Category: Hypertension

Identification of the Teaching Topic

Negative implications of high blood pressure among women do not usually concern many of them, as opposed to their fear of breast cancer. However, it is as important to detect high levels of blood pressure as soon as possible, regardless of age. The high necessity of detecting hypertension is associated with the fact that it is a condition that does not show clear symptoms; thus, women should be vigilant about being in control of their pressure to have an understanding of whether their health is in danger on not. Teaching women about the importance of monitoring blood pressure and acting upon the negative indicators is a challenge for health educators (nurses in particular) due to the gaps in knowledge regarding this issue among the female population.

According to the Centers for Disease Control and Prevention (2016), only a half (54%) of people diagnosed with hypertension have their diagnosis under control, which is an astonishing fact that needs to be taken into consideration within the context of health teaching. Moreover, the CDC identified that high blood pressure varies by age, and beginning from 34-35 years, women’s blood pressure tends to increase. With regard to race and ethnicity, 31.3% of white women suffer from hypertension compared to 28.9% of Mexican Americans and 45.7% African Americans (Centers for Disease Control and Prevention, 2016).

Hypertension in women has not been extensively explored in medical or nursing literature, although there are some findings pointing at severe implications of high blood pressure. According to Gudmundsdottir, Høieggen, Stenehjem, Waldum, and Os (2012), there is an ongoing misconception that women are not at a high risk of cardiovascular disease, especially compared to men. However, patients should understand that the attainment of optimal blood pressure has a direct impact on lowering the chances of cardiovascular morbidity and mortality. Moreover, Gudmundsdottir et al. (2012) identified risk factors specific to women. One of such factors is preeclampsia, a pregnancy disorder characterized by hypertension and increased amounts of protein in the urine. The chances of suffering from cardiovascular disease in the future increase by four times if a woman experienced preeclampsia during her pregnancy.

Research conducted by Pemu and Ofili (2008) found that women that take oral contraceptives are at a higher risk of increased blood pressure compared to those women that never took oral contraceptives. The chances of high blood pressure increase if a woman taking oral contraception has a family history of hypertension, obesity, occult renal disease, and if she is 35 years old and older (Pemu & Ofili, 2008). Therefore, women should be aware of the importance of monitoring blood pressure throughout contraceptive therapy to ensure that the negative implications can be prevented altogether or eliminated as soon as they occur.

According to Lackland (2014), decades of research on the issue of hypertension found a significant disparity in high blood pressure risks among Caucasians and African Americans, with the latter being at a higher risk. Reasons for such a disparity remain understudied. However, the racial differences in control rates of blood pressure are not associated with the differences in treatment or levels of awareness, which means that women of all races are provided with equal treatment and education regarding the risks of hypertension. Lackland (2014) found that the equal treatment for Caucasian and African American women gives different results, for example, the DASH diet that includes the restriction of sodium has resulted in better health outcomes among the African American population compared to the Caucasian. Therefore, it can be concluded that racial characteristics play a certain role in influencing the risks of high blood pressure in women, so there is a need to account for such differences in the course of health teaching.

Learning Need of the Client

As mentioned previously, women do not pay enough attention to monitoring their blood pressure due to the misconception that they are at a lower risk of cardiovascular diseases compared to the male population. Furthermore, researchers, for example, Steven Asch et al. (2005) found some disturbing gaps in the treatment of women with hypertension when analyzing the levels of care of more than two hundred women. This suggests that women should be provided in-depth information about the possible implications of blood pressure negligence to enhance their awareness of the issue and ensure improved health outcomes.

Client’s Demographic Information

The client (Mrs. J) involved in the health-teaching project is a 34-year old Caucasian female who has a full-time job in the sphere of retail. She has been married for six years and has two children: a three-year-old son and a five-year-old daughter. Mrs. J has a family history of cardiovascular disease (her father had a stroke two years ago); however, she never paid attention to monitoring her blood pressure because her mother did not have any history of cardiovascular issues. During her recent visit to a family physician, the client found out that her level of blood pressure was higher than the norm, which caused a major concern for her health.

Mrs. J indicated that she experienced regular headaches that could be associated with her menstrual cycle as well as her taking oral contraceptives. Furthermore, on her mother’s side, Mrs. J has a history of thyroid complications, so she pays a lot of attention to monitoring hormone levels and visiting the endocrinologist for check-ups. Therefore, the client understands the importance of continuous health monitoring, although she lacks knowledge about the necessity of keeping blood pressure under control. This health-teaching project will be targeted at educating Mrs. J about the negative implications of hypertension among Caucasian women aged 30 and older as well as motivating her to spread the message of monitoring blood pressure among her women friends and relatives.

The Client’s Learning Need

The learning need of the client involved in the health-teaching project is associated with providing her with knowledge about the issue of hypertension in white women aged 30 and older. Discussing possible risks and negative outcomes of high blood pressure among women is an internal force that will motivate the client to pursue the goal of closing the gap that exists between her current level of competence on the topic of hypertension and the level of competence Mrs. J is planning to achieve. Identifying the learning need of the client within the process of health teaching is a primary step towards designing an instructional plan targeted at addressing the deficit in the knowledge of hypertension among women aged 30 and older.

In many instances, patients do not have a full understanding of what they need to know about their health needs. Moreover, there may be a discrepancy between what a health educator perceives as a learning necessity and what the patient regards a requirement for learning. For instance, when a pharmacist gives patient information about a medicine prescription, the patient may say that he trusts his doctor, so there is no reason for him to know the details. In this instance, the most effective approach the pharmacist can take is saying why the information is important as well as that the outcome of the treatment depends on whether the patient is aware of the appropriate procedures associated with the prescribed medication. The case of Mrs. J is similar to this example because she did not have any interest in learning the risks associated with hypertension until her doctor indicated that her blood pressure is higher than the norm.

Learning about the risks of hypertension is important for the client because she has a family history of cardiovascular disease, which points to the necessity of paying more attention to monitoring blood pressure to avoid negative implications. The client is thirty-four years old, which is an age when women begin experiencing higher levels of blood pressure, as reported by the Centers for Disease Control and Prevention (2016). Furthermore, the findings of medical research presented at the teaching topic identification stage mentioned the association between increased blood pressure in women and the usage of oral contraception, which the client is currently taking. Her headaches may also be associated with irregular blood pressure patterns, so it is crucial to provide Mrs. J with the necessary knowledge concerning the risks of hypertension.

Client’s Preferred Learning Style

Determining the client’s learning style and readiness are requirements outlined in the patient and family education standards of the Joint Commission on Accreditation of Health Care Organizations (Euro-Med Info, n.d.). This stage of the teaching process starts with the nurse identifying the most effective way in which the client learns. Finding out whether the client learns best through reading, listening, or experiences is a relatively straightforward process. To identify Mrs. J’s learning style as well as her readiness to learn about hypertension among women of her age, a quick questionnaire was composed. It includes the following eleven questions:

1. In your opinion, what time of the day do you perceive and process new information the best?
2. What do you prefer: listening or reading?
3. When you were at the university/college, what was your preferred method of revising for exams?
4. Do you have any issues with remembering information that is delivered verbally?
5. Do you often write information down to remember it?
6. Does experiencing something yourself help you learn better? (For example, do you remember a new recipe through reading through it or do you prefer to cook a meal yourself to understand the process better?)
7. What information/skills are you hoping to acquire after the health-teaching program?
8. How would you apply the acquired information/skills in your daily life?
9. Do you like discussing new topics or do you prefer analyzing them yourself?
10. In your opinion, what teaching strategies are effective and which ones are not?
11. Is there anything that prevents or distracts you from learning new information? How do you usually avoid distractions?

After completing the questionnaire presented above, it is important to interview Mrs. J’s immediate family to fill in some gaps in the gathered information. This will help the health educator to get a better understanding of how others perceive the client’s learning as well as find out whether the family will be supportive of Mrs. J’s learning.

The rationale for the Identified Learning Need

A brief review of the health literature concerning the topic of hypertension among women aged 30 and older suggests that the female population is under-informed about the risks of high blood pressure and does not pay enough attention to monitoring this indicator. The lack of awareness about the negative implications of hypertension in women is a contributor to poor health outcomes; thus, providing the client with the necessary information will be the first step towards improving her condition and preventing hypertension from exasperating.

When it comes to hypertension, like any other disease, it discriminates against various characteristics; age, weight, ethnicity, and pregnancy are all risk factors that put women in danger of experiencing negative implications of high blood pressure (Mirken, 2017). Birth control, hormone therapy, unhealthy weight, diet pills, or even some cold medicines can be contributors to hypertension. Therefore, the rationale for the learning need encompasses a range of components that need to be taken into consideration in the course of the health-teaching project. It is also important to mention that there is a gap in care among men and women with high blood pressure; as found by the American Heart Association, only 60% of women with high blood pressure receive treatment while only a third of them can maintain their pressure at appropriate levels (as cited in Mirken, 2017).

Client-Centered Behavioral Objectives

• Specific: the goal of the health-teaching project is to educate the patient about possible implications of hypertension and facilitate the improvement of her health indicators (specifically, reducing blood pressure).
• Measurable: the goal will be considered achieved when the client acquires new knowledge about the risks of hypertension and shows improvement in her blood pressure indicators.
• Achievable: the goal will be achieved by providing the client with the necessary information, designing a comprehensive teaching plan, and collaborating with the family and health care professionals.
• Realistic: the goal is worthwhile because it is associated with improving the client’s health and is meaningful for the client herself because she has concerns about her health.
• Time-Bound: six months is a feasible timeframe for achieving better health outcomes.
• Client-centered: the goal of educating the client and teaching her to achieve better health outcomes is client-centered because it focuses on the specific learning needs of the patient and her expectations about health outcomes.

Teaching Project Description

The preparation for the teaching project started with collecting all available information about what Mrs. J had known before the project implementation, identifying the client’s learning needs and learning styles, as well the assessing literacy and education levels of the content taught. It can be concluded that Mrs. J was not aware of the importance of monitoring blood pressure, even though her father had a history of cardiovascular disease. Therefore, there is a need for learning more about the negative implications of her condition in order to enhance the level of awareness and subsequently improve health outcomes. The assessment of the learning style showed that Mrs. J is versatile in her learning and can process information that comes from a variety of sources; this offers the nurse more teaching options, tools, and methods. The client’s level of literacy is relatively high, so it is expected that she will be able to process new information that can be considered complicated to other patients.

It was chosen to implement the hybrid (blended) teaching style with the client because the assessment of the learning style indicated that Mrs. J learns best from different sources. A hybrid teaching style is an integrated approach to teaching, which combines the skills and knowledge of the educator with the needs of the client; moreover, it is a teaching method that takes into consideration what strategies are the most appropriate in specific circumstances. The teaching style will also integrate the lecture model that is predominantly educator-centered. Brief lectures will be useful in the primary stages of the learning program because they are effective in providing a client with general information about the main topic, on top of which new knowledge and skills will be built.

The content taught in the course of the teaching project will focus on reducing the gap in the client’s knowledge regarding the implications of hypertension among Caucasian women aged 30 and older. The majority of the information will be associated with examining positive practices, treatments, and interventions that have proven to be effective in reducing blood pressure. Both medication and non-medication interventions will be discussed in great detail, so the patient will possess a full scope of knowledge about different methods of improving her health outcomes and starting to change her lifestyle to prevent hypertension from exasperating.

According to Smith and Zsohar (2012), patient education is a process that provides clients with nursing care beyond “here and now” (p. 1), so it is crucial for an educator to ensure that the chosen teaching method aligns with the patient’s needs and learning objectives. Since it has been identified that the patient learns through the use of various tools and resources, the nurse can implement a variety of strategies to enhance the client’s knowledge about the issue at hand. Brief lectures and one-on-one conversations will be suitable for instances when a patient is visiting a health care facility for a check-up while sending the patient written material via email will be an effective strategy when the patient does not have enough free time to interact with the nurse. Therefore, mixed approaches to teaching will offer both the nurse and the client some level of flexibility without taking away from the orientation on the client’s objectives.

The chosen teaching content and methods are appropriate for the client because she is a busy woman who has a family and a full-time job, so her learning schedule should be flexible enough. While Mrs. J’s family agreed to put an emphasis on her health, there is still not much time for her to regularly visit the nurses’ office. Hand out material, video seminars, participation in forum discussions can be effective learning tools for Mrs. J to acquire more knowledge about her health issue and decide what practices she can incorporate into her daily routine to prevent her condition from getting worse. The chosen teaching tactic will ensure that the patient stays motivated and focused on achieving her SMART goal. It is important to mention that the nurse will encourage the family to participate in Mrs. J’s learning program in order for the entire family to be aware of the health issue and move towards the adoption of a healthy lifestyle where the risks of hypertension among the members will be reduced to zero.

References

Asch, S., McGlynn, E., Hiatt, L., Adams, J., Hicks, J., DeCristofaro, A.,…Kerr, E. (2005). Quality of care for hypertension in the United States. BMC Cardiovascular Disorders, 5(1), 1-9.

Centers for Disease Control and Prevention. (2016). High blood pressure facts. Web.

Euro Med Info. (n.d.). Assessing learning needs. Web.

Gudmundsdottir, H., Høieggen, A., Stenehjem, A., Waldum, B., & Os, I. (2012). Hypertension in women: Latest findings and clinical implications. Therapeutic Advances in Chronic Disease, 3(3), 137-146.

Lackland, D. (2014). Racial Differences in Hypertension: Implications for High Blood Pressure Management. Am J Med Sci, 348(2), 135-138.

Mirken, B. (2017). Women and high blood pressure. Web.

Pemu, P., & Ofili, E. (2008). Hypertension in women: Part I. Journal of Clinical Hypertension, 10(5), 406-410.

Smith, J., & Zsohar, H. (2013). Patient-education tips for new nurses. Nursing, 43(10), 1-3.

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.

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 person’s physiological functions to produce hypertension. The assumption was that the ability of a person’s 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 person’s 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 one’s 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 one’s 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.

Introduction

Hypertension and difficulties with the control of blood pressure are more common in African Americans than the white population. The premature onset of the condition (elevated blood pressure) complicates the issue as other comorbidities such as diabetes mellitus or chronic kidney disease lead to an elevated risk of mortality among African Americans even with no regard to the blood pressure (Ortega, Sedki, & Nayer, 2015).

Other factors that complicate and contribute to the development of hypertension include prevalent obesity among African Americans (one in six African American women are extremely obese) and salt sensitivity that is often present in African Americans with hypertension (Ortega et al., 2015). Both ethnicity and genetics can be related to the development of hypertension. Another problem is the presence of resistant hypertension that is more common for African Americans than whites and can cause such complications as “albuminuria, depressed kidney function, obesity, target-organ injury, diabetes, and severe BP elevations” (Ortega et al., 2015, p. 142). The antihypertensive drug resistance leads to decreased levels of control over the condition, which increases the risk of comorbidities.

Summary of Advocacy Campaigns

Equitable Care Health Outcomes (ECHO) was an advocacy campaign that aimed to address the disparities in control of hypertension among African Americans. Specific emphasis was put on the education of participants, culturally appropriate storytelling, behavioral counseling, self-management of blood pressure, and its monitoring (Bartolome, Chen, Handler, Platt, & Gould, 2016). In this campaign, proactive health care teams were engaged to provide African Americans who participated in the study with education and counseling. An important tool, in this case, was culturally appropriate and responsive care that was provided by trained and motivated physicians.

The second campaign was aiming at spreading and supporting disease prevention strategies among African Americans with the help of community-based churches and the clergy who worked there. As communication is believed to be one of the major components of disease prevention, the authors of the study and the campaign decided that the church as one of the most trusted institutions among African Americans could be engaged in the education of disease prevention (Lumpkins, Greiner, Daley, Mabachi, & Neuhaus, 2013).

The study demonstrated how pastors in predominantly African American churches advocated for health management. The identified strategies included the way pastors communicated behavior strategies that could help address disease prevention, pastors’ view of health problems in the congregation, the use of authority to promote health strategies, the relation between spirituality, religion, and health, and pastors’ encouragement of health events and advocacy (Lumpkins et al., 2013). An important factor was also the church’s role in health advocacy, where the church acted as an agent for health care equity.

Attributes That Made Campaigns Effective

In the first campaign, the attributes that contributed to its effectiveness were the following: educational programs that targeted treatment intensification were led by physicians; care teams consisted of motivated professionals where individual responsibilities were defined and divided accordingly; the use of new care delivery design, which aim was to encourage patients to have and follow their treatment plan; the use of risk stratification of the target population; and included culturally tailored programs (Bartolome et al., 2016).

The effectiveness of the second campaign was in its emphasis on spirituality and the support coming from the clergy. Here, the authors of the campaign considered the authority that the church had and measured the role of pastors in health promotion (Lumpkins et al., 2013). The empowerment of individuals, the encouragement of them becoming proactive, the use of interpersonal and group communication, pastors’ authority, and spirituality resulted in individuals’ increased attention to their health. The campaign demonstrated how effectively the combination of spirituality, health advocacy, and church authority could be utilized to encourage African Americans to pay more attention to their health, manage chronic illnesses and prevent conditions (including hypertension).

Health Advocacy Campaign Plan

Hypertension, as a disease more prevalent in African Americans, presents a serious public issue because current policies do not focus on the population from a culturally appropriate approach. The education of the population is based on accepted approaches that do not consider cultural specifics. The proposed policy will target African Americans specifically, providing a new, evidence-based, and culturally appropriate policy that will help increase the management of hypertension in the African American population and add a spiritual approach to it. The proposed solution consists of multiple steps:

• Physician-led care teams with clear team roles and responsibilities that will help patients monitor hypertension and manage it.
• Cross-cultural awareness workshops to increase the effectiveness of medical personnel in the provision of care appropriate for the chosen population.
• Team-building activities to positively influence the engagement of team members (Bartolome et al., 2016).
• Blood-pressure follow-up programs for nursing professionals that stimulates BP to recheck.
• Hypertension patient education by RNs or other team members.
• Implementation of spiritual practices and patient-centered education.
• Assistance from pastors and the clergy in promoting health-related events.
• Events dedicated to health practices should be integrated into the life of communities (Lumpkins et al., 2013).
• Possible media coverage to attract supporters (Dorfman & Krasnow, 2014).

Hypertension is a serious issue that can lead to complications and even fatal outcomes in the African American population. Although the healthcare system in the United States has different programs that target vulnerable populations (such as Medicare and Medicaid), prevention techniques and advocacy campaigns that emphasize the importance of disease prevention and management can be highly beneficial for the African American population (Knickman & Kovner, 2015).

The objectives of the policy are the following:

• Increase patient education effectiveness in hospitals and other healthcare facilities with the help of physician-led teams.
• Provide care that is based on cross-cultural awareness.
• Create workshops dedicated to patients’ healthcare plans and integrate them into healthcare facilities.
• Add spiritual counseling as a complementary form of care in healthcare facilities.
• Increase the number of patients (throughout the state) who complete BP recheck and visit follow-ups.
• Promote dietary and physical activity interventions among African American patients to decrease the risk of hypertension and subsequent complications.
• Support evidence-based approaches in teams that provide care to African Americans with hypertension.
• Increase the number of events dedicated to hypertension in African American communities (Leyk et al., 2014).
• Engage the church in African American communities as an advocate for correct self-management and screening for cardiovascular risks.

Conclusion

As can be seen, both structural and transformative changes are needed. Teams that provide care to African Americans with hypertension need to learn how cultural specifics can assist them in making management and treatment more effective. The church and the clergy can help in promoting healthcare-related events at local communities, as well as provide psychological and spiritual help to those African Americans who have the condition and need spiritual guidance.

References

Bartolome, R. E., Chen, A., Handler, J., Platt, S. T., & Gould, B. (2016). Population care management and team-based approach to reduce racial disparities among African Americans/Blacks with hypertension. The Permanente Journal, 20(1), 53-59.

Dorfman, L., & Krasnow, I. D. (2014). Public health and media advocacy. Annual Review of Public Health, 35, 293-306.

Knickman, J. R., & Kovner, A. R. (Eds.). (2015). Health care delivery in the United States (11th ed.). New York, NY: Springer Publishing.

Leyk, D., Rohde, U., Hartmann, N. D., Preuß, P. A., Sievert, A., & Witzki, A. (2014). Results of a workplace health campaign: What can be achieved? Deutsches Ärzteblatt International, 111(18), 320-327.

Lumpkins, C. Y., Greiner, K. A., Daley, C., Mabachi, N. M., & Neuhaus, K. (2013). Promoting healthy behavior from the pulpit: Clergy share their perspectives on effective health communication in the African American church. Journal of Religion and Health, 52(4), 1093-1107.

Ortega, L. M., Sedki, E., & Nayer, A. (2015). Hypertension in the African American population: A succinct look at its epidemiology, pathogenesis, and therapy. Nefrología, 35(2), 139-145.

The patient is a 30-year-old female who is married and has three children. Her ethnicity and religious beliefs are not identified. The woman works full-time. The learning need related to this patient is associated with health promotion. Considering that she smokes, has a large family, and high-stress rates, the patient is at risk of hypertension. Stanhope and Lancaster (2014) define health promotion as “activities that have as their goal the development of human attitudes and behaviors that maintain or enhance well-being” (p. 34). In this regard, it is essential to provide learning for this patient, making it clear that preventative measures are to be performed on a constant basis. Namely, there is a need for developing the care plan for health promotion and hypertension prevention.

The patient may come up with the following goal: to avoid hypertension to prevent health complications and feel better. To accomplish the client’s goal, a nurse should initiate the teaching sessions, through which the most important information is to be revealed. First of all, it is necessary to develop proper eating habits and try to avoid smoking. Moreover, adequate physical exercises, as well as psychological relief, compose an effective way to prevent hypertension. The paramount issue is that it is the patient who is responsible for all the above initiatives. The measurable objective may be stated as follows: I will start a healthier lifestyle.

Family support plays an essential role in the struggle against hypertension. It may be rather difficult for the patient to change her lifestyle. The family members may help her both psychologically and physically. For example, it is useful to spent evenings, playing some active games, or visiting the gym. In case the whole family would change their eating habits, namely, avoid fast food and eat more vegetables, it would be easier for the patient to adjust to a new lifestyle. It is significant to strengthen the patient’s motivation and progress through psychological assistance. A nurse should personally communicate with the patient, talking to her, and carefully listening to her needs and expectations.

Nowadays, the issue of hypertension is a rather serious problem. Approximately 29 percent of the US adult population (75 million people) suffer from the periodic or continuous high blood pressure that is also known as hypertension, as stated by the Centers for Disease Control and Prevention (“High Blood Pressure Facts,” 2015). It should also be noted that health-related quality of life and well-being objective stated by Healthy People 2020 aims at improving the lives of all individuals. According to the mentioned objective, the overall well-being is to be achieved through a positive impact on the health status (“Health-Related Quality of Life & Well-Being,” 2017).

In this connection, the community resources are to be used to help the patient to achieve her goal. For example, the Centers for Disease Control and Prevention may be contacted to identify the most applicable community resource and also receive additional recommendations. The patient’s plan of care may be integrated into the community with the same health problem and demographics by empowering individuals to take actions related to the promotion of their health (Kumar & Preetha, 2012). At the community level, individuals may support and encourage each other to reach the common health outcomes, raising awareness of the disease and its risk factors, and promoting responsibility for health maintaining.

References

Health-Related Quality of Life & Well-Being. (2017). Web.

High Blood Pressure Facts. (2015). Web.

Kumar, S., & Preetha, G. (2012). Health promotion: An effective tool for global health. Indian Journal of Community Medicine, 37(1), 5-12.

Stanhope, M., & Lancaster, J. (2014). Foundations of nursing in the community (4th ed.). New York, NY: Elsevier Health Sciences.

Introduction

Nowadays, everyone is bound in real-life problems. Those days are passed away when a person had little worries with a simple lifestyle, but now things are changed and this world has become the racing ground. Hypertension is a gift of this fast-moving world, HTN or HPN or hypertension is also referred to as high blood pressure. Hypertension is a medical condition in which blood pressure is chronically elevated. Basically, hypertension can be categorized into two: Primary hypertension and secondary hypertension.

There are different causes of hypertension some are: Obesity, Sodium sensitivity, Role of rennin, Insulin resistance, Sleep apnea, Genetics, Age, and Liquorices. Ace inhibitions and angiotensin block ii repeaters are widely used for renal failure patients for the treatment of hypertension (MacDougall, 2008). Both these products are well tolerated with few side effects. ACE inhibitors are widely used for failure heart treatment. According to the American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for the treatment of chronic heart failure, even patients with the stage (Field, 2008).

Side effects

ACE inhibitors may induce skin rashes, angioneurotic edema, diarrhea, cough, and dizziness. Ace inhibitors usually do not cause a lot of side effects but a few of their side effects include: Cough, swelling around lips, can cause faintness, dizziness, and low blood pressure. Ace inhibitors can cause some problems to your kidneys or potassium level (Heart Failure Medicine, 2002).

On the other hand, angiotensin receptor blockers can cause dizziness, headache, hyperkalemia, rash, diarrhea, dyspepsia, abnormal liver function, muscle cramp, myalgia, back pain, lower abdomen pain insomnia, decreased hemoglobin levels, renal impairment; it can also cause nasal congestion.

Frequency

24 patients were selected with uncontrolled hypertension despite taking ACE inhibitors. Patients were taking 16 mg of candesartan per day with a combination of Plasma plasminogen activator inhibitor (PAI-1) antigen (Ag), tissue plasminogen activator (t-PA) Ag, and high C-reactive protein (hsCRP) levels, were

Measured during low salt intake at baseline after 2 weeks of ARB therapy. Results showed reduced systolic (155±17 vs. 139±13, p<0.001), and diastolic (91±9 vs. 81±8, p<0.001) blood pressures (BP). No major changes were measured in PAI-1 Ag (66±51 vs. 68±52, p=0.9), t-PA Ag (12.6±5.3 vs. 13.3±4.7, p=0.3), TAFI % activity (119±30 vs. 118±32, p=0.9) and hsCRP (3.9±3.4 vs. 3.6±3.6, p=0.7) levels after the addition of an ARB(Yusuf S, 2000).

ACB inhibitors and astigmatism blockers are more effective in patients with CKD (KODI, 2003). ACB inhibitors and ARB can be used combinable for the treatment of lower blood pressure and Proteinuria. With the use of AT1 blockers, about 7% of patients reported prescription-related issues within a few days of hospital discharge.

If Doctors continue prescribing it, it would be easy to control hypertension in patients, with few side effects; little more research is needed to overcome the side effects of these two new hypertension drugs. Some doctors prescribe a combination of these two products which also include some adverse effects. However, they can be controlled in different ways (Kober, 1996). Nitric Oxide and other naval therapies are the best replacement for these two drugs. With the aid of these therapies, a patient can easily fight against hypertension. There are different states of hypertension seen in different patients (Shawl, 2002).

According to which a doctor can not suggest the same treatment for all patients, treatments and drugs/ medicines varies from patient to patient depending upon their conditions and symptoms. Symptoms of hypertension also vary from patient to patient, according to which doctors prescribed treatments and drugs for hypertension patients. As it has been stated earlier that two types of hypertension are usually found in patients primary hypertension and secondary hypertension.

Naval therapies affect a lot in both types of hypertension. Naval therapies are one of the best options for the treatment of hypertension, though these therapies are not very common in the future it can be stated that these therapies would be among one of the best treatments for hypertension. The use of lipid-lowering products is also one of the best options for treating hypertension. Inhaling nitric oxide also helps in reducing hypertension in patients.

Proper assessments and diagnoses play an important role in treating hypertension disease as well as with the aid of proper on-time treatment a patient can easily fight against hypertension disease (Farar, 1985).

Therapies are one of the best options for treating hypertension, nitric oxide, and naval therapies can help a lot in fighting against hypertension in most patients. However, it might be possible that in some cases these techniques would not work in a better way as a combination of Ace inhibitors and ARB works, in that case, some measures are required to be taken for controlling the adverse effects of these drugs.

Pulmonary hypertension always requires proper on-time diagnosis and proper medication else it can get worse. Naval therapies are helpful in treating pulmonary disease on time (Sprung, 2005). A combination of ACE and ARB works well these days but in some cases it gets fails then different treatments are offered to treat hypertension. Delaying and unprescribed treatments make situations/diseases worst most of the time. So, it’s always recommended to use only prescribed medications and treatments for treating any disease.

References

IAIN C. MacDougall, (2008), the role of ACE inhibitors and angiotensin II receptor blockers in the response to epoetin. Web.

Katherine M. Field,( 2008), Knowing When to Play the Ace: The Use and Underuse of ACE Inhibitors in Primary Practice. Web.

Yusuf S (2000), ACE-Inhibitor Myocardial Infarction Collaborative Group. Long-term ACE-inhibitor therapy in patients with heart failure or left ventricular dysfunction: a systematic overview of data from individual patients. 355:1575-81.

Heart Failure Medicine,(2002). Web.

K/DOQI Clinical Practice Guidelines on Hypertension and Antihypertensive Agents in Chronic Kidney Disease,(2003). Web.

Kober L, (1996). Angiotensin-converting enzyme inhibition after myocardial infarction: The Trandolapril Cardiac Evaluation Study. Am Heart J; 132:235-43.

Shaul PW, (2002) Regulation of endothelial nitric oxide synthase: Location, location, location. Annu Rev Physiol 64:749-774.

Farrar DJ, 1985. Right ventricular function in an operating room model of mechanical left ventricular assistance and its effects in patients with depressed left ventricular function. Circulation. 72.

Sprung J, (2005), Impact of pulmonary hypertension on the outcomes of no cardiac surgery: predictors of preoperative morbidity and mortality. J Am Coll Cardiol; 45:1691-1699.

Abstract

ACE Inhibitors and Angiotensin II receptor blockers are very important drugs in combating hypertension. In this paper, I delve into both of these drugs in detail. An analysis of their mechanisms is given whereby I explained that while ACE inhibitors and ARB’s were similar in terms of inhibiting the effect of angiotensin II, they differ in terms of the blockage of angiotensin II; the breakdown of bradykinin; and the suppression of angiotensin II levels during chronic treatment.

I also look into their beneficial effects, explaining what makes them highly effective. These included reducing heart attacks; strokes; kidney problems; reducing cholesterol build-up; and so on. I then contrast this with their side effects which are more common and severe for ACE inhibitors as compared to ARB’s. Some of these include coughing and angioedema in ACE inhibitors; headaches, dizziness, a runny nose, and muscle cramps in ARB’s. I round off the discussion with a conclusion of my findings. Overall, this provides a balanced and comprehensive analysis of two of the most important drug types in the field of hypertension.

Introduction

ACE Inhibitors are a class of very useful drugs that prevent the formation of the natural substances that are responsible for increasing blood pressure (“Glossary Cardiac Terminology”, 2007). These drugs assist in reducing the heart’s workload and also prevent heart muscle damage. They treat hypertension (or high blood pressure) and do this by controlling the behavior of angiotensin-converting enzymes or ACE (“Hypertension Dictionary”, 2008).

Examples of ACE Inhibitors are enalapril (Vasotec®), captopril (Capoten®), and lisinopril (Zestril®). Angiotensin II receptor blockers, on the other hand, are drugs that help lower blood pressure levels by interfering with the action of angiotensin II (“John Hopkins Hypertension”, 2007). They help blood vessels relax and widen and some examples are Avapro, Diovan, and Cozaar. Both these drugs have served in making the lives of hypertension patients a lot easier than in the past.

Mechanisms of Action

• A mechanism of action basically refers to the mechanism through which a pharmacologically active substance produces an effect in a biochemical system or on a living organism (“Mechanism Of Action”, 2008).
• Drugs work in varied ways in order to achieve the desired result (whether curative or preventive) and so do ACE Inhibitors and Angiotensin II receptor blockers.
• Though these two drugs give more or less of the same results, their mechanisms of action are markedly different.
• The similarity between the two is that both of them inhibit the effect of angiotensin II which then causes blood vessels to widen, reducing the workload of the heart and blood pressure (“Angiotensin II receptor”, 2008).
• In addition, both ACE inhibitors and ARB’s intervene in the renin-angiotensin system (RAS) cascade. The difference is that ACE inhibitor action is more specific than that of ARB’s since they affect the final step of this cascade which is the binding of the angiotensin II to its receptor (“Mechanism Of Action”, 2007).
• Moreover, they also differ in that ACE inhibitors work by lowering the levels of angiotensin II while Angiotensin II receptor blockers (ARB’s) prevent/ block angiotensin II substances from entering receptors in the blood vessels and smooth muscles of the heart. This is because, since angiotensin II can be formed by other enzymes apart from ACE such as chymase, blockade of angiotensin II at cellular receptors, therefore, represents a more precise and effective mechanism for inhibiting the renin-angiotensin system.
• Another difference between the two is that while ACE inhibitors reduce the breakdown of bradykinin (potentiation), ARB’s have no such effect (“Mechanism Of Action”, 2007). Bradykinin is a protein that has a very powerful effect on the contraction of smooth muscles such as the heart. This probably explains why very few patients who receive ARB’s experience the “ACE inhibitor cough” as compared to 15- 20 percent of those patients treated ACE inhibitors.
• In addition, angiotensin II levels do not remain suppressed during chronic treatment using an ACE inhibitor but instead increase towards the level they were at before treatment (“Mechanism Of Action”, 2007). This suppression is believed to be a result of bradykinin potentiation. ARB’s, on the other hand, block the AT1- receptor and increase plasma angiotensin II at the same time. This results in a situation whereby the AT1- receptor becomes blocked and the AT2- receptor becomes exposed to its agonist angiotensin II. This is quite beneficial and experimental studies show that stimulation of the AT2-receptor may produce anti-proliferative effects treatment (“Mechanism Of Action”, 2007).

Beneficial Effects

Both the ACE inhibitor and angiotensin II have immense benefits for patients beyond just treating hypertension. Medicine Net (2008) gives the following benefits:

• ARB’s and ACE inhibitors both reduce heart attacks or myocardial infarction.
• Both reduce strokes.
• Both prevent the re-occurrence of cardiac arrest.
• They both benefit the kidney by reducing proteinuria (loss of protein in the urine), slowing the progression of renal failure especially in diabetics, and also preserving renal (kidney) function.
• They both promote greater health by fighting cholesterol build-up.
• One difference is that ACE inhibitors have been found to have a therapeutic effect on patients which helps them relax and even recover more (“Therapeutic Benefits”, 2008). This has not been established in the case of ARB’s.

Side Effects

Despite these admittedly remarkable benefits, both ACE inhibitors and ARB’s have their slight weaknesses although side effects with ARB’s are rare and of lesser magnitude. According to the Joint Commission (2005), these side effects include:

• ACE inhibitors often cause a dry, persistent cough while ARB’s do not. This occurs in one out of ten patients who use ACE inhibitors.
• ACE inhibitors cause angioedema (an allergic reaction that is characterized by edema of the lips eyelids and certain mucosa or other parts of the body and facial swelling. It can prove to be especially dangerous when it affects the laryngeal or pharyngeal mucosa. The swelling then inhibits breathing and can also cause true asphyxia (“Patients and Public”, 2008).
• ARB may cause lesser symptoms such as headaches, dizziness, a runny nose, and muscle cramps though this is quite rare.
• A very small percentage of people do experience potentially serious side effects from ARB’s such as hyperkalemia, kidney impairment, and altered liver function (Weber, 2008).

Conclusions

In summary, it is evident that both ACE inhibitors and ARB’s are crucial in the treatment of hypertension. As discovered, these drugs do not only treat hypertension but also have extra benefits that make them especially attractive for usage. Overall, ARB’s are better since they have fewer side effects. However, they are more expensive than ACE inhibitors which may prevent many potential users from using them.

References

About Hypertension. 2008. Hypertension dictionary. Web.

Atacand. 2007. Mechanisms of action. Web.

John Hopkins Health Alerts. 2007. Johns Hopkins Hypertension (High Blood Pressure) and Stroke Glossary. Web.

Joint Commission. 2005. ACE-inhibitor and ARB contraindication/ intolerance. Web.

Medicine Net. 2005. ARB’s & ACE Inhibitors offer hidden benefits…beyond blood pressure control. Web.

Medscape Today. 2008. Therapeutic benefits of ACE inhibitors and other antihypertensive drugs in patients with Type 2 Diabetes. Web.

Sherman Health Regional Heart Centre. 2007. Glossary of cardiac terminology. Web.

The Free Dictionary. 2008. Mechanism of action. Web.

The UCB Institute of Allergy. 20008. Patients and public. Web.

Weber, C. 2008. What are Angiotensin Receptor Blockers? Web.

Your Total Health. 2008. Angiotensin II receptor blockers. Web.

Improvements in the quality of life and access to healthcare worldwide are associated with greater longevity – for instance, in some countries, life expectancy may amount up to 80 years and more. While a longer life is a positive tendency, it gives rise to an increase in age-related health disorders which contributes to the global and national burden of disease. One of the most prevalent health conditions associated with age is hypertension. According to a report by World Health Organization, almost half of the people over the age of 25 suffered from hypertension at least once in their lives (Kishore, Gupta, Kohli, & Kumar, 2016). This essay will provide an informative summary of symptoms, causes, and treatment of hypertension.

Hypertension

Hypertension is a health condition that is characterized by high blood pressure (HBP). For blood pressure to be considered abnormally high, the readings should consistently display 140 over 90 or higher. It is essential to understand that a single occasion of HBP due to some factors be it stress or environmental conditions does not mean that a patient suffers from hypertension. For a proper diagnosis, a patient showing typical symptoms and making complaints should make regular appointments at his or her GP’s and measure blood pressure at home as well.

The symptoms of hypertension can be very mild, and the condition may go unnoticed for years on end. The signs may vary from patient to patient, but typically, if symptoms are present, they include severe headaches, chest ache, difficulty breathing, the feeling of weakness, and fatigue. The main reason why it is imperative to pay attention to symptoms and make an early diagnosis is the extensive list of possible complications. When neglected and untreated, HBP can lead to heart attack or a stroke, aneurysm, heart failure, and even dementia; in some cases, HBP can be lethal.

The primary risk factor for HBP is old age since blood vessels lose their elasticity over time (Buford, 2016). Among other factors is the presence of the condition in a patient’s close relatives. Other underlying causes are associated with a patient’s lifestyle: drinking alcohol in excess, smoking tobacco, and not being physically active (Leung et al., 2017). If diagnosed with HBP, a patient is usually prescribed beta-blockers, diuretics, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin II receptor blockers (ARBs) (Weber et al., 2014). However, taking medication alone does not solve the problem, and a patient should revise his or her daily habits and make improvements.

Target Audience and Health Literacy

A study by McNaughton et al. (2014) showed that the lack of medical knowledge was associated with elevated blood pressure especially in those patients who had not been officially diagnosed with HBP. Hence, it is critical that a patient takes charge of his or her health and takes measures to prevent or control the condition and improve their overall health literacy. The target audience of the health brochure on hypertension would consist of patients over 45 years – a typical age of onset.

It is also reasonable to spread the brochure among patients belonging to risk groups – for instance, among those suffering from obesity or diabetes. Even though hypertension is associated with mature or old age, as per the report by the World Health Organization, young people might also be susceptible to developing HBP. Thus, a health practitioner could promote better dietary habits and a fitness routine to help to eliminate risks.

Conclusion

Over the last few decades, heightened blood pressure has become a significant public health challenge as it was found to be one of the risks of cardiovascular mortality. Hypertension, or high blood pressure, is alarmingly prevalent among individuals over the age of 45. While health practitioners are trained to address the issue, the patients should gain control of their lifestyle as well. An informative health brochure with links to credible sources can help patients make well-informed health decisions.

References

Buford, T. W. (2016). Hypertension and aging. Ageing Research Reviews, 26, 96-111. Web.

Kishore, J., Gupta, N., Kohli, C., & Kumar, N. (2016). Prevalence of hypertension and determination of its risk factors in rural Delhi. International Journal of Hypertension, 2016, 7962595.

Leung, A. A., Daskalopoulou, S. S., Dasgupta, K., McBrien, K., Butalia, S., Zarnke, K. B.,… & Gelfer, M. (2017). Hypertension Canada’s 2017 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults. Canadian Journal of Cardiology, 33(5), 557-576. Web.

McNaughton, C. D., Kripalani, S., Cawthon, C., Mion, L. C., Wallston, K. A., & Roumie, C. L. (2014). Association of health literacy with elevated blood pressure: A cohort study of hospitalized patients. Medical Care, 52(4), 346-353. Web.

Weber, M. A., Schiffrin, E. L., White, W. B., Mann, S., Lindholm, L. H., Kenerson, J. G.,… & Cohen, D. L. (2014). Clinical practice guidelines for the management of hypertension in the community: A statement by the American Society of Hypertension and the International Society of Hypertension. The Journal of Clinical Hypertension, 16(1), 14-26. Web.

The medical problem

The medical problem that will be discussed in the paper is hypertension. High blood pressure, which is the second name for hypertension, is the most common type of diseases belonging to the cardiovascular group. Hypertension is defined as a constant elevation of one’s arterial blood pressure (Adams, Holland, & Urban, 2014). The typical signs and symptoms include a severe headache, pain in the chest, fatigue, pounding in ears, neck, or chest, problems with vision, and blood in the urine (Adams et al., 2014).

There is no unified onset, location, or timing of hypertension since its development is affected by such aspects as family history, bad habits, and underlying conditions. However, the disease is observed in adults more frequently than in children.

Usually, a person starts feeling a shortness of breath, headaches, and extreme tiredness. The course since onset involves the aggravation of these characteristics, which gradually leads to constantly raised blood pressure. Aggravating factors include obesity, smoking, stress, substance abuse, and a sedentary lifestyle. Alleviating factors involve increased potassium, physical activity, stress management, and weight control. Usual age groups are represented by young adults and elderly people.

Typical presenting signs and symptoms

The rate of hypertension is dramatically growing both in the USA and globally. In the US, only 50% of citizens have blood pressure lower than 140/90 mm Hg, and systolic blood pressure of over 13% of people is 160 mm Hg or higher (Frieden, Coleman, & Wright, 2013). An even more aggravating fact is that many of hypertensive patients additionally suffer from such concomitant states as heart failure, coronary artery disease, diabetes, renal failure, dementia, and hyperlipidemia (Adams et al., 2014).

Thus, there is an urgent need to find an effective treatment for hypertension and increase the quality of life for millions of people. The pathophysiology of hypertension involves the end-organ damage and high levels of mortality and morbidity. There are four organs that are most frequently influenced by prolonged or ineffectively managed hypertension: the brain, heart, retina, and kidneys (Adams et al., 2014). Additionally, this disease may affect the vascular system, leading to the damage of blood vessels.

Concomitant disease states associated with the diagnosis

Differential diagnoses of hypertension include chronic kidney disease, obstructive uropathy, and renal artery stenosis. The rationale for choosing chronic kidney disease as the major differential is that many of its signs and symptoms coincide with hypertension. These include problems with urination, weakness, and shortness of breath. Obstructive uropathy was selected because its signs include severe pain, urinary issue, and high blood pressure. The rationale behind renal artery stenosis is that this disease is manifested through unexplained high blood pressure.

The pathophysiology of the problem

Some viable solutions to managing hypertension may be found in current evidence-based practice. Research by Frieden et al. (2013) indicates that the use of standardized, evidence-based protocols has a number of benefits for hypertensive patients and their caregivers. Protocols can reduce clinical variability, empower all healthcare workers to bolster the significance of blood pressure control, and lead to cost-effective medication choices (Frieden et al., 2013).

Another intervention is described by James et al. (2014) who suggest that initial antihypertensive treatment should be composed of an angiotensin-converting enzyme, a thiazide-type diuretic, or an angiotensin receptor blocker. The expected outcomes of both of these evidence-based approaches include the lowered blood pressure and the elimination of the possibility of cardiovascular damage. With the help of evidence-based practice, scholars and healthcare practitioners hope to reach positive results for millions of patients suffering from hypertension.

References

Adams, M. P., Holland, L. N., & Urban, C. Q. (2014). Pharmacology for nurses (4th ed.). Upper Saddle River, NJ: Pearson.

Frieden, T. R., Coleman, S. M., & Wright, J. S. (2013). Protocol-based treatment of hypertension: A critical step on the pathway to progress. JAMA, 311(1), E1-E2.

James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J., … Ortiz, E. (2014). 2014 evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the eighth joint national committee (JNC 8). JAMA, 311(5), 507-520.