the study cannot be generalized.

In the final study, Cooper et al., (1999) reviewed published literature. This kind of research methodology is not reliable because publishers can alter the results. For instance, a publisher can change the data that the researcher has given him to publish because of personal interests. Therefore, we cannot fully rely on the fact that there is a correlation between slavery and the prevalence of hypertension because the information was from secondary sources.

The Critique of Results

In the first study, Cooper et al., (1999) found that hypertension was prevalent in United States. They presented the information in a bar graph. Bar graph is a good presentation of information because it is easy to understand. For example, from the bar graph of incidence of hypertension, one can see that blood pressure is uncommon in African countries. Additionally, they presented the information about the relationship between body mass index and hypertension on a graph.

This makes it easier for someone to understand that hypertension is common in the United States because many people have a body mass index that is more than twenty five. The limitation of the graph method of data presentation is that the researcher cannot present the findings in details. For example, Cooper et al., (1999) did not present information about exercise, diet, and increase in age and cholesterol, yet they play a significant role in development of hypertension.

In the second research about how environmental factors interact with a persons physiological functions to produce hypertension, Cooper et al., (1999) presented the findings in forms of diagrams and a graph. They found out that the higher the levels of angiotensinogen in blood, the higher the blood pressure.

The advantage of a diagram is that it attracts the attention of the reader. Therefore, many people are empowered with information about the cause of rising levels of angiotensinogen in the blood and its role in alleviating the blood pressure. The graph about the relationship between genes responsible for hypertension and its incidence portray a clear picture of the puzzle of hypertension. This is because in Nigeria where many people have the genes, the prevalence of high blood pressure is low.

In the final study about blood pressure and slavery, Cooper et al., (1999) presented the data in notes form. They found out that hypertension was prevalent among Africans who had migrated to Europe than among the whites. This kind of presentation is difficult for the reader to understand. As a result, many may ignore the study yet it has an imperative message.

The Critique of Conclusions

In the first study, Cooper et al., (1999) concluded that hypertension is prevalent among the Americans. This study was biased because the sample population was small. Therefore, it cannot be generalized. Additionally, the fact that some Africans countries did not have clear medical records could have interfered with the findings and the conclusion. There is a very high possibility that hypertension was common in United States because they had clear and accurate records and not because majority of them are obese.

In the second study, Cooper et al., (1999) concluded that the higher the levels of angitensinogen in ones body, the higher the risk of hypertension. This conclusion is biased because there are a number of factors like diet and stress that affect the levels of angiotensinogen in ones body, yet Cooper et al., (1999) did not explore them.

In the final study, Cooper et al., (1999) concluded that hypertension was common in slaves. This conclusion cannot be generalized because the researchers reviewed secondary data. Additionally, the sample population was small.

Conclusion

It is difficult to understand the cause of hypertension. This is because environmental and physiological factors play a significant role in the occurrence of the disease. Additionally, there are confounding factors, which have not been identified, yet they are responsible for the occurrence of the disease. This could be the reason why some people had the genes responsible for the disease yet they did not have hypertension. Therefore, researchers should conduct studies about the causes of hypertension.

Reference

Cooper, R., Rotimi, C., & Ward, R. (1999). The Puzzle of Hypertension in African-Americans. Scientific Americans , 56-63.

Initial Search Process

High blood pressure contributes to the existing mortality gap between Black and White Americans in a substantial manner (Odedosu, Schoenthaler, Vieira, Agyemang, & Ogedegbe, 2012). The National Health and Nutrition Examination Survey (NHANES) reveals that approximately 40 percent of African Americans suffer from hypertension and hypertension-related outcomes such as cardiovascular complications (as cited in Ferdinand, 2015).

It follows that better control of the chronic condition can substantially improve health outcomes for the population. Telemonitoring of blood pressure has been identified as an effective method for improving hypertension management (Margolis et al., 2013). Unfortunately, the adherence to hypertension self-management behavior among African Americans is much lower than that in other racial groups (Flynn et al., 2013). Therefore, it is necessary to investigate whether telemonitoring of blood pressure can become a viable alternative for controlling hypertension among African Americans. This paper aims to outline an initial search process needed to answer a PICO question.

PICO Question

Among African Americans with hypertension, does telemonitor of blood pressure compared to office visit monitoring improve blood pressure control?

Search Process

To arrive at credible evidence necessary for answering the PICO question, an initial search was performed at the library of the University of Maryland. Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Medical Literature Analysis and Retrieval System (MEDLINE) were searched to find relevant materials. The scope of the search was limited by the specific variables of the PICO question.

The period of peer-reviewed articles included in the search was set at 2012-2017, to ensure that the evidence, which will help to guide evidence-based practice (EBP) is the most current. Only articles published in the English language were selected for the study.

To discover published studies that investigate the effectiveness of different methods for hypertension management, the following keywords were used: hypertension management, telemonitoring, hypertension control, BP monitoring, home, and telecare. CINAHL and MEDLINE have searched again for relevant studies identified in reference sections of articles discovered during the initial search. The selection of potentially eligible studies was based on the analysis of the information presented in the articles abstracts (Wilson, Guluma, & Hayden, 2015).

A randomized control trial (RCT) and the presence of a control group with traditional blood pressure monitoring were established as the inclusion criteria for the initial search. The first search yielded 74 results. After applying database-specific search limiters to the keywords, only 38 articles were left for the initial analysis. The application of the inclusion criteria furnished a set of 20 articles for the study. Upon carefully reviewing the remaining articles, only 9 articles were left for the final analysis. Eleven articles were excluded due to the presence of additional outcome measures for two groups, lack of control for the adherence to treatment, and incomplete data for blood pressure outcome measures.

PRISMA Diagram

Figure 1 presents a PRISMA diagram for the search process.

Challenge

The research experience was associated with the challenge of assessing a large number of studies, the majority of which were unsuitable. The sheer number of search results made the process of abstract evaluation extremely time-consuming.

Conclusion

The paper has discussed the need to find alternative approaches to controlling hypertension among African Americans. It has also presented steps in the initial search process for answering the PICO question. After applying multiple inclusion and exclusion criteria, nine peer-reviewed articles were included in the study. The paper provided references for two of those studies and made a graphical representation of the search process.

References

Ferdinand, K. (2015). Hypertension in high risk African Americans: Current concepts, evidence-based therapeutics and future considerations. New York, NY: Springer.

Flynn, S., Ameling, J., Hill-Briggs, F., Wolff, J., Bone, L., Levine, D.,&Boulware, L. (2013). Facilitators and barriers to hypertension self-management in urban African Americans: perspectives of patients and family members. Patient Preference and Adherence, 7(1), 741-749.

Margolis, K., Asche, S., Bergdall, A., Dehmer, S., Groen, S., Kadrmas, H.,&Trower, N. (2013). Effects of home blood pressure telemonitoring and pharmacist management on blood pressure control: A cluster randomized clinical trial. JAMA, 310(1), 46-56.

Odedosu, T., Schoenthaler, A., Vieira, D., Agyemang, C., & Ogedegbe, G. (2012). Overcoming barriers to hypertension control in African Americans. Cleveland Clinic Journal of Medicine, 79(1), 46-56.

Wilson, M., Guluma, K., & Hayden. (2015). Doing research in emergency and acute care: Making order out of chaos. New York, NY: John Wilson & Sons.

Logan, A., Irvine, M., McIssac, W., Tisler, A., Rossos, P., Easty, A.,&Cafazzo, J. (2012). Effects of home blood pressure telemonitoring with self-care support on uncontrolled systolic hypertension in diabetics. Hypertension, 60(1), 1-9.

Problem/Question

The research was will be carried out in African American population to find out what might be the real cause of hypertension among elderly people and how it can be prevented (Burns, Grove and Gray, 2010, p. 87). Hypertension is a medical condition that can limit the information given by its patients and their family members. This is because they do not have to go deep into the disease rather than understand how to administrate the prescribed medication. Therefore, according to Burns, Grove, and Gray (2010, p.56), the research question will be: What are the possible ways to prevent hypertension in African American population?

Literature Review

High blood pressure is a disease that affects African Americans in unique ways, which include early development unlike other people in the United States of America. This means that hypertension develops among young people in this group of people. Most cases of hypertension develop among the elderly in society due to reduced immunity in the body system (Klymko et al, 2008). In addition, those affected in African- American society remain with high chances of developing related complications. Unlike, in other parts of the US and the world in general, stroke, kidney diseases, blindness, and heart diseases are rampant among people with high blood pressure in African American societies (Terre, 2009).

Genetic factors contribute a lot to these unique exposures to hypertension and related complications. This can be proved by the fact that people back in Africa with their traditional lifestyles are less likely to acquire these diseases (Hekler et al, 2008). In addition, those who are unlucky to develop hypertension do not develop related complications easily (Hershkovitz et al, 2007). This happens to Americans, as well. Another factor that contributes to high blood pressure among African American population is environmental factors. The environment forces the black to adapt to new lifestyles, which include feeding habits and social lifestyles. (Hughson et al 2006). This means that they should adopt lifestyles that aim at improving their health and resisting the development of high blood pressure.

Sample Selection

The sample to be used for this study should be the young people in the African American population. Since the disease develops in young people, they are best fit to give data on what they think about hypertension and its prevention. The young blacks in America can provide adequate information regarding high blood pressure. They can openly discuss their lifestyles and feeding habits hence helping in the assessment of foods that can cause high blood pressure (Burns, Grove and Gray, 2010, p. 77).

The target population can be reached through social media at specified times. This means that since the majority of the target population is the youth who spend much of their time on social networks, they can be approached to respond to the set research questions.

Methodology

The research should use various methods to collect data from the selected sample of the population. Data collectors will make use of the internet through social networks to reach most of the target population. This means that data collectors will talk to their Facebook friends from the African American society and try to figure out what they think about the disease. In addition, data collectors will be sent to areas where these people are prevalent and try to carry out physical interviews to collect reliable information from society about hypertension.

Finally, researchers will use observation to collect information regarding hypertension in African American society (Burns, Grove, and Gray, 2010, p. 67). This will involve the known facts from past experiences. For example, they may observe their feeding habits and other lifestyles and compare with the present theories regarding hypertension and its prevention.

Dependent variables can be changed or manipulated by other factors. For example, the lifestyles of people in this society will be the dependent variables. This is because they can be varied by changing lifestyles hence altering the results (Hershkovitz et al, 2007). For instance, smoking increases the rate of developing hypertension but people may decide to quit smoking hence affecting the rate.

Independent variables cannot be changed by other factors hence remain fixed. Hypertension is the independent variable because once it has developed there is not much the researcher can do about it but to study how to deal with it. This means that once one has developed hypertension or related complications, not much can be done to reverse it. Studies can be carried out on how to manage it or prevent its occurrence to other people.

Confounding variables are variables whose presence affects the variables being studied. In this study culture is the confounding variable it affects variables being studied (Terre, 2009). This is where culture may prevent people from disclosing important information to the researchers. People in this society may have their theories regarding causes of hypertension hence affecting the study.

Institutional Review Board

It is ethical to keep all information given voluntarily in confidence at all times. This is noteworthy because respondents feel safe disclosing their health status to data collectors. Information regarding ones health is vital and should be confidential hence disclosing it to the public may result in a court suit. To safeguard the participants, data collectors will be trained on ethically handling the respondents hence winning their trust.

Data Analysis/Results

A lot of data concerning hypertension will be collected from the research. For example, it will be possible to collect data regarding the age at which hypertension develops in many cases. In addition, researchers will be able to understand the taboos and other beliefs that are there concerning the alarming prevalence of the condition in African American society. Information about causes and prevention of the disease will also be collected and recorded (Terre, 2009).

After the study is carried, information will be compiled and analyzed using various tools of data analysis. Therefore, an inclusive report will be written so that it will help its audience to deal with the menace. It will be useful to the African American and other scholars in maintaining the condition.

Discussion

The research was to find what should be done to tackle the issue hypertension. This should include how the society should control their eating habits in order to curb the menace. All concerned people should make sure that they give vital information about how to handle the disease (Burns, Grove and Gray, 2010). Then the information gathered was to help the same people to handle complications related to hypertension.

The study may face several challenges which involve ignorance from people. This means that people may be unwilling to respond to questions asked or give partial information due to lack of knowledge on the disease. Data collectors may also face challenges due to language barrier where they may have to interview people with different languages hence requiring translation. In addition, the cost of carrying out the study may be high as data collectors may be required to move from places to places.

Finally, the study should come up with a report that will provide enough information to nurses and the public in general. This means that the information from the study should offer guidance on how to handle hypertension in this society. In addition, the report should recommend to the nurses on how to manage patients with high blood pressure related complications.

References

Burns, N., Grove, S. K. & Gray, J. (2010). Understanding Nursing Research: Building an Evidence-Based Practice. Amsterdam: Elsevier Health Sciences.

Hekler, E. B., Lambert, J., Leventhal, E., Leventhal, H., Jahn, E. & Contrada, R. J. (2008). Commonsense illness beliefs, adherence behaviors, and hypertension control among African Americans. National Center for Biotechnology Information, 31(5). Web.

Hershkovitz, D., Burbea, Z., Skorecki, K. & Brenner, B. M. (2007). Fetal Programming of Adult Kidney Disease: Cellular and Molecular Mechanisms. Clinical Journal of the American Society of Nephrology, 2(2). Web.

Hughson, M. D, Douglas-Denton, R., Bertram J. F. & Hoy, W. E. (2006). Hypertension, glomerular number, and birth weight in African Americans and white subjects in the southeastern United States. National Center for Biotechnology Information, 69(4). Web.

Klymko, K. W., Artinian, N. T., Washington, O. G., Lichtenberg, P. A. & VanderWal, J. S. (2008).Effect of impaired cognition on hypertension outcomes in older urban African Americans. National Center for Biotechnology Information, 17(6). Web.

Terre, T. (2009). Advancing the Prevention and Control of Hypertension. American Journal of Lifestyle Medicine, 25(9). 123-134. Web.

Determining 30-day Readmission Risk for Heart Failure Patients

The first article under consideration examines the ways to predict readmission rates among patients with chronic heart failure (CHF). Therefore, the research questions developed by the authors are: How to create a scale to address the mentioned task? Which demographic and clinical factors can affect the precision of the assessment outcomes? Their consideration within the research scope is guided by the aim to reveal the characteristics affecting the possibility of complications for people with CHF (Chamberlain et al., 2018). Hence, the scholars hypothesize that the evaluation of the pre-defined set of factors will reduce the number of readmissions and the duration of hospital stay, thereby cutting the treatment costs. For the purposes of the study, dependent and independent variables are used. The former includes the length of hospitalization, inpatient mortality, and the frequency of complications, whereas the latter is presented by patients personal characteristics.

Reducing Rates of Readmission and Development of an Outpatient Management Plan

The second article is the study of outpatient disease management in the case of pulmonary hypertension (PH). This papers aim is to elaborate on the theoretical basis for the absent guidelines for improving the health of people with this condition. In order to formulate the task and address the gaps in healthcare practices, the scholars pose the following research questions: How can the measures used for enhancing the treatment outcomes in CHF be applied to PH? How can this knowledge reduce the readmission rates for patients with PH? (Dolan et al., 2020). From this perspective, the hypothesis is that the similarity of the mentioned conditions allows adopting ones measures for anothers better management. In research, the independent variables are presented by CHF interventions, mortality rates, and population size, whereas the dependent variable is the possible results of their use for people with PH.

References

Chamberlain, R. S., Sond, J., Mahendraraj, K., Lau, C. S., & Siracuse, B. L. (2018). Determining 30-day readmission risk for heart failure patients: The Readmission After Heart Failure scale. International Journal of General Medicine, 11, 127-141. Web.

Dolan, J., Mandras, S., Mehta, J. P., Navas, V., Tarver, J., Chakinala, M., & Rahaghi, F. (2020). Reducing rates of readmission and development of an outpatient management plan in pulmonary hypertension: Lessons from congestive heart failure management.Pulmonary Circulation, 10(4). Web.

Introduction

Depression is one of the leading causes of various health problems in modern society. According to a recent report (1), depression will become the second most common health problem in the world because of the emerging lifestyle. The emerging technologies are changing the normal lifestyle and people are working extra hard to meet the new needs. Increasing cases of single-parenting, divorce, tough economic conditions, joblessness, and family pressure are likely going to increase levels of depression, especially among those aged 30 years or older. According to a recent study (2), the problem that medical practitioners face when dealing with depression is that most patients often ignore it. People rarely consider extreme stress as a medical condition that may require medical attention. If it is left unchecked, depression can lead to other serious health problems, besides disruptive the social and economic status of an individual. Studies have indicated that hypertension is often caused by depression (3). The studies show that both depression and hypertension share a common pathway, so it is possible for depression to lead to hypertension. Hypertension is also becoming common among adults. In Saudi Arabia alone, studies suggest that the prevalence of hypertension is 27% among those who are aged 30 years and above. In this paper, the focus is to determine the effect of hypertension on primary health care depressive patients.

Importance of the Research

According to a recent study (4), depression is known to cause a number of health-related problems, one of which is hypertension. As such, medical scholars have conducted wide studies on how depression leads to hypertension or causes other diseases. However, little attention has been given to how other health problems may cause depression. Depression and hypertension have a common path and as such, it is likely that hypertension may lead to depression. However, this is an approach of study that is yet to be given serious focus by scholars. Depression can be very disruptive not only on ones health conditions but also in other spheres of life. Once one has been put on treatment, it is always necessary to take necessary precautions to ensure that other forces do not affect the recovery process. One of the studies (5) warns that hypertension may have a negative effect on primary healthcare depressive patients. It may slow the rate of recovery or even make the patients slide further into depression. It is necessary to determine the relationship between these two medical conditions to ensure that one does not hinder the management of the other. That is why this study was considered important.

Research Question

Primary health care depressive patients are often delicate and as such, it is necessary to find ways of eliminating other factors that may affect the healing process. That is why this research focuses on the relationship between hypertension and depression, with a special focus on how the former affects the latter. The following research question was developed to help in the process of collecting data.

Does comorbidity of hypertension and depression worsen the recovery rate?

Through this research question, it will be possible to determine if primary health care depressive patients who also have hypertension may have a problem in recovering at a normal rate.

Research Objectives

It is important to outline the objectives of the study that was used to assess whether the research project was a success. The following are the research objectives that were set for the research:

1. To determine the correlation between the level of depression and level of control of hypertension;
2. To evaluate the effect of depression on hypertension, satisfaction, lifestyle.

Methods

Literature Search Strategy

In this study, it was important to collect secondary data from reliable sources to help support data collected from primary sources. According to a recent report (6), it is always necessary to review the existing literature to avoid any possible duplication of already published information. Articles and books were retrieved from PubMed, EBSCOs Medical Databases, MEDLINE, PsycINFO, and Cochrane Database of Systematic Reviews. Additional books and journals were available in the college library. These sources provided important information about what other scholars have found out in this field. It formed the basis for the study.

Primary Data Extraction

This was a case-control study that was conducted at all the Ministry of Healths PHC clinics in AL Khobar city, in the Kingdom of Saudi Arabia. The study was conducted from March to April 2017. The study used 190 cases and 190 controls to help determine the relationship between depression and hypertension among primary health care depressive patients in the selected hospitals.

Findings and Discussion

Hypertension

According to a recent survey (7), it is predicted that about 1.56 billion people will be living with hypertension in the world by the end of the year 2025. The report states that one is considered to be suffering from hypertension if ones blood pressure goes past 140 over 90 mmHg. Although most of the reports indicate that the problem is severe in developed countries such as the United States where about 75 million people have been diagnosed with the condition, one study (8) warns that the problem may be more serious in the developing nations of Africa, parts of Asia, and some countries in the Middle East. In most cases, hypertension goes for a very long time without the patient realizing that it is a condition that needs medical attention. The report shows that diseases related to hypertension such as cardiovascular diseases have become leading causes of death in many developed and developing countries around the world.

Dietary factors and ones lifestyle are believed to be the primary causes of hypertension. Limited physical inactivity, excessive use of alcohol, regular use of tobacco, and regular intake of diets high in sodium are known to cause hypertension. Other factors such as age, race, size, and sex may also be considered risk factors. The problem is more common among the elderly than in the younger generation. African Americans are at a higher risk of developing the problem than Hispanic Americans. Those who are obese or overweight are at a greater risk of having high blood pressure than those of normal weight. Women are more prone to hypertension at an older age while men are more prone to hypertension at a younger age (9). Diabetes, depression, kidney disease, and Cushing syndrome are secondary causes of diabetes. Doctors are often keen on managing this health problem as soon as a diagnosis is made because of the devastating effect of related diseases if left unchecked.

Depression

Depression, which can be described as clinical depression or major depressive disorder, is defined in (9) as a serious mood disorder. Depression is known to disrupt the way one thinks, eats, sleep, works, or is related to people around them. It can be a mild condition such as baby blues that may last for about two months before clearing without any medication, or a more serious problem such as perinatal depression or persistent depressive disorder that can last for over two years. Other common types of depression include seasonal effective disorder, psychotic depression, and bipolar disorder (10). Persistent anxiety, hopelessness, worthlessness, helplessness, fatigue, difficulty in concentration, difficulty in sleeping or waking up, persistent headaches, loss of appetite and weight, and having suicidal thoughts are some of the common symptoms. The number of people who are suffering from this condition is increasing in various parts of the world and the worst affected group is the adults, especially the middle-aged individuals. Constant stress, trauma, and major life changes are known to be the primary causes of depression. Individuals with a family history of depression are also likely to develop the problem (11). Certain illness, especially those that cause pain, discomfort, or disability may also cause depression. This is common among patients who are incapacitated temporarily or permanently in a way because of their medical condition. Depression may cause other serious medical problems if left unchecked.

Correlation between Level of Depression and Level of Control of Hypertension

In the study that was conducted in AL Khobar citys Ministry of Health clinics, it was established that there is a relationship between hypertension and depression. Among the primary health care depressive patients who were part of this study, a pattern was identified where primary health care depressive patients with high blood pressure recovered at a slower rate than those who were not suffering from hypertension. It came out clearly that comorbidity of hypertension and depression made the condition of the patient worse in two main ways. The first is the hypertension and depression has a common path of development. As such, it is likely that a patient who is suffering from hypertension may also have a problem of depression. Until and unless the problem of hypertension is addressed, such a patient may not fully recover from depression irrespective of the efforts that are put in place by the practitioner. The patient may be given the right dosage of medicine and proper psychological support, but as long as hypertension is still an issue, depression may set in as soon as the emotional support is stopped or is suspended. There are cases where a patient may completely fail to respond to the medication for depression when they have serious problem of hypertension.

The second factor is when a patient suffering from hypertension has developed a life-threatening condition (12). For instance, a patient may be diagnosed with a serious cardiovascular disease that is directly attributed to hypertension. The thought that the condition is not curable or the fact that they cannot do what they used to enjoy doing before may result into serious levels of stress that can easily degenerate into depression. As noted in one of the recent studies (13), sometimes a doctor may issue strict dietary guidelines and the physical and social guidelines that a patient suffering from high blood pressure must follow. If such a patient was receiving therapy for depression or anxiety disorder, then the treatment may not achieve much. This is specifically so because the stressors are not eliminated. Depression becomes more serious, not because depression and hypertension share a common path, but because the impact of hypertension is causing very high levels of stress that a patient cannot easily deal with under normal circumstances. Such patients easily become suicidal when they start viewing themselves as worthless and unable to do things that they use to do in the past.

Comorbidity of Hypertension and Depression

The case-control study that was conducted in the Ministry of Health PHC clinics in AL Khobar city shows a worrying trend about comorbidity of hypertension and depression. 190 cases and another 190 controls were used in this study. It was observed that patients with hypertension were likely to have depression. 85% of the patients with hypertension were diagnosed with varying degrees of depression. On the other hand, 25% of the patients with depression had hypertension. It was important to establish the reason behind this comorbidity. The researchers wanted to determine if it is hypertension that is causing depression or vice versa, or if these two health problems are independent of each other. Of the 190 cases, it was unfortunate that most of the participants could not tell when they started experiencing the problem of depression or hypertension, especially those who work in stressful environments and suspect that their condition was caused by the nature of their workplace environment. Among the participants suffering from both hypertension and depression, they were unable to tell which of the two health problems started ahead of the other. In fact, some of them were completely shocked that intense stress (depression) is a condition that should be managed through medical procedures. However, the study was able to establish a number of facts from the analysis that was conducted as discussed below.

Explaining why patients with hypertension were more likely to suffer from depression

It was established that 85% of the patients with hypertension suffered varying degrees of stress. The investigation revealed reasons why the comorbidity of hypertension and depression was very high among patients who have hypertension. Hypertension is caused by a number of factors, one of which is prolonged depression. When one is suffering from depression, it is not guaranteed that such an individual will develop hypertension. It is also likely that the depression may still be in early stages and as such cannot cause hypertension. As such, an individual with depression may be a potential candidate that can develop hypertension. On the other hand, when hypertension sets in after a period of depression, it is less likely that the hypertension will be successfully treated without treating the primary cause, depression. That is why a higher percentage of people with hypertension suffer from depression compared to the percentage of people with depression who suffer from hypertension. One of the recent studies (14) explains that in many cases, uncontrolled depression is a sure path to high blood pressure, especially if ones physical activities is significantly reduced, dietary practices become unchecked, and social behavior gets affected. In the early stages, such individuals may not exhibit signs and symptoms of hypertension. However, the more the condition gets worse, the higher the chances are that the condition will develop into hypertension, or even into worse conditions related to hypertension such as cardiovascular diseases.

It was also established that other besides depression, a number of other factors are also responsible for hypertension among patients. One of them is dietary problem. In the Kingdom of Saudi Arabia, fast foods are becoming popular, especially among the young adults and teenagers. The poor eating habits are responsible for the increasing cases of obesity and overweight. Obesity is one of the known causes of hypertension. Some of the junk foods taken from the fast food stores have high sodium content. Food rich in sodium are known to cause hypertension, especially if taken regularly and in large proportions. The emerging lifestyle where indoor activities are becoming more popular than outdoor physical activities is also to blame when it comes to the rising cases of depression. Most of the teenagers prefer video games instead of the physical sports. On the other hand, the young adults currently spend most of their free time on Facebook, Twitter, and YouTube instead of visiting friends and family physically. It is considered a convenient way of engaging loved ones easily without having to strain. A combination of wrong eating habits and reduced physical activities is considered to be causing rapid increase in the number of people suffering from hypertension. It means that besides, depression, a number of factors can also contribute to hypertension.

Once one develops hypertension, they can easily become stressed up trying to deal with their new condition. Even for those whose high blood pressure was caused by depression, they start worrying about many other things about their lives, including a possibility of a sudden death. It explains why a high number of those who are suffering from hypertension are likely to develop depression. On the other hand, depression can only lead to hypertension if it lasts for a very long time without being properly managed. Many people who suffer from depression do not develop hypertension, especially if the conditions last for a while then disappears through therapy or on its own when the stressors are eliminated. It is important to note that the study established that the number of people diagnosed with depression is less than those who are suffering from hypertension. One of the studies (15) attributed this finding to a number of factors. The report shows that many people either fail to realize that they have the problem or ignore it as a normal state given the socio-economic and political forces in the environment. As such, this problem is often understated. Hypertension cannot be ignored, especially if its symptoms include pain. As such, statistics available shows that hypertension is more common than depression. One of the reports (16) also stated that the emerging technologies are introducing a new lifestyle likely to lead to hypertension and related diseases. It is more likely that a person with hypertension will seek medical attention than a person with depression would.

Effect of Depression on Hypertension, Satisfaction, Lifestyle

The analysis of comorbidity of hypertension and depression clearly outlines the relationship between the two conditions, and how one can lead to the other if no proper mechanism is taken to address it. It was established in the study that depression is a major cause of depression if it is left unchecked. It is important to address depression before it can degenerate into hypertension. Ones satisfaction with life can also be affected by depression. According to one of the recent surveys (7), depression can have serious negative impact on ones level of satisfaction with life. Perinatal depression or persistent depressive disorder may last for a very long time and may cause a feeling that one is worthless or helpless, depending on its cause.

When one is struggling with forces beyond ones control and he or she is unable to achieve the desired success, stress may set in. If the stressor is not eliminated in time, it may lead to depression. A feeling of helplessness comes in first, and if it is not address, then one may start feeling less useful to self and to the society. The level of satisfaction goes extremely low as one tries to battle with these forces. Many people become suicidal when the depression is not eliminated at the right time. They develop a feeling that they are not worthy enough to be alive. Severe depression is often accompanied with pain (5). The problem is that many people do not realize that they need professional help. They bear the pain silently or sometimes share with people who lack the capacity to give them professional help. Some people consider taking their own lives when the levels of satisfaction drop considerably.

The lifestyle of an individual can be significantly affected by stress. According to one of the studies (4), persistent depressive disorder makes it difficult for one to relate easily with others in social settings. Such individuals are often easily irritated and sometimes make irrational decisions. They tend to be judgmental and moody, and their actions or reactions very unpredictable. They find it making friends under that state of mind. Their friends and families will try to keep their distance when they realize that such a person is not capable to control their moods. It is common to find cases where a social person loses friends and close associates when their levels of depression go unchecked. They become lonely, making them to spend more time focusing on stressors instead of factors that can be used to overcome their condition. One may end up losing their valuable jobs if their behavior at work becomes erratic or when their performance drops considerably. Loss of ones job may have further devastating impact on the patient, making them to slide further into depression.

Conclusion

Hypertension and depression are common medical conditions that are major causes of concern in the modern society. Poor dietary practices, limited physical exercise among the young adults and teenagers, and stress are some of the major causes of hypertension. Patients suffering from hypertension are likely to develop depression. The study shows that hypertension worsens conditions of primary health care depressive patients. The comorbidity of depression and hypertension makes it difficult to address either of the two conditions while the other is ignored. The conditions must be treated concurrently to ensure that a patient is able to overcome both of them. As shown in the study, it is highly advisable for one to identify stressors in life and find a way of dealing with them before the condition can degenerate to hypertension. The study also suggests that people should remain physically active to fight obesity, hypertension, and other related health complications. Being positive towards medication is critical, especially for a patient who has both conditions.

References

Li Z, Li Y, Chen L, Chen P, Hu, Y. Prevalence of depression in patients with hypertension a systematic review and meta-analysis. Medicine. 2015; 94(31): 1317.

Al-Qadhi W, Rahman S, Ferwana M, Abdulmajeed A. Adult depression screening in Saudi primary care: prevalence, instrument and cost. BMC Psychiatry. 2014; 14(190): 1-9.

Al-Khathami A, Al-Harbi L, Al- Salehi S, Al-Turki K, Al-Zahrani M, Alotaibi N, et al. A primary mental health programme in Eastern Province, Saudi Arabia, 20032013. Mental Health in Family Medicine. 2013; 10(1):203210.

Martin L, DiMatteo R. The Oxford handbook of health communication, behavior change, and treatment adherence. New York: Cengage; 2014.

Feinstein R, Connelly J, Feinstein M. Integrating behavioral health and primary care. Hoboken, Wiley & Sons; 2017.

Silva D. Evidence: helping people share decision making: a review of evidence considering whether shared decision making is worthwhile. London: The Health Foundation; 2012.

Black H, Elliott W. Hypertension: a companion to braunwalds heart disease. Philadelphia: Elsevier/Saunders; 2013.

Theodore S, Fava M, Wilens T, Rosenbaum J. Massachusetts general hospital comprehensive clinical psychiatry. London: McMillan; 2016.

Unger J, Schwartz Z. Diabetes management in primary care. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2013.

Cecil R, Goldman L, Schafer A. Goldmans Cecil medicine. Philadelphia: Elsevier/Saunders; 2012.

Haber D. Health promotion and aging: practical applications for health professionals. London: Springer; 2013.

Burns C. Pediatric primary care. Philadelphia: Saunders Elsevier; 2013.

Talbott J. The year book of psychiatry and applied mental health. Hoboken, Wiley; 2012.

Hammond B, Zimmermann P, Sheehy S. Sheehys manual of emergency care. New York: Cengage; 2013.

Chakraborty B, Moodie E. Statistical methods for dynamic treatment regimes: reinforcement learning, causal inference, and personalized medicine. New York: Springer; 2013.

Kumar P, Clark M. Kumar & Clarks clinical medicine. Hoboken: Wiley & Sons Publishers; 2012.

Introduction

Hypertension-related problems are frequently observed in adults, and the task of medical workers is to take preventive measures and reduce their blood pressure to normal limits. The application of antihypertensive drugs is one of the common therapies that can be offered to patients, but this intervention has to be properly implemented (Aronow, 2018). In this paper, change to decrease hypertension in patients older than 50 years will be based on Kotters model. In his intention to lead change, John Kotter developed an 8-step change model in the middle of the 1990s. Compared to other models that consist of three or six steps, the choice of eight steps was explained by the necessity not to neglect any process and predict failure. To make sure change is properly understood and accepted, the following factors should be considered: urgency, coalition, vision, a volunteer army, barriers, short-term wins, acceleration, and change (8-step process, n.d.). Each step has its characteristics and goals, and an understanding of the theory promotes the success of the whole intervention to increase positive health outcomes in hypertensive patients.

The reasons for the selection of Kotters change model include the possibility of focusing on the environment, as well as the necessity of understanding people, their needs, processes, and access to available resources. The first step of the model is to create a sense of urgency for change (8-step process, n.d.). It means that all the participants and stakeholders should understand why it is necessary to act immediately. The second step is building a collation, the members of which can guide and coordinate other people while changing the environment. The next task is important in terms of developing a vision with the help of which initiatives gain meaning. Then, it is necessary to understand how many people should be involved (voluntary) to move the change.

As soon as participants are chosen and understand their roles, the analysis of barriers is required to remove all obstacles. The generation of short-term wins helps to identify the results and explain the possible progress (8-step process, n.d.). After all these steps are taken successfully, acceleration sustainability must be underlined as it serves as the only credible factor of system improvement. Finally, the institution of change is observed when all connections are established, and old habits are replaced with new approaches. All these steps are not difficult to take, and its selection is characterized by thoughtful preparation and description of every single task to promote success and effectiveness.

Implementation of Change Model

During six months, patients, aged 50 years or older, have to demonstrate consistent adherence to antihypertension drugs. It means that a nurse or a group of nurses should consult patients and their families about the importance of such factors as consistency and adherence to therapy. Kotters change model has already been successfully applied to predict the risk of surgical site infection and needle stick injuries (Aziz, 2017; Burrden, 2016). Its usefulness was explained by the necessity of never giving up and fostering the environment regarding high-quality outcomes.

In the case under analysis, the goal is to implement the intervention and help hypertensive patients to control their blood pressure and prevent the growth of health problems. The implementation of this change model consists of eight steps, and none of them should be skipped. To create urgency, one needs to underline the presence of high blood pressure in millions of adult patients, and the development of antihypertension drug therapy can be proved as an effective solution. A guiding collation may include a researcher, several nurses, and facility administrators who have to control the treatment process. The introduction of a strategic vision like the decrease of hypertension using drugs in adult patients is obligatory to create a volunteer army, including nurses, patients, and their families.

When participants are chosen, and the intervention is explained, some barriers may occur, and the task is to remove them by collaborating and discussing alternatives. The next step is an understanding of short-term wins of antihypertension drugs within the next six months. The coalition and a volunteer team focus on the sense of urgency and address the chosen vision any time it is necessary to support the goals. Finally, acceleration plays a vital role because resistance may challenge the intervention. Nurses and patients should not give up and support each other to make sure the change works. This change model covers several aspects that define the quality of nursing care and the process of healing after a specific treatment plan is implemented.

In general, the implementation of Kotters model in the project, the goal of which is to decrease hypertension and promote positive health utilizing antihypertension drugs, has certain benefits. This change model includes the value of researching the field and analyzing the achievements that have already been made. In addition, the roles of nurses and other stakeholders are as important as the presence of resources and the environment. The only recommendation for its implementation is to never miss a step and follow a plan introduced by Kotter several decades ago.

References

8-step process. (n.d.). Kotter.

Aronow, W. S. (2018). Antihypertensive drug therapy. Annals of Translational Medicine, 6(7).

Aziz, A. M. (2017). A change management approach to improving safety and preventing needle stick injuries. Journal of Infection Prevention, 18(5), 257-262.

Burden, M. (2016). Using a change model to reduce the risk of surgical site infection. British Journal of Nursing, 25(17), 949955.

Introduction

Pulmonary hypertension, often abbreviated as PH, is a rare but life-threatening form of high blood pressure. According to Ogo (2020), the condition occurs when blood vessels in the lungs (pulmonary arteries) are clogged, narrowed, blocked, or destroyed. It creates a condition where the heart has to use extra force to pump blood into the lungs. The extra load damages heart muscles, especially in the right ventricle, causing weakening and enlargement of the organ and can lead to untimely death (Hodler et al., 2019). Once a person is diagnosed with this condition, they have to manage it through medication and a change of lifestyle. In this paper, the researcher seeks to investigate causes, pathophysiology, symptoms, and treatment for pulmonary hypertension.

Pathophysiology

Pulmonary hypertension is one of the major life-threatening diseases, although it is rare. Ogo (2020) defines it as a condition that is characterized by narrowing of pulmonary arteries, causing stress on the heart muscles and can cause death. Although the primary cause of PH is unknown, Sergi (2019) explains that genetic mutation through the family tree may be one of the causes. Use of prescription drugs, abuse of hard drugs, congenital heart disease, and chronic conditions such as cirrhosis and HIV are also attributed to the condition. The condition starts when the pulmonary artery is narrowed. If nothing is done to correct it at an early stage, the narrowing will continue and the vessel may eventually be blocked. The heart responds to the problem by using extra force to ensure sufficient blood reaches the lung. As the condition progresses, the heart muscles start to weaken and the body becomes weak. Without proper management mechanisms, the heart can fail abruptly, leading to untimely death of the patient.

Signs and Symptoms

It is necessary to understand signs and symptoms of this disease. According to Hodler et al. (2019), some of the common symptoms of this disease include dyspnea (shortness of breath), dizziness, and chest pain, edema, cyanosis, and heart palpitations. Such a patient may frequently faint, complain of chest pain, and be fatigued even when they have not done anything physically or mentally demanding. Different tests can be used to diagnose the problem. One of them is chest X-ray that provides the picture of the heart. Right heart catheterization is another common approach that can be used to test for the condition. Other tests include electrocardiogram (ECG), echocardiogram, or blood test.

Treatment

Managing of pulmonary hypertension is critical in enabling a patient to lead a normal life. Sergi (2019) observes that treatment often focuses on the underlying condition. In cases the diagnosis reveals that it was as a result of clotting of blood which eventually blocked pulmonary arteries, cardiologists often prefer using anticoagulant medicine such as warfarin that helps in preventing further clotting. Water tables, often known as diuretics may be used to eliminate excess fluid to prevent heart failure. For a patient struggling to breath, oxygen treatment may be necessary. Digoxin can help to strengthen the heart and slow the rate of pumping. It may be necessary to have a surgical procedure such as atrial septostomy, balloon pulmonary angioplasty, or pulmonary endarterectomy (Des et al., 2020). One may be put on strict diet with limited calories as a preventive measure when the condition is detected early.

Conclusion

Pulmonary hypertension is a life-threatening medical condition that may have devastating consequences on a patient. It is believed that drug abuse, genetics, heart diseases, and chronic conditions may cause PH. A patient may exhibit a wide range of symptoms and different tests may be conducted for its diagnosis. When managing the condition, the focus is always on its manifestation. The researcher chose this topic because the disease is life-threatening but it is less known.

References

Des, J. T., Burton, G. G., & Phelps, T. H. (2020). Clinical manifestations and assessment of respiratory disease (8^th ed.). Elsevier.

Hodler, J., Kubik-Huch, R. A., & Schulthess, G. K. (Eds.). (2019). Diseases of the chest, breast, heart and vessels 2019-2022: Diagnostic and interventional imaging. Springer Open.

Ogo, T. (2020). The evolving role of balloon pulmonary angioplasty in the management of chronic thromboembolic pulmonary hypertension. 19 (1): 2124.

Sergi, C. M. (2019). Diagnosis and management of pediatric diseases. Multidisciplinary Digital Publishing Institute AG.