Hypertension in Afro-American and Health Laws

Introduction

The issue of the adverse influence of hypertension on the health status of the African American population remains unresolved because of the lack of attention to cultural and ethnic specifics. The health advocacy campaign proposed for managing the issue includes multiple steps that range from the integration of physician-led care teams for helping patients monitor their hypertension to coverage of the problem in the media to attract the support of multiple stakeholders. This means that newly integrated regulations should be put in place in order to address the challenge of hypertension in the African American population. Because the problem is serious and can lead to further complications and contribute to the declining health outcomes of the population, the creation of a new legislation is the most viable solution for enacting the proposed advocacy campaign.

New Approach Toward Policymaking

It is proposed to introduce a new regulation because of the differences between old and new paradigms within the context of health care. For example, a new regulation is more likely to implement a team approach, make nurses full members of teams, promote coordinated holistic care, focus on patient-centered home health, involve value-based organizations as well as “relevant professionals” that can help patients make informed decisions about their health (Milstead, 2016, p. 6). Therefore, in order to manage the problem of hypertension in African American population, there should be a firm action to support the integration of new policies and regulations that will follow the latest paradigms of healthcare and take into consideration the specific needs of the population group.

Role of Existing Legislations

The existing regulations on the management of hypertension as a problem are likely to contribute to the proposed campaign through providing a guideline, on top of which new efforts can be built. It is expected that the American College of Cardiology (2017a) guideline for high blood pressure in adults will influence the proposed regulations the most because it includes specific rules on how patients with hypertension should generally be approached, screened, followed-up, what are the most appropriate strategies of drug therapy, as well as how special populations should be treated. Also, it is important to mention that in November 2017, ACC and AHA lowered the definition of hypertension “from 140/90 mm Hg to 130/80 mm Hg […] to account for complications that can occur at lower numbers and to allow for earlier intervention” (American College of Cardiology, 2017b, para. 2). Therefore, when creating a regulation to address the issue of hypertension in African American population, it is important to take into account the recent developments in already existing policies.

Three-Legged Stool: Influencing Policymakers

In order to influence policymakers to support the implementation of the proposed regulation, extra attention should be given to national nurse groups that can play the roles of advocates for the target population. Since the proposed regulation targets the African-American population, the representatives of this ethnic group from the nursing profession are likely to better communicate the problem that the population faces to relevant policymakers. Cultural and ethnic representation of the target population should be the key strategy for influencing relevant policymakers because the issue has initially appeared from the lack of attention to the specific needs of this group.

For analyzing how policymakers will be influenced, it is important to mention Milstead’s (2016) three-legged stool of lobbying model. The first leg implies the act of influencing to make sure against what stakeholders should or should not vote. Influencing in the case of the campaign to manage the problem of hypertension in African American population can be done through getting feedback from real patients on how the condition influences their quality of life as well as what challenges they encounter when seeking care. Learning about the issue from the stories of those who are directly impacted by it will create a better idea of whether the proposed regulation is needed. The second leg is linked to grass roots (indirect) lobbying, which implies the influencing of the public opinion on the legislation and encouraging the general audience to take action. With the availability of such forms of information sharing as social media, the campaign can be lobbied on websites, local forums, Facebook profiles of relevant organizations (e.g., ACC or AHA), and so on (American Heart Association, 2014).

Getting the attention of the public will inevitably increase the awareness of the problem and subsequently lead to discussions about the need for introducing a regulation that will address the issue of adverse effects of hypertension on the African American population. The third leg of the lobbying stool refers to the financial contribution targeted at getting the legislative agenda to move forward. Larger organizations such as the American Heart Association or the American College of Cardiology should be involved in the financial support of the proposed regulation. In addition, public funding through charitable donations will also be encouraged because the more financial support the regulation gets, the easier it will be for the involved parties to facilitate its implementation in real life. In addition, strong financial support is especially high on the agenda for the proposed regulation because African American households have lower median incomes compared to other groups as reported by Long (2017) from the Washington Post. Overall, the three-legged model applied to the proposed regulation will take into consideration the key problems that exist in the context of African American health care because the cultural and ethnic needs of the populations remain unaddressed.

Challenges of the Legislative Process

Within the legislative process, several challenges and obstacles are expected to arise. The first potential obstacle relates to financial support of the proposed regulation because the distribution of governmental funds is significantly limited to the existing regulations and legislation and there may be not enough financial resources to address the needs of the proposed program. The second possible barrier to the implementation of the proposed program refers to the lack of nurses’ education on cultural and ethnic specifics of the African American population as well as why such patients are more likely to be susceptible to adverse risks of hypertension (Ortega, Sedki, & Nayer, 2015). For addressing the mentioned barriers, the proposed legislation should not only appeal to the public for gaining support but also encourage healthcare facilities to assess their professionals’ expertise in the specifics of care for diverse ethnic and cultural groups. With the appropriate education of nurses, the campaign is expected to gain momentum quickly. When it comes to financial support, state representatives should be contacted and asked to present the problem to the higher-standing legislations. Also, local efforts of different communities should become integral players in the campaign.

References

American College of Cardiology. (2017a). 2017 guideline for high blood pressure in adults. Web.

American College of Cardiology. (2017 b). New ACC/AHA high blood pressure guidelines lower definition of hypertension. Web.

American Heart Association. (2014). Unlock the doors and keep kids healthy. Web.

Long, H. (2017). African Americans are the only racial group in U.S. still making less than they did in 2000. Washington Post. Web.

Milstead, J. (2016). Health policy and politics: A nurse’s guide (5th ed.). Burlington, MA: Jones and Bartlett Publishers.

Ortega, L., 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.

Multivariate Analysis in Pulmonary Hypertension Study

Introduction

Multivariate analysis is considered to be one of the most frequently used methods of statistical evaluation of data available in contemporary research. If 50 years ago many features of multivariate analysis were unavailable due to certain difficulties in accessing, processing, analyzing, and synthesizing information, with the development of information and communication technology, it has become possible to implement multivariate analysis with greater frequency than ever before. The technology enables the researchers to collect, store, and transport large databases from observation and experimentation. Multivariate techniques are invaluable for their ability to help discover the interrelatedness between different variables within massive sets of data. Because of this, it is paramount to understand the necessary methodology behind the multivariate research, its numerous methods, and implementation, as well as strengths and weaknesses within the context of a particular situation. The purpose of this paper is to explore these concepts by comparing and contrasting two types of research that use a multivariate analysis approach to studying data.

What is Multivariate Analysis?

Multivariate analysis, as the name suggests, is based on observation and analysis of many statistical outcomes at the same time. Its difference from a multiple regression lies in the fact that multiple regressions, while studying more than one independent variable in its equations, always have only one dependent variable, whereas a multivariate analysis includes several. Multivariate analysis is used to perform studies across several dimensions of research while taking account of numerous effects and responses at the same time. It is excellent for studying increasingly large and complex amounts of data (Mengual-Macenlle, Marcos, Golpe, & Gonzales-Riva, 2015). As it stands, multivariate analysis is the most accurate representation of reality through statistics, as it allows for modeling and simultaneous analysis of several datasets, including different variables approach for each sample studied. There are numerous types of multivariate analysis, but in general, they can be classified into three separate groups, based on the types of variables included in the research. These types are (Mengual-Macenlle et al., 2015):

  • Dependent
  • Interdependent
  • Structural.

In quantitative research, there are four types of multivariate analysis. These methods are regression analysis, survival analysis, analysis of variance, and canonical correlation. These types of analyses are implemented when the dependent variable is quantitative. Should the dependent variable have qualitative features, the researchers are advised to use one of the three statistical models, such as discriminant analysis, conjoint analysis, or logistic regressions.

Weaknesses and Limitations of Multivariate Analysis

Every kind of analysis has its weaknesses. In the case of multivariate analysis, the main weakness of the method lies in its complexity. Manual processing of data is virtually impossible due to the number of complex calculations required to perform the analysis. Multivariate research cannot be completed without high-level statistical software, which is expensive. The results of multivariate analysis are complex and prone to misinterpretation due to being based on assumptions that are difficult to assess (Mengual-Macenlle et al., 2015). Also, multivariate analyses tend to have high standard error margins, which demand large sample sizes for the results to be meaningful. Lastly, running statistical programs required a specialist to make sense of the data output. Because of these limitations, multivariate analysis is generally restricted to large-scale researches with large budgets and data samples (Mengual-Macenlle et al., 2015).

Pulmonary Arterial Enlargement and Acute Exacerbations of COPD

Multivariate analysis is often used in medical research. The promotion of electronic data files for patients offered new possibilities for the implementation of multivariate analysis, as it significantly simplified the data collection processes and enabled access to very large sample databases. This research is dedicated to studying pulmonary arterial enlargement and acute exacerbations of COPD. It was published in the New England Journal of Medicine. The research tests the hypothesis, which states that a computed tomographic metric of pulmonary vascular disease is associated with previous cases of severe COPD. To determine the level of association between various patient characteristics and the occurrence of COPD, the researchers used the univariate logistic regression method.

The second step of this multivariate analysis research dealt with variables that showed a univariate association with severe COPD-related symptoms with a P < 0.10 (Wells et al., 2012). These variables were included in a stepwise backward univariate logistic model. Other variables that were included in this model were also individually associated with COPD exacerbations, as showed in the ECLIPSE study.

The authors found that there are significant associations between severe COPD exacerbations and the following variables (Wells et al., 2012):

  • Younger age
  • Black race
  • Congestive heart failure
  • Sleep deprivation
  • Asthma
  • Chronic Bronchitis
  • Hazardous labor

Multivariate analysis was useful in handling many covariates and cofounders, as it enabled the use of interaction testing and effect modification. Also, multiple logistic regression analyses showed an association between severe COPD-related exacerbations and several other factors, such as younger age, high SGRQ scores, and lower FEV1 values (Wells et al., 2012).

Multiple logistic regression analysis used in this research is a robust method of data analysis, which is resistant to many common limitations and vulnerabilities that other methods of analyzing quantitative and qualitative data have. However, in the context of this research, the limitation of this type of analysis lies in its limited number of outcome variables. In this scenario with degrees of severity in COPD-related exacerbations, multiple logistic-regression analysis is limited because it is best suited for dealing with categorical and not continuous outcomes (Hampel, Ronchetti, Rousseeuw, & Stahel, 2011).

Multivariate Statistical Analysis of Cigarette Design Feature Influence on ISO TNCO Yields

This study was published in Chemical Research in Toxicology in 2016. It is considered with differences in the physical design of cigarettes and how they affect the variance of tar, nicotine, and carbon monoxide in inhaled mainstream smoke, and then comparing it to the ISO smoke standards (Agnew-Heard et al., 2016). The choice of multivariate statistical analysis for this research was dictated by numerous variables that needed to be processed to achieve any meaningful conclusions. These variables include not only the quality and type of tobacco used in over 50 domestic US brands, but also the rod length, filter length, circumference, overlap, draw resistance, pressure drop, and filter tip ventilation (Agnew-Heard et al., 2016). These components are present in 44 out of 50 samples and constitute the majority of cigarettes produced worldwide (Agnew-Heard et al., 2016).

The data was analyzed using computerized programming software. Multivariate analysis was performed in several steps. First, all data received from the tests had to be transformed into a set of uncorrelated principal components to perform a multiple logistic regression analysis, as it considered a primary requirement for many multivariate analyses. Afterward, the principal components were analyzed using a K-means cluster algorithm to form groups of cigarettes depending on their similarities of data. Lastly, the relationship between the original ISO TNCO and the nine design parameters was established using the partial least squares analysis. To summarize the systematic multivariate analysis implemented in this research, physical parameters, univariate correlations, and principal components were used to form the K-Means clusters, which then were used to perform the partial least squares method within and between sample groups (Agnew-Heard et al., 2016).

After the evaluation of the 50 cigarette brands, the research identified three components out of nine that accounted for 65% of the variability in the TNCO values for each of the clusters (Agnew-Heard et al., 2016). The correlation between the predicted and observed yields was between 0.5 and 0.9 (Agnew-Heard et al., 2016). Multivariate analysis results indicate that while all nine components have a degree of influence on the end TNCO yields, none of them is considered a dominant enough factor present in all 50 samples. The variation between yields is associated not with the position of the components within the cigarette, but with the qualities of each component determined by its construction.

The research uses a solid method of step-by-step data analysis, first converging it into non-correlated data sets, and then using cluster analysis to determine the connection between variables within and between clusters. This gradual analysis is very robust against most deviations and sample-related errors, but not all of them (Cramer, 2016). One of the biggest weaknesses of multivariate data analyses lies in the assumptions that researchers have to deal with before their implementations. One of these assumptions is homoscedasticity, which assumes that the errors and qualities of variables across all samples are equal (Hampel et al., 2011). In the case of this study, this may not be applicable because there are differences between different components in cigarettes. This refers to the construction of filters, the quality of tobacco, structural compositions, features, and ingredients. According to the researchers, “the PLSR models in this study cannot account for cigarettes with different filter technologies and paper types, tobacco blend compositions, ingredients, or variations in static burn rate, which impact the total puff count, even though the resulting ISO generated TNCO yields can be similar in select cases” (Agnew-Heard et al., 2016, p. 1060)

Multivariate Analysis Methods Comparison

When comparing the two types of research, it can be noticed that the second research used a more complicated data analysis model when compared to the first. The research involving congestive heart failure used multiple logistic regression models as its primary tool in data analysis. The second research that analyzed the effectiveness of different cigarette components on mitigating the amount of tar, nicotine, and other harmful substances used a step-by-step multivariate analysis, where logistic-regression models were used only as an intermediary tool to transform the data into a form more acceptable for further analysis using the clusters method and later the partial least squares regression method, which is considered more thorough (Cramer, 2016). Both types of research have to deal with several weaknesses that are connected to their respective methodologies and research designs. The latter research has fewer weaknesses due to increased funding, which enabled it to use a more thorough and software-demanding analysis.

Conclusions

Multivariate techniques and methodologies are very efficient at analyzing large databases and processing various variables to model a more complete and authentic statistical representation of reality. Multivariate analysis methods are heavily reliant on statistical software due to the complexity of calculations and data processes, which make them costly for small-scale and personal research. Nevertheless, they provide incredible amounts of reliable data, is it was possible to see in the example studies provided in this paper. Nevertheless, multivariate analysis design has several weaknesses associated with sample sizes and variable homogeneity, which has the potential to obfuscate the results due to high margins for standard errors.

References

Agnew-Heard, K. A., Lancaster, V. A., Bravo, R., Watson, C., Walters, M. J., & Holman, M. R. (2016). Multivariate statistical analysis of cigarette design feature influence on ISO TNCO yields. Chemical Research in Toxicology, 29(6), 1051-1063.

Cramer, H. (2016). Mathematical methods of statistics. New Jersey, NJ: Princeton University Press.

Hampel, F. R., Ronchetti, E. M., Rousseeuw, R. J., & Stahel, W. A. (2011). Robust statistics: The approach based on influence functions. New Jersey, NJ: John Wiley & Sons.

Mengual-Macenlle, N., Marcos, P. J., Golpe, R., & Gonzales-Riva, D. (2015). Multivariate analysis in thoracic research. Journal of Thoracic Research, 7(3), 2-6.

Wells, J. M., Washko, G. R., Han, M. K., Abbas, N., Nath, H., Mamary, A. J., Dransfield, M. T. (2012). Pulmonary arterial enlargement and acute exacerbations of COPD. New England Journal of Medicine, 367(10), 913-921.

Hypertension Treatment with Thiazide Medication

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 Elliot’s 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 Elliot’s 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 Elliot’s 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 Elliot’s 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.

“Change in Weight Status and Development of Hypertension” by Parker et al.

Hypertension (HTN) is a health condition that may lead to severe complications and reduce the life quality of a person. There is a large number of collateral conditions and diseases that HTN may entail if not treated, and its underlying causes are not addressed. The disease enhances cardiovascular morbidity and mortality in question that yields long-term adverse effects on a patient’s health. Physical disability, cardiovascular conditions, stroke, dementia, and fractures may be linked to hypertension, revealing its dangers, and the mechanisms behind it. HTN affects an increasingly high fraction of the population in the US, being the most frequently reported primary disease. A significant part of research dedicated to HTN is focused on its correlation with weight – the reviewed article “Change in Weight Status and Development of Hypertension” by Parker et al. addresses the same side of the issue.

Several researchers have established a strong correlation between one’s lifestyle and high blood pressure. Alcoholism, smoking, an unhealthy diet, obesity, and lack of exercise were proven to enhance the risks of developing HTN (Muruganathan, 2016). The research also shows that the likelihood of the disease increases significantly if it is present in one’s family medical history in close relatives (Kjeldsen, 2018). Therefore, a substantial information corpus indicating that HTN progression is related to the factors influenced by genetics and unhealthy and risky behaviors already exists.

Parker et al. (2016), in their article, strive to reinvestigate the correlation between BMI, alterations in blood pressure levels, and the development of HTN. The study was authorized and controlled by the HealthPartners Institutional Review Board, ensuring its compliance with ethicality and that the rights of research subjects are protected (Parker et al., 2016). The research’s population consisted of 101 606 subjects among children and teenagers up to seventeen years old (Parker et al., 2016). Health systems from all over the US served as the source for the data apropos of the individuals included in the research, namely HealthPartners Medical Group in Minnesota, Kaiser Permanente Colorado, and Kaiser Permanente Northern California (Parker et al., 2016). Parker et al. (2016) used weight, height, and blood pressure indicators in the study that were taken while the individuals involved had their routine primary care visits. The Task Force guidelines formed the basis for the researchers to establish HTN or prehypertension if blood pressure from an electronic medical record reached certain levels (Parker et al., 2016). The research appears to be thoroughly prepared and executed by ethics in human medical research.

The results of the study concur with similar research done in its field. In this way, Parker et al. (2016) do not focus on bringing innovative knowledge, but on reestablishing well-known clinical findings – the study determined the link between blood pressure levels and obesity. According to Parker et al. (2016), “over a median of 3.1 years of follow-up, 0.3% of subjects developed HTN. Obese children ages 3 to 11 had a twofold increased risk of developing HTN compared with healthy weight children” (p. 1). The researchers noted that children and teenagers who continually gained excess weight had a higher likelihood of experiencing the most significant increase in blood pressure from the research population. Overweight children and teenagers were two times more likely to endure HTN symptoms, and those with severe obesity were four times more likely and constituted the primary risk group (Parker et al., 2016). These outcomes lead to a comparison with children and teenagers in a healthy weight range and show that those did not develop HTN.

Although the research conducted by Parker et al. in their article reinvestigates a well-known issue and comes without unanticipated results, it shows the importance of revising the accumulated knowledge. Jackson et al. (2018) state that nearly one in seven US teenagers has experienced continual elevated blood pressure from 2013 to 2016 (p. 2359). The study under review emphasizes the poignancy of the problems, and its conclusions may serve as a call for action. HTN is a cause of an enormous strain on public health, and despite the significant body of research dedicated to it, the disease continues to be prevalent in the US (Dzau & Balatbat, 2019). This tendency demonstrates that the future of hypertension investigation may need to accentuate, additionally, methods of health education and promotion to be more efficient. Moreover, it is stated that recent research in HTN has not positively affected the clinical picture in the country and that HTN drug development was decelerated (Dzau & Balatbat, 2019). This lack of discoveries and targets signals that investigation in the field needs to, potentially, undergo a reorientation.

Conclusively, the correlation between HTN, BMI, and lifestyle has seemingly been well-established for a long time. “Change in Weight Status and Development of Hypertension” is a research that does not seek to advance the domain of HTN research with innovative methods or unexpected results. Its paramount objective instead is to reintroduce and accentuate the importance of healthy weight among children and young adults for their health and future life quality.

References

Dzau, V. J., & Balatbat, C. A. (2019). Future of hypertension. Hypertension, 74, 450–457.

Jackson, S. L., Zhang, Z., Wiltz, J. L., Loustalot, F., Ritchey, M. D., Goodman, A. B., & Yang, Q. (2018). Hypertension among youths – United States, 2001-2016. American Journal of Transplantation, 18(9), 2356–2360.

Kjeldsen, S. E. (2018). Hypertension and cardiovascular risk: General aspects. Pharmacological Research, 129, 95–99.

Muruganathan, A. (2016). Manual of Hypertension. JP Medical Ltd.

Parker, E. D., Sinaiko, A. R., Kharbanda, E. O., Margolis, K. L., Daley, M. F., Trower, N. K., Sherwood, N. E., Greenspan, L. C., Lo, J. C., Magid, D. J., & O’Connor, P. J. (2016). Change in weight status and development of hypertension. Pediatrics, 137(3), 1-11.

Home Blood Pressure Monitoring in Patients With Hypertension

Abstract

Hypertension describes a condition when blood vessels are under consistent raised pressure. It is the most common cause of cardiovascular disease, often leading to heart and kidney problems. With around 1.13 billion people worldwide diagnosed with it and many unaware of having it as the symptoms may be found untraceable, hypertension treatment is a rather pressing issue (“World Health Organization”, n.d.). Home blood pressure monitoring is a part of most international guidelines on treating this disease, proving to efficiently contribute to the medication regimens (George & MacDonald, 2015). The need for its introduction arose with the discovery of the limitations of the office monitoring. Even though home devices still have a way to go to become completely accurate, they have already proven their indispensability. Invoking better understanding of the disease management among patients, home monitoring leads to an increased consciousness about health and compliance with treatment courses (White, 2016). Combined with assistance from health care professionals, HBPM allows to control the state of the patient better and change the regimen when needed based on the most recent data (George & MacDonald, 2015). Still, while proving to be useful for patients diagnosed with hypertension, HBPM often leads to inaccurate measurements, provoking anxiety, excessive monitoring, or even unauthorized changes to the medication intakes (George & MacDonald, 2015). This paper will examine whether daily home blood pressure monitoring influences compliance with medication regimens for hypertension in adults who have hypertension after diagnosis.

Hypertension is the most widespread cause of cardiovascular disease nowadays. Home blood pressure monitoring (HBPM) is the tool usually introduced as a part of the course of treatment and recommended by the general guidelines (George & MacDonald, 2015). Hypertension is known to increase the risks of heart stroke or failure, kidney disease and more (George & MacDonald, 2015). Thus, HBPM offers patients an opportunity to keep track of their blood pressure on a daily basis and is considered an essential part of medication regimens. Consequently, in the framework of this paper, it will be proven that HBPM influences compliance with treatment courses in people with hypertension.

Hypertension describes a situation in which the blood vessels are consistently under raised pressure. According to the World Health Organization (WHO) (n.d.), 1.13 billion people worldwide have hypertension, and less than 1 in 5 have the problem under control. With it being a major cause of premature death and with around 2/3 cases of it discovered in low- or middle-income regions of the world, the problem of finding an effective treatment becomes crucial (“World Health Organization”, n.d.). Multiple recommendations reduce the probability of hypertension, including reducing salt, trans or saturated fats consumption, adding fruits and avoiding tobacco (Singh, Shankar, & Singh, 2017). However, all of these appear hard to follow, especially in cases of developing countries, where the nutrition issue remains the pressing one (“World Health Organization”, n.d.). Overall, hypertension is hard to track, resulting in many people living with it unaware of their condition as it often does not show any symptoms (Kitt, Fox, Tucker, & McManus, 2019). Still, this disease progresses severely among those in high-risk groups and requires thorough treatment.

Home blood pressure monitoring

The need for HBPM itself arose both from the disadvantages of the office blood pressure (BP) measurement and the discovered cost-efficiency of the home one. HBPM showed to have many other advantages, for example, taking readings over an extended time period, avoiding white-coat reactions, detecting blood pressure variability and letting patients better understand how to manage the disease (George & MacDonald, 2015). Nevertheless, there are also some limitations, such as inaccuracy, induction of anxiety and excessive monitoring, risks of medication regimen change by patients based on the normality of their BP (George & MacDonald, 2015). Besides, some of the accuracy problems come from the fact that devices themselves vary considerably – there are manual and automatic auscultatory methods, oscillometric method, tonometry, hybrid and cuffless devices (Stergiou, Parati, & Mancia, 2019). Despite the limitations HBPM demonstrates, it remains crucial in the course of hypertension treatment.

There are multiple effects home blood pressure monitoring proves to have in cases of hypertension management. First of all, it provides doctors with data on BP levels of their patients in larger time frames than possible with the use of office monitoring (White, 2016). That allows better assessment of the medication regimens’ efficiency, and, most importantly, does increase patients’ compliance with those (White, 2016). Apart from that, HBPM improves BP control for patients with uncontrolled hypertension, reduces systolic and diastolic blood pressure, as well as therapeutic inertia (George & MacDonald, 2015). It is also stressed that HBPM is most effective when it is combined with telemonitoring from a health care professional (George & MacDonald, 2015). It means that home readings are instantly checked, and medication regimen is directly affected by the changes in BP, obtained from home monitoring (George & MacDonald, 2015). While there are still limitations regarding home monitoring devices, they continue to diminish, increasing the overall importance of HBPM in the course of hypertension treatment.

References

George, J., & MacDonald, T. (2015). Home Blood Pressure Monitoring. European Cardiology, 10(2), 95–101. Web.

Kitt, J., Fox, R., Tucker, K. L., & McManus, R. J. (2019). New approaches in hypertension management: A review of current and developing technologies and their potential impact on hypertension care. Current Hypertension Reports, 21(6), 44. Web.

Singh, S., Shankar, R., & Singh, G. P. (2017). Prevalence and associated risk factors of hypertension: A cross-sectional study in urban Varanasi. International Journal of Hypertension, 2017, 5491838. Web.

Stergiou, G. S., Parati, G., & Mancia, G. (2019). Home blood pressure monitoring. Cham: Springer.

White, W. B. (Ed.). (2016). Blood pressure monitoring in cardiovascular medicine and therapeutics (3d ed.). New York, NY: Humana Press.

World Health Organization. (n.d.). Web.

Trends in Hypertension Prevalence, Awareness, Treatment and Control in Older US Adults

The objectives of this study were to explain the occurrence of hypertension in the US among mature persons above 60 years using NHANES data. The second study sought to determine appropriate measures to be taken to curb the blood pressure condition among mature individuals more than 60 years. As stated above, nursing is an occupation that concentrates on the care in terms of health for persons as well as societies so that they could retain, or recuperate to their normal health states. Therefore this study is highly related to nursing. This research may also be termed as nursing investigation (Ostchega, Dillon, Hughes, Carrol and Yoon, 2007).

The setting of the study was in two parts. First was the NHANES III from 1988-1994 and the second was NHANES data from 1994-2004. Participants from data in NHANES III were 5093 while those from NHANES data were 4710. Measurements were performed to ascertain the presence blood pressure in mature individuals above 60 years.

In the second study, during the 1999 to 2004 research, a percentage of 67 of adults in the US had hypertension. This was a 10% increase from NHANES III. On contrasting the control of the HBP condition between NHANES III and NHANES, for men, the control increased from 39% to 51% and for women from 35% to 37%. Non-hispanic black individuals had higher occurrences of blood pressure than non-hispanic whites who were probable to have controlled the condition as opposed to Mexican-American persons. Furthermore persons between 60 to 69 years were highly probable to control the condition as compared to those above 70 years. “The measuring of hypertension within a period of 6 months was considerably associated with greater awareness, greater treatment in men and women, and greater control in women. A history of diabetes mellitus or chronic kidney disease was significantly associated with less hypertension control” (.24)

For the second part, an augment in the occurrence of blood pressure was noticed from 1988 t0 2004. The control of the condition persists to be difficult in women, individuals more than 70 years, non-Spanish blacks and Mexican-Americans plus persons having diabetes mellitus. In this case, it is similar too to the perspectives of individuals from the EBP. According to the research from the EBP, persons with more than 60 years are anticipated to have retired thus they are jobless. They tend to have a lot of worries and stress on how they should get food thus being prone to hypertension. The case becomes serious to persons above 70 years. This correlates to the results from the study.

This study has an implication that blood pressure affects people regardless of their ages. And therefore measures undertaken against hypertension should be taken seriously by all persons. Mature individuals above 60 years should go for regular health checkups and advised accordingly by the nurses. This investigation concentrates on mature adults who have their ages more than 60 years. The results for this study were ideal and comprehensive too. Persons more than 60 years should be taken good care of and since a large number of them are facing the condition; the regulation amongst them will help a lot in lowering the cases of the situation among all the people in the US.

In conclusion, HBP is a dangerous condition that should be avoided. In spite of the efforts to put up measures to reduce HBP, the efforts aren’t adequate thus the control hasn’t been achieved. It is upon all the people all over the world to join and put hands together against HBP. Nonetheless, great care and attention should be channeled towards older persons more than 60 years so that the pandemic is avoided.

Reference

Ostchega, Y., Dillon F. C., Hughes P. J., Carrol, M. and Yoon, S. (2007). Trends in Hypertension Prevalence, Awareness, Treatment and Control in Older U.S. Adults: Data from the National Health and Nutrition Examination Survey 1988 to 2004. Journal of the American Geriatrics society, 55, 1056-1065.

Arterial Hypertension and Lipoproteins Levels in Older Adults

Hypertension

Arterial Hypertension among Elderly of Bridgetown, Barbados: Prevalence and Associated Factors

The research question of the current study was: ‘what risk factors are associated with the occurrence of arterial hypertension?”. The hypothesis for the study was that sedentary lifestyle and poor general were directly correlated with the prevalence of arterial hypertension. The research design was quantitative in nature. Cross-sectional household survey on a total sample of 1,508 participants was examined (Borbosa & Borgatto, 2010, p. 614) and the information collected mainly contained demographic figures and is also quantifiable.

There are several independent variables in this and include lifestyle, general health, and such socio-demographic characteristics as gender and race. The dependent variable in this study was the occurrence of hypertension among the participants (Borbosa & Borgatto, 2010, p. 615). Lifestyle was the independent variable adopted by the current study. Others include consumption of alcohol, smoking, and exercising.

An operational definition for general health has also been provided based on whether the patient had been previously been diagnosed with arthritis, heart attack, embolism and diabetes mellitus. Sociodemographic characteristics have also been provided and they include age bracket, sex, race, job, and marital status (Borbosa & Borgatto, 2010, p. 615). An operational definition of the dependent variable was if a physician or a nurse had ever told the patient they had high blood pressure or asked them whether they were taking hypertension medication.

A relationship between explanatory variables and the occurrence of the diseases was conducted for the whole sample. A wald test was done to measure the percentage of the association of the variables with hypertension (Borbosa & Borgatto, 2010, p. 616). There was high prevalence among women, those who reported having been diagnosed with the diseases under the general health variable and among smokers and alcohol users.

Extraneous variables included cultural factors, genetics, and salt intake. These could have caused the difference because they are often listed as risk factor for development of hypertension because of their impact on the independent variables. Among the African Americans, genetics or family history play a crucial role in determining occurrence of the disease. The authors conclusions were that variables including lifestyle and socio-demographic characteristics did not have significant relationship with occurrence based on the model of determination employed (Borbosa & Borgatto, 2010, p. 613). However, obesity showed significant positive correlation with hypertension prevalence.

Lipoprotein Levels Are Associated With Incident Hypertension in Older Adults

The research question of this paper was: “does the presence of serum lipoprotein indicate higher possibility of developing hypertension?” The hypothesis for the study was that elevated levels of serum lipoprotein are not a predictor of developing hypertension (Wildman et al, 2004, p. 916). This was a quantitative study considering that it was a prospective cohort study aimed at collecting and analyzing the information. The independent variable in this study was the serum lipoproteins while the dependent variables included the baseline blood pressure and heart rate. The research offers conceptual definition of independent variable.

BMI was given as dividing the weight (Kgs) of the participants by the height (meters) of the participants. The paper does not indicate a conceptual definition of the dependent variable (Wildman et al, 2004, p. 917). The article indicates an operational definition of the serum lipoproteins as independent variable constituting HDL-C, LDL-C and apoliproteins (Wildman et al, 2004, p. 917). The paper indicated an operational definition of dependent variable as the blood pressure and heart rate measured by trained investigators. The measures were done after 30 minutes after rest on a single day.

Three additional extraneous variables that the researcher could have examined as factors affecting the outcome include race, genetics and hormonal activities of insulin. Race and genetics have been associated with being a risk factor in occurrence of hypertension considering that research has found that the prevalence is very high among the African Americans. On the other hand, insulin has another mechanism of causing hypertension. Insulin resistance can cause vasoconstriction leading to high blood pressure (Wildman et al, 2004, p. 919). Insulin can as be accompanied by salt sensitivity hence causing more sodium reabsorption and therefore stimulating adrenaline hence causing hypertension.

The conclusion drawn by the researchers was that the study helped to answer the questions and the hypothesis of the study (Wildman et al, 2004, p. 916). The inferences drawn revealed that older adults who presented abnormal serums lipoproteins were positively correlated with the occurrence of high blood pressure.

Reference List

Borbosa, A.R., & Borgatto, A. F. (2010). Arterial Hypertension in the Elderly of Bridgetown, Barbados: Prevalence and Associated Factors. J Aging Health, 22(5), 611-630.

Wildman, R.P. et al. (2004). Lipoprotein Levels Are Associated With Incident Hypertension In Older Adults. J Am Geriatr Soc, 52(6), 916-921.

The Risk Factors for Elderly Developing Hypertension

Research Problem

It has been established by various researchers that older members of society are losing their lives due to issues relating to hypertension. This is much discouraging considering the efforts made by all relevant authorities especially the government is trying to curb the problem. The purpose of this research is to point out the various risk factors for elderly people developing hypertension.

As suggested by a report from a joint national committee on hypertension, currently about fifty million Americans are affected by hypertension while globally slightly above one billion people are suffering from the disorder (Wenyu et al, 2006: 2). This thus has been a health concern worldwide and more so, nationally, particularly for Americans.

Additionally, it has been predicted that as the human population grows, the problem of hypertension will be much worse. For instance, a study carried out by Wenyu et al 2006: 43 examined HT in American Indians established the chances of developing hypertension are tremendously rising especially in the elderly. Studies previously carried out have consistently depicted that, hypertension is closely linked to heart diseases or disorders (Ostchega et al., 2007: 1060).

If these hypertension risk factors for elderly individuals could be brought out clearly, then the nursing fraternity will be in a better position to adequately advise and treat members of society who are at risk of suffering from HT. Additionally, the findings will help affected individuals and those close to them to make a rational decision on how best to curb the problem in the future.

Research Purpose

The purpose of this research is to point out the various risk factors for the elderly developing hypertension. Similarly, the research will seek to find out how prevalent is the problem and the advantages associated with early and proper identification of the risk factors that make older members of the society develop hypertension. Additionally, establishing recommendations on how to address the risk factors is also part of the proposed study.

The importance of the study is first linked to pointing out the major risk factors for hypertension. This will help them to re-evaluate lifestyles and adopt the one that will foster their lives. Similarly, nurses will have a clue on the same factors hence be in a better position in advising patients. Similarly, better strategies will be developed to curb the problem associated with hypertension. Lastly and more importantly, the research will lay the ground for further related studies.

Literature Review

Hypertension has been considered as a cardiac medical condition in which the systematic arterial blood pressure ends up being elevated. It has been found that, when hypertension gets to a higher level, especially to those elderly individuals, it becomes a risk factor for stroke complications, myocardial infarctions, heart failures, as well as an arterial aneurysm.

It was found by Shailendra, et al. (2010: 42) that, hypertension plays a major role in the etiology of cardiovascular disease, ischemic heart problems as well as cardiac and renal failures in old aged and adult individuals. In addition, Mendoza, et al. (2006, p 173) found that it also negatively affects specific cognitive responsibilities, like resulting in an attention deficit, learning a long with memorization.

Rodrigues, & Borgatti (2010, p 624), added that hypertension, which has become a world disaster causes stroke, heart failure along kidney problems. This has been going hand in hand with its modifiable risk factors like obesity and sedentary lifestyle, (Fernandez, et al, 2001, p 864). The best way of preventing such risks caused by hypertension is to carry out studies that will help in the identification of its risk factors causing it

It was found by Shailendra, et al. (2010: 40) that, both lifestyle and anthropometric dimensions predict the prevalence of hypertension compared to ethnicity. In developing countries, a central and overall increase in obesity amongst the population has emerged as being a major cause of increased blood pressure, which eventually leads to hypertension.

Obesity has been thought to be caused by imbalances between caloric consumption and expenditure over a long period. In old age, overweight occurs as a result of decreased exercise and a high-fat diet. This in general increases cholesterol concentration in the body leading to heart failure, (Shailendra, et al, 2010: 40).

On the other hand, Rodrigues, & Borgatti, (2010: 625) stated that, elderly individuals suffer more from hypertension as compared to the youths and children. This has been due to smoking habits in old aged individuals. Despite the fact that smoking is not a direct cause of HT it is attributed to temporal higher level of blood pressure.

This occurs due to factors like injuries caused by smoking on blood vessels. In addition, elderly individuals have been already susceptible to other hypertension risk factors; research has shown that smoking increases the risk of secondary hypertension complications.

Mendoza, et al. (2006: 172) also connected plasma concentration with the body mass index, which is mostly present in patients having insulin resistance. This has been reported as being one of the factors leading to cardiovascular diseases like hypertension. Going with the point of body mass index, it has been found that, elderly individuals have higher body mass index, indicating the presence of high body fats. The cases of high body mass index is high in elderly individuals is due to lack of exercise.

In that connection, an increase in body fats increases the risks of metabolic disease like diabetes, which might lead to hypertension and certain CVDs with more effects on the elderly individuals. In addition, higher body mass index in increases the chances of being obese, hence obese factors come into play. According to Mendoza, et al. (2006: 173), there are oxidative stresses as well as inflammations, which are casual variables that might lead to atherosclerosis and arterial hypertension. The results indicated that, the level of leptin in elderly people is mostly linked to the presence of SBP, which is as a result of high fat content.

It was found by (Ellis, et al, 2010: 806) that; pronounced alcohol usage in elderly individuals, leads to hypertension. Research as shown that consumption of increased alcohol increases water concentration in the body. This ultimately increases retention of salts. It has been established that when water is in excess in the veins as well as arteries the heart is overworked as space for fluid which are vital for flow of blood is constricted.

As a result, this leads to an increase in blood pressure to ensure enough blood transportation within the body. Alcohols in addition cause incidences of high blood pressure to individuals having, overactive nervous systems. Another effect of alcohol on blood pressure and hypertension is the presence of calories in alcoholic drinks; hence ends up increasing the amount of calories in the body that might either increase the body mass index and obesity. Generally, the proper reducing salt intake, usage of alcohol changing dietary habits, taking exercises along with taking blood pressure modifications, are the practices recommended for blood pressure improvement.

It was stated by Van der Niepen, & Dupont, (2010: 585) that, prevalence of concomitant cardiovascular risks include sub clinical organ damage. Some of these diseases, which render the kidney inefficient in absorbing in absorption salts from blood. Higher concentration of salt in blood results to high blood pressure since there is increased rate of absorption of water ultimately causing high blood pressure. In addition, “hypertension as a result of kidney diseases occurs due to renal artery stenosis is as a result of systematic vascular resistance as well as an increase in cardiac output” (Van der Niepen, & Dupont, 2010: 543).

It has been noticed from literature that, a very large number of elderly individuals are affected with hypertension risk factors like alcohol drinking and smoking, salt intake, obesity, sex, cholesterol and kidney problems. However, According to the study by Zhaoqing, et al. (2010: 5), hypertension risk factors can be identified in an urbanizing environment as well as diet westernization and heath practices. The differences in hypertension incidences between ethnic groups as shown in their results were explained as being due to genetic variations, (Shailendra, et al. 2010: 38).

In situations where one’s family members have suffered from hypertension, subsequent generations are also at risk of HP. This explains the genetic component that leads to the development of hypertension. In addition, in looking at obesity, there are some genes which cause obesity or weight gain, so due to the fact that most elderly individuals don’t participate in physical exercises, this factor ends up being another risk factor causing hypertension.

Zhaoqing, et al. (2010, p, 4) also confirmed that, types and levels of salt intake has an effect on hypertension incidences especially in elderly individuals. Though salt is one of the essential to individual’s body, however in elderly individuals, the kidney seem to be not effective in its function as compared to young individuals.

As an effect, high salt concentration in blood ends up increasing blood water absorption, which automatically increases blood volume in blood vessels. This effect of high blood volumes ends up hindering blood flow in vessel lumen; hence overworking the heart by making it constrained and this increases blood pressure which latter leads to hypertension.

In the analysis of hypertension risks in aged individuals, Wildman, et al. (2004: 54), found that high triglyceride as well as apolipoprotein B levels and lower HDL-C levels being a univariate factor of hypertension, hence supporting other studies that linked serum lipoprotein and hypertension. It has been found that higher levels of Triglyceride or cholesterol are far much risky in the development of cardiovascular diseases.

Food stuff rich in fat raises the cholesterol levels as well as triglyceride which ultimately affects both veins and arteries. This effect ends up reducing the arterial lumen hence increasing blood pressure with the aim of forcing blood through smaller blood lumens. This problem affects elderly individuals because; their body cells no longer required triglyceride. (Wildman, et al. 2004: 29)

According to Ostchega, et al. (2007: 1060), hypertension affects men and women in elderly individuals. But it has been indicated that, this occurs more in women as compared to men, irrespective of availability of health insurance or if proper measures are not put in place. This can be explained that, sex is also a risk factor causing hypertension in elderly individuals. Due to awareness in elderly men as compared to women, there have been some improvements in men as compared to women.

In addition, with the availability of health insurance for both elderly sexes, women still have problems in treatment as well as control. It was found that, men having health insurance have higher chances of being treated unlike women. This is based on the fact that, health care providers approach the CVD in women much different as compared in men, this is because, most health care providers downgrade the risk factors associated with cardiovascular risk in women as compared men, hence are reluctant in the provision of preventive measures for women as they could do to men.

Research Question and Hypotheses

The research question for the study is, ‘What are the risk factors associated with hypertension in aging population?’

The hypothesis thus is; hypertension in elderly people in the United States is associated with risk factors such as smoking, obesity diet, lack or decrease exercise and family history.

The study approach that will be used is quantitative, non experimental research. Quantitative research will also be employed in the study. It is worth noting that the approach employs a step by step empirical examination of quantitative attributes as well as phenomenon and their links. Models are then developed with regards to the phenomenon in question.

This approach is the only one that can verify the hypotheses hat are true since the information generated in purely based on a given case study. Additionally, the approach usually generates numerical data. With this, analysis of data has been an easy task. It is the numerical values help researchers to accurately generalize.

The purpose of non-experimental study design is to explain and fully describe the present existing characteristics for this study the risk factors of hypertension. Quantitative study design is a flexible tool that can be easily manipulated o fit the study purpose. Additionally it yields quantitative data which are easy to analyze (Polit & Beck, 2007:242).

Variables and Definitions

The major variables are risk factors and hypertension. According to Ostchega et al., 2007: 23 risk factors have been thought of as variables that are closely linked with an increased risk of suffering from infections or diseases. Hypertension is a health condition in which the normal blood pressure in arteries is considered to be elevated. Hypertension is conceptually defined as a person with B/P > 140/90 and at least taking one hypertensive medication.

To measure this I will ask a question “Have you ever been informed by a doctor on more than two occasions that you have high blood pressure?” another additional question to be asked will be “Are you under medication to lower high blood pressure?” Individuals who will respond yes to these questions will then be considered to be suffering from HP.

The IVs are the risk factors which are increased weight or BMI, diet (high salt, and high fat or cholesterol diet), family history, decrease or lack of exercise, smoking, and alcohol. Body Mass Index has been thought of as “the measure of body fat typically based on height and weight of individuals who are adult” (Fernandez et al. 2008: 1868).

To calculate BMI the weight measured in kilograms is divided by height in m2. The classification of the finding will be by the criteria used by the National Institute of Health and include; less than normal (25.0 kg/m2), overweight (25.0-29.0 kg/m2), and obese (> 30 kg/m2). “Abdominal obesity was defined as a waist circumference >88cm for women and >102 cm for men according to the Adult Treatment Panel III definition” (Van der Niepen & Dupont, 2010:575).

The measurements (weight, waist circumference, and height) will be taken by a trained technician based on a standardized protocol. Additionally, they will be taken three times and an average computed. A portable GPM anthropometer will be used to measure height while weight will be measured using a weighing standard scale and weight circumference will be measured with nylon tape. It is the mean values that will be used in the analysis.

Smoking refers to “the process in which individuals inhale smoke from a burning tobacco that is either encased in pipes, cigarettes or cigar” (Zhaoqing et al., 2010: 6). To measure smoking, I will provide three sets of choices, current, never, and former; this will provide information regarding who are presently smoking, never smoked, and quieted smoking. It is worth noting that there are active and inactive/passive smokers.

The former is of interest since they indulge in smoking cigarettes. In addition to the state of smoking, the study will seek to establish the number of cigarettes one smokes or smoked per day as well as the time is taken to smoking. From such information, it will be possible to compute pack years of those who smoke.

By a pack, this means that one smokes 20 sticks of cigarettes in a day for 12 months. Family history is a situation where we are interested in establishing whether close family members are or have ever suffered from the medical condition being examined. This will be measured by digging in the history to find out the family members who ever suffered from HT (Fernandez et al. 2008: 1863). The question to be as will be “Has any of your family members known to you been told to be hypertensive?” a yes will be considered to a family history of having hypertension problems.

Additionally, consumption of alcohol has been deemed to be a risk factor associated with HT. It will be measured by establishing weekly consumption of alcohol. The choices that will be used to measure this include 0, 1 day a week, 2 days a week, 3 days a week more than 4 days a week. Additionally, the type of drinks will be sought after.

Lack of exercise in this research is defined as not engaging in any physical exercise or vigorous activities at least three times a week in the past year. The question posed for this will be “For the past one year, how many times a week have you participated in a vigorous physical activity?” the choices will be 0, 1, and 2 more than 3.

Consumption of fast food for sake of the project will be considered as a diet with high salt concentration as well as a high level of cholesterol. To measure this independent variable, the respondent will be asked the number of times per week they consume fast food. 0, 1, 2, 3, and more than 4 will be the options to be chosen. Similarly, I will try to estimate the amount of salt taken in foods. “The number of pinches added will be multiplied by 0.37g” (Shailendra et al., 2010: 28)

Additionally, it is worth noting that attributes relating to gender, level of education, marital status, race, income, employment as well as health status will be considered as covariates.

Methodology

Research method

The research methods that will be employed will be quantitative research, nonexperimental. This will play a major role in helping me fully describe present as well as existing events or issues about hypertension. The quantitative approach will ensure that numerical data is collected and can be easily analyzed for inferences to be made (Polit & Beck, 2007:142).

Research design

The research design that will be employed in my study is retrospective and correlational. With the correlational design, it will be possible for the study to establish the relationship between the risks factors and hypertension.

It is worth noting that a retrogressive study aims at looking back at what happened previously. It is a fast method of studying events that could otherwise take a decade. Additionally, the design is cheap as one needs to acquire existing data and work on it; similarly, such data can be supplemented by asking the subjects about the topic one is investigating.

Because the risk factors being studied take long before their effects are felt, it will be rational to use existing data and probably support the findings with interviews or any other method. The retrospective is looking backward in time to find from the subjects who are elderly with HT as a disease already and finding out the risk factors that lead to the development of such hypertension as a disease. The only problem with the design is that it might be challenging to find out certain information.

Sample

For my study the target population is all elderly; however, the accessible population is the elders from different ethnic groups. Therefore the sample will be a random selection of elderly individuals of a population size of 300 each from African Americans, whites, Latinos, and Caucasians origin.

The main reason for selecting this group of individuals is that they are in a better position to help be me answer the question since they are capable of providing relevant data. Additionally, this will help give a general picture of hypertension in elderly people in America. Individuals of age 60 -85 yrs and above with no clinically diagnosed history of cardiovascular disease (CVD), diabetes, or renal problems will constitute the sample.

Individuals, less than 60 years and over 85 years will be excluded. Additionally, persons with a clinical history of CVD, diabetes, and renal disease will also be excluded.

The sampling strategy used is the quota sampling method. It entails choosing a population, segmenting it into distinct mutual sub-sections. It is worth noting that the segments to be used will be the ethnic grouping; i.e. African Americans, whites, Latinos, and Caucasians origin. The strategy was chosen because the time for the research is limited, a sampling frame is not available and the budget for the research is tight.

Setting

The study will be carried out in two major American states; Texas and New York. The major reason for choosing these two states is due to higher rates of diversity/cosmopolitans. Healthcare facilities that are known to treat heart-related diseases will be targeted to provide the relevant information.

Data collection

Data collection is via survey data collection. It will entail calling doctors and getting a random list of elderly people with Hypertension from different ethnic groups stated above bearing in mind the inclusion and exclusion criteria. Similarly, independent variables such as smoking alcoholism lack of exercise family history diet, increase weight, or BMI. I will measure smoking, alcohol, lack of exercise, and diet by ordinal method, weight, and height by ratio measurements. The dependent variable in the study was hypertension (nominal)

Data Analysis

I will use ANOVA to analyze the collected data. The reason solemnly rests on the fact that there will be four major groups that need to be compared. Additionally, correlation analysis will be carried out to establish the relationship between the risk factors and hypertension. Cross tabulation will be employed to test the most significant risk factor. The significance level is set at p=0.005. With this alpha level, the accuracy level is higher. Data presentation will be done by use of descriptive statistics such as tables, graphs, and figures such as charts (Polit & Beck, 2007: 121).

Mean will be used to describe the age; of the elderly, that hypertension is more pronounced. With mode, I can be able to identify the ethnic group that is more affected by hypertension. Additionally, the range will be used to clearly describe the highest and lowest age of elder people suffering from hypertension.

Limitation of the study

They’re a few limitations in my study with the fact that the research is highly reliable and valid since the sample size, random sample selection among other suggestions were all put in place. Because the research will have factored in the issue of race, history, among others, and that reliability, as well as validity, will be greatly checked, the finding will be able to help bring out a generalized picture of hypertension and associated risk factors not only in America but also in the entire world.

Ethical Considerations

Because the research involves human subjects, there was a need for a high level of ethical consideration to be upheld. Some of the ethical consideration includes the following; the accessible sample populations that will be involved in the study to provide relevant information are to be informed. The reasons for carrying out the survey as well as how they stand to gain from the study will also be brought out clearly.

It is important to note here that the rights and welfare of the participants involved in the study must be protected and guaranteed. To do this, their identities will be kept confidential. Moreover, the information collected while soliciting for data is to be kept confidential and opt not to be used for any other purpose apart from what was initially intended for. Additionally, the information to be provided will be voluntary.

Implication for practice

As previously stated, the research will of paramount importance to nurses, patients among other relevant groups in society. The importance of the study is first linked to pointing out the major risk factors for hypertension. This will help them to re-evaluate lifestyles and adopt the one that will foster their lives.

Similarly, nurses will have a clue on the same factors hence be in a better position in advising patients. Similarly, better strategies will be developed to curb the problem associated with hypertension. Additionally, with the identification of the major risk factors associated with HT, family members of the affected individuals will be in a better position to help the individual overcome certain habits such as smoking, alcoholism, engage in exercise among others.

Additionally, the government through the ministry of health will be able to carry out a public campaign to educate the public about HT risk factors. Lastly and more importantly, the research will lay the ground for further related studies.

References

Ellis, C. et al. (2010). “The Effect of Minority Status and Rural Residence on Actions to Control High Blood Pressure in the U.S.” Public Health Reports, 25(6): 801-809.

Fernandez, S. et al. (2008). “A Senior Center–Based Pilot Trial of the Effect of Lifestyle Intervention on Blood Pressure in Minority Elderly People with Hypertension.” JAGS, 56(1):1860–1866.

Mendoza, M. et al. (2006). “Hyperleptinemia as a Risk Factor for High Blood Pressure in the Elderly.” Arch Pathol Lab Med, 130(1): 170-175.

Ostchega, Y. et al. (2007). “Trends in Hypertension Prevalence, Awareness, Treatment, and Control in Older U.S. Adults: Data from the National Health and Nutrition Examination Survey 1988 to 2004.” JAGS,55(1):1056–1065.

Polit, F. & Beck, C. (2007). Essentials of Nursing Research. 6th edition. Baltimore: Lippincot.

Rodrigues, B. & Borgatto, F. (2010). “Arterial Hypertension in the Elderly of Bridgetown, Barbados: Prevalence and Associated Factors” Journal of Aging and Health22(5): 611–630.

Shailendra, K. et al. (2010). “Hypertension and its correlates in two communities of dissimilar genetic ancestry in Sikkim, India.” Annals of Human Biology, 37(1): 23–43.

Van der Niepen, P. & Dupont, A. (2010). “Improved Blood Pressure Control in Elderly Hypertensive Patients Results of the PAPY-65 Survey.” Drugs Aging,27 (7): 574-588.

Wenyu, et al. (2006). “A longitudinal study of hypertension risk factors and their relation to cardiovascular diseases.” Hypertension, 47(1): 403-409
Wildman, P. et al. (2004). “Lipoprotein Levels Are Associated with Incident Hypertension in Older Adults.” JAGS,52(6): 917-921.

Zhaoqing, S. et al. (2010). “Incidence and Predictors of Hypertension Among Rural Chinese Adults: Results From Liaoning Province.” Annals of Family Medicine, 8(1): 4-7.

Pregnancy-Induced Hypertension: Preeclampsia and Eclampsia

Pregnancy Induced Hypertension

A woman with pregnancy induced hypertension (PIH) experiences high blood pressure and protein deposits are found in her urine. In most cases, this condition occurs after twenty weeks of pregnancy and is common among first time mothers, teenagers and old mothers above forty years and who have had multiple pregnancies.

Symptoms

  1. Rushes or spots on the face.
  2. Protein in the urine.
  3. Sudden weight gain
  4. Sharp pain in the stomach especially on upper right side and around the ribs

Treatment

The condition can be detected through urine tests that check protein levels in the urine and using a Doppler scan that monitors flow of blood in the placenta. If the PIH is mild, the doctor recommends less salt consumption and resting by lying on left side so as to suppress the weight of the baby acting on the blood vessels. For severe cases, the doctor may use medications such as a magnesium sulfate injection to lower the blood pressure. Other medications include methyldopa, labetalol, and calcium channel blockers. Among these medications, research has shown methyldopa is the best of all because it has very few side effects to both the mother and fetus (Seneviratne, 1998, p. 167).

Pre-Eclampsia

Pre-eclampsia is a form of pregnancy induced hypertension that is associated with presence of proteins in the urine commonly known as proteinuria. It occurs at about twenty weeks of pregnancy but it is mostly common beyond twenty four weeks. It affects women who are having their first pregnancy as well as those who get pregnant in the course of pre-existing hypertension conditions.

Diagnosis

The condition is characterized by a rise in blood pressure that can go above 140/90mmHg. It is usually diagnosed during a routine antenatal checkup and in some cases the condition may warrant admission of the patient for close monitoring. Medical researchers have not fully discovered the pathophysiology of pre-eclampsia. However, it is believed to be a placental disorder that could result from poor perfusion in the placenta. It could also result from poor nutrition and high body fat. The underlying effect is poor development of the fetus, which is normally smaller than usual, mainly due inadequate flow of blood in the placenta. Severe pre-eclampsia may be experienced by a pregnant woman who previously had a mild type of this disease. The most dangerous thing about this condition is that it often appears with little or no warning. The blood pressure rises to about 160/110mmHg and there is a high quantity of protein deposits in the urine. The patient may have one or a combination of the following symptoms: severe headache, blurred vision, epigastric sharp pain similar to a heartburn, nausea and vomiting, muscle twitching and swelling of limbs (Wickham, 2008, p. 212).

Treatment

Treatment for pre-eclampsia in particular focuses on the high blood pressure. Doctors usually advise bed rest and antihypertensive medication may be administered to lower the blood pressure if the patient is in critical condition. In cases where the patient has convulsions, drugs to counter convulsions may be given. Doctors believe the best treatment for pre-eclampsia is induced premature birth, which is usually done through caesarean section. The following medications are used for reducing blood pressure:

  1. Magnesium sulfate, which prevents the risk of developing eclampsia
  2. Calcium channel blockers
  3. Methyldopa
  4. Nifedipine

Methyldopa, which is administered orally, is considered the best medication among these since it has fewer side effects.

Eclampsia

One of the complications that could results from pre-eclampsia is where the pregnant woman develops seizures and eventually goes into coma. The symptoms for eclampsia are similar to those of pre-eclampsia. However, the most common symptom for eclampsia is seizures. The tests for both pre-eclampsia and eclampsia include, blood platelet count, protein check in the urine and kidney function analysis.

Treatment

An intravenous injection of magnesium sulfate helps to reduce the chances of seizures recurring. Other medications may also be given to manage the level of blood pressure. These medications include hydralazine and labetalol. Premature birth may also be induced by use of oxytocin or prostaglandins, which can induce labor pains and hence prepare the cervix for delivery.

Side Effects of the Various Medications

Magnesium sulfate has adverse effects on muscles, as it makes them to grow weaker. It may also cause dizziness and slow breathing. Hydralazine may cause loss of appetite, mild diarrhea and vomiting. He patient could experience severe side effects such as yellowing of eyes, irregular heartbeat, joint pains and swelling of the mouth. Labetalol could induce side effects such as nose stuffiness, fatigue, indigestion, wheezing, persistent cough, chest pains and yellowing of the eyes. Oxytocin’s side effects include abrupt uterus contraction, vomiting, heavy bleeding during childbirth and blood clotting problems. Calcium channel blockers could cause side effects such as reduced heart rate and constipation. The use of Nifedipine has been known to have side effects such as blurred vision, heartburn, swelling of gums and limbs and constipation (Lyall & Belfort, 2007, p. 250).

References

Lyall, F., & Belfort, M. A. (2007). Pre-eclampsia: Etiology and clinical practice. New York, NY: Cambridge University Press.

Seneviratne, H. (1998). Pregnancy induced hypertension. Himayatnagar, Hyderabad: Orient Longman.

Wickham, S. (2008). Midwifery: Best practice, volume 5. New York, NY: New York Press.

Hypertension in Mexican Americans

Introduction

Hypertension is a heart disorder that causes increased diastolic and systolic blood pressure. Normal diastolic blood pressure in arteries ranges between 60 and 80 mmHg while systolic pressure ranges between 90 and 120 mmHg. During hypertension, the diastolic blood pressure in arteries increases and ranges from 80 to 100 mmHg while systolic blood pressure increases to ranges from 120 to 160 mmHg. Hypertension is a fatal heart disorder that does not only affect the heart and circulatory system, but also the functions of other organs like liver, kidney, and the brain, thus affecting general health condition of a patient. Epidemiological studies in the United States of America show that there is a significant racial and ethnical difference in the prevalence of hypertension among Americans. The studies show that Mexican-Americans are the second largest ethnical minority in the United States with high prevalence of hypertension as compared to other racial or ethnic groups. Salcido argues that, “two decisive factors make Mexican- Americans high-risk candidates for hypertension; their low socioeconomic status and the barriers erected against them by the health care system” (1979, p.373). Hence, their social and economic lifestyles together with inaccessible health care services predispose Mexican-Americans to hypertension. In order to understand the extent of prevalence of hypertension among Mexican-Americans, this essay explores the causes, treatment, cultural beliefs, health care barriers, cultural pattern of communication, and design culturally sensitive treatment plan.

Causes

Current studies indicate that the leading cause of hypertension is lifestyles such as poor diet and lack of physical exercise. Poor diet among Mexican-Americans due to social and economic factors has predisposed them to hypertension because “the researchers concluded that they had demonstrated a difference between Mexican-Americans and whites in occupational level, education, and family income” (Salcido, 1979, p.375). Therefore, Mexican Americans are prone to hypertension for they cannot afford healthy diets because of their low economic status as ethnical minority in the United States. Moreover, low educational level coupled with cultural beliefs make Mexican Americans to live lifestyles that predispose them to hypertension such as smoking, lack of exercise, alcoholism, and unhealthy diet. Unhealthy diet results into lack of important vitamins and minerals that are essential in regulating the homeostasis mechanism of the body resulting into hypertension. Studies have established that deficiency in potassium and vitamin D will result in hypertension particularly in an individual with poor health lifestyle.

Obesity and diabetes are also responsible for the development of hypertension. Obesity increases cholesterol levels in blood and constricts blood vessels and thus resisting smooth circulation of blood in the body. Research studies conducted on Mexican-Americans relative to other racial groups show that Mexican-Americans are more obese due to their unique lifestyles. Salcido reports that although cardiovascular conditions among Mexican Americans are comparatively similar to those of the whites, “like other low socioeconomic groups, they had a higher prevalence of obesity than persons of higher socioeconomic status, which may constitute a predisposing condition for hypertension” (1979, p.375). Hence, the prevalence of obesity among Mexican-Americans reflects the prevalence of hypertension in the community. Insulin deficiency results into poor regulation of sugar level in blood and subsequent osmotic potential of the body, which contributes to the occurrence of hypertension in the body. Hence, hypertension can arise due to complication of obesity and diabetes.

Hormonal imbalances in the endocrine system can cause hypertension. Adrenal hormones such as cortisol are responsible for regulating osmotic potential of blood and the functioning of the heart. Thus, diseases such as Cushing’s syndrome that causes overproduction of cortisol hormone increases osmotic potential of the blood vessels and increases pumping stress of the heart and eventually leads to hypertension. Eamranond and Patel argue that, “hormonal disorders such as hypothyroidism and Cushing’s syndrome significantly contribute to the hypertension among the elderly” (2007, p.671). Prevalence of hypertension in the older Mexican-Americans can be due to weak hormonal balance by their endocrine system. Endocrine system plays a significant role in homeostasis mechanism, which is very important in regulation of osmotic and ionic content of blood. Therefore, hormonal imbalance affects osmotic and ionic regulation of blood and predisposes one to hypertension.

Genetic factors also predispose one to hypertension and that explains existence of racial and ethnical disparities of the disorder. Pickering argues that epidemiological studies regarding hypertension show that, “there are huge differences in its prevalence among ethnic or cultural groups, as hypertension was more than 50% more common in many West European countries than in the United States or Canada, despite a presumably common gene pool” (2004, p.281). Therefore, prevalence of hypertension among Mexican-Americans can be due to genetic factors that dominate the gene pool of the ethnical minority relative to other racial and ethnical groups in the United States.

Treatment

Since hypertension is a heart disorder that results from changing lifestyles such as unhealthy diet and lack of exercise, it follows that proper nutrition and exercise will help in preventing the disorder. Medical experts advise hypertension patients to adhere strictly to healthful lifestyles by ensuring that they eat nutritiously and exercise well for their circulatory system and heart to remain healthy. Unhealthy diet and low social economic status are factors that are responsible for the hypertension among Mexican-Americans. Therefore, to help in preventing occurrence of hypertension in the community of Mexican-Americans, change in eating and exercising lifestyles is critical. Eamranond and Patel argue that, “lifestyle of Mexican-Americans that increases the prevalence of obesity and diabetes is the cause of hypertension” (2007, p.671). To improve health status of Mexican-Americans, change in eating and exercising lifestyles is very crucial in preventing obesity and diabetes, which in turn leads to prevention of hypertension.

Medical experts recommend on the increased consumption of potassium, magnesium, calcium, and vitamin D for they are very important elements in regulation of osmotic pressure in the blood. They also recommend on reduction of sodium intake because it increases osmotic pressure of the blood and thus hypertension. Among Mexican-Americans, obesity and diabetes are two major health disorders that predispose them to hypertension. Proper treatment and prevention of hypertension requires concomitant treatment of diabetes and obesity. According to Vijayaraghavan and Stoddard, “Mexican Americans comprehensive hypertension prevention and control efforts should also address obesity prevention and treatment. Additional efforts should involve reducing dietary salt consumption, a major risk factor” (2010, p.171). Thus, prevention and treatment of diabetes and obesity provides a milestone in controlling hypertension among Mexican-Americans.

Change in lifestyle provides a basis of using medication to prevent and control hypertension among patients. Medications cannot be effective if patients continue with unhealthy lifestyles such as eating unhealthy diet and failing to do physical exercises as well. Taking antihypertensive drugs is only effective when patients adhere to healthy lifestyles that help in preventing obesity and diabetes. “Efforts to improve blood pressure control should focus not only on increasing access to treatment and preventing hypertension but also on educating patient and health care providers to intensify treatment regimens for high blood pressure among adults with diabetes” (Vijayaraghavan & Stoddard, 2010, p.172). Hence, creating awareness on the nature of the disorder, treatment, and prevention of hypertension among Mexican Americans is going to help in controlling occurrence of hypertension in the population.

Cultural Beliefs

Mexican-Americans strongly believe in folk medicine practiced by natural healers popularly known as curanderos and santeros who give comprehensive treatment of all diseases. The folk system of healing consists of both medical and spiritual aspects of healing. Curanderos use herbal extracts when curing diseases while santeros invoke divine healing powers. Mexican-Americans believe that health is a gift from God and thus good or bad health depends on the relationship of a person with God. Galarraga argues that, “Mexican-Americans commonly perceive health as a gift from God regardless of whether they take part in the folk system of healing for health can be a reward for good behavior, and illness can sometimes be a punishment for wrongdoing” (2007, p.4). Hence, for the case of hypertension, they also view it as a punishment from God. To them, people suffering from a condition such as hypertension must have done something wrong against God and therefore deserve punishment. Although such beliefs are against medical perception of illness, Mexican-Americans believe strongly that their folk system of healing is very effecting in curing all diseases.

According to Mexican-Americans, substances that cause disease fall into two categories, ‘hot’ and ‘cold’ substances. The imbalance between ‘hot’ and ‘cold’ substances is responsible for the illness and thus folk healers need to balance the two. Galarraga asserts that, “an imbalance between hot and cold is considered a source of illness, with hot and cold not strictly referring to temperature but referring to the cultural classification of a particular substance or illness” (2007, p.5). Folk healers give guidelines to the people on how to balance ‘cold’ and ‘hot’ substances and failure to comply with the guidelines results into illness for example hypertension. ‘Pasmo’ is paralysis of the body due to failure to comply with the guidelines of balancing ‘hot’ and ‘cold’ experiences of life.

Mexican Americans also believe that illness can result from supernatural evil forces such as ‘mal de ojo’, which originate from envy. According to them, evil envy can befall anyone due to success in life or good health. For instance, a person can suffer from hypertension due to envy from other people or supernatural evil forces. “A supernatural cause of illness that comes from outside the body is “mal de ojo” and is caused by excessive admiration” (Galarraga, 2007, p.7). Hence, envy and evil forces are responsible for the illness that affects Mexican-Americans.

Since Mexican Americans believe that, their folk system of healing provides comprehensive physical and spiritually healing, they anchor onto it even in the contemporary society of technology. Curanderos employ herbal extract in treating diverse diseases like hypertension that they perceive as a heart condition while santeros use divine powers in praying for the sick and casting out evil spirits that are source of illness. Galarraga explains that, “treatments by curanderos and santeros include massages, herbs, counseling based on their spiritual capacities and cleanings that are performed as baths with a particular mix of plants. Santeros may also prescribe herbs, ointments, lighting of candles for saints and incense” (2007, p.8). For the case of hypertension, folk healing system treats both physical and spiritual aspect of the disease by use of herbs and spiritual powers respectively.

Health Care Barriers

Since Mexican-Americans are one of the ethnical minorities in the United States, social and economic marginalization causes them to stick to their cultural beliefs despite the fact that the mainstream society is advancing in modern medicine.

“Mexican-Americans fall far short of the white population in both income and health status because investigation of the Los Angeles health system showed the morbidity and mortality rates among Mexican-Americans to be two to three times higher than in the white population” (Salcido, 1979, p.372). Analysis of the economic and social status of the Mexican-Americans shows that the white majority has marginalized and sidelined them in terms of economic, political, and social spheres of life. The mainstream society has neglected Mexican-Americans leaving them to continue in their traditional ways of life since they have not adapted modern culture.

Historically, Mexican-Americans were a minority ethnical group that experienced racial discrimination during the colonial period and Mexican-Americans have since experienced racial discrimination causing them to ‘shy’ away from the modern civilization and advancement in technology. Salcido argues that, “stereotypes of Mexican-Americans provide an excuse for the health care system to ignore Mexican-American health care needs … because they prefer their traditional folk culture practices, such as use of curanderos and brujas and herbal remedies, to modern medical practice” (1979, p.374). Thus, stereotyping Mexican-Americans has created a barrier that prevents them from seeking medical attention concerning hypertension and hence they resort to folk system of healing that involves the use of herbs and divine powers.

Education is another barrier that prevents Mexican-Americans from accessing health care services equally as other races and ethnic groups. The mainstream society has neglected Mexican-Americans in terms of education and thus majority does not speak English language that is essential in communicating effectively. Research done to ask Mexican Americans why they do not go for the health care services revealed that language differences, dehumanizing experience of seeking health care services and difficulties in associating with the medical professional are the main barriers. This shows that educational system has not done much in ensuring that Mexican-Americans speak English as national language. “Language barriers may be an important cause of lack of awareness and under diagnosis of hypertension among Mexican Americans and this would imply that educating Mexican Americans through Spanish television, radio, and/or publications may possibly improve awareness and understanding of hypertension” (Eamranond & Patel, 2007, p. 703). Improving educational standards for Mexican-Americans to speak English and creating more awareness about modern medicine would significantly enhance their perception of the society and health matters. Moreover, preventive measures and treatment of hypertension requires some educational knowledge to demystify traditional beliefs and superstitions about causes and treatment of the disorder.

Cultural Communication and Treatment plan

Mexican Americans portray their emotions quietly in public, as they are very secretive and are very shy in that, they cannot maintain direct eye contact because they consider it disrespectful. Moreover, they are very expressive in terms of gestures as they consider that effective communication should entail use of culture. In Mexican-Americans, touching is a normal act of association between same sexes for it has no negative connotation as in the case of other racial ethnical groups in the United States. In terms of thought patterns, they are literal and direct in their arguments or explanation. They strongly believe in their family lineage, traditional healing system, and family values that keep them together as community. Mexican-Americans are also culturally sensitive to gender issues as female and male normally are distinct members of the society. Galarraga argues that, “the oldest man in the household holds the greatest power publicly and will often be in charge of making healthcare decisions and women are expected to adhere to the man’s opinion as a form of respect in the public sector” (2007, p.12). Thus, communication in the family follows hierarchy in the family structure of Mexican Americans.

Culturally sensitive treatment plan should incorporate communication patterns and cultural beliefs of Mexican-Americans in order to enhance treatment of the hypertensive disorder. For instance, treatment of a young man suffering from hypertension requires the medical professionals to understand the communication patterns of the patient and cultural beliefs regarding treatment to enhance diagnosis and treatment of hypertension. Since Mexican-Americans highly respect family protocol in the issues of health, the use of elders to convince the young man to accept modern medicine is paramount as a plan to incorporate modern medicine into their cultural set up. Moreover, medical professionals should talk friendly, use gestures, and probe quietly to increase compliance of the patient. The elders should have their opinion concerning treatment of hypertension so that they can give confidence to the patient and family members to accept modern medicine.

In addition, incorporation of therapeutic modalities and modification of traditional treatment will enhance cultural sensitivity to the treatment of hypertension. Medical professionals should adopt cultural names of referring herbalists and spiritual healers and use them in professional settings. For example since Mexican-Americans refer to herbalists as curanderos, adoption of the name to refer to the physicians can significantly change perception of the young man because he will perceive that he is going to see a modern curanderos. Likewise referring to psychotherapist as santeros would help in changing perception of modern medicine from traditional point of view. Thus, incorporation of cultural names into modern medicine can significantly encourage Mexican-Americans to seek treatment of hypertension and comply with the most neglected conditions of treatment due to negative attitudes or traditional beliefs.

Conclusion

Hypertension is a heart disorder due to increased blood pressure in the arteries. Unhealthy eating habits, lack of exercise, and hormonal imbalances are the major causes of the disorder. Prevention and treatment of the disease entails practicing healthy lifestyles and use of antihypertensive drugs. The prevalence of hypertension disorder is very high among Mexican-Americans because they deeply believe in the folk system of healing that is ineffective in treating the disorder. Moreover, since Mexican-Americans are one of the ethnical minorities in the United States, they do endure racial discrimination and marginalization by the mainstream races and ethnic groups that dominate the United States. Low social and economic statuses are the major causes of hypertension since Mexican-Americans are unprivileged and cannot access proper nutrition and healthcare services because they are very expensive. Moreover, marginalization has created language barrier that prevents Mexican-Americans from interacting effectively with the mainstream society, hence they shy away from seeking medical services from the available healthcare systems.

References

Galarraga, J. (2007). Hispanic-American Culture and Health. National Academic Press, 1-34

Eamranond, P., & Patel, K. (2007). The Association of Language with Prevalence of Undiagnosed Hypertension among Older Mexican Americans. Ethnicity & Disease, 17, 699-705.

Pickering, T. (2004). Hypertension in Hispanics. The Journal of Clinical Hypertension, 6(5), 279-282.

Salcido, R. (1979). Needed: Hypertension Research for Mexican Americans. Public Health Reports, 94(4), 372-375.

Vijayaraghavan, M., & Stoddard, P. (2010). Blood Pressure Control, Hypertension, Awareness and Treatment in Adults with Diabetes in the United States-Mexico Border Region. Rev Panam Salud Publica, 28(3), 164-173.