High Blood Pressure Case Study

Modern medical advancements have significantly decreased the prevalence and severity of infectious disease as well as the treatment of acute, traumatic conditions. Pharmacological research has also gained insight into the management of chronic disease. Still, there is an epidemic of chronic, treatable diseases like stroke, heart disease, and kidney disease. Hypertension proves to be the underlying factor associated with these diseases. Hypertension is often referred to as the silent killer because of its indication in deadly disease, and the importance of monitoring ones blood pressure is vital. Lifestyle, diet, and genetic predisposition are all factors of high blood pressure. Chronic high blood pressure above safe levels, known as hypertension, puts elevated physical stress on the renal and cardiovascular systems. By controlling this factor in patients, healthcare providers can decrease cardiovascular events, improve health outcomes, and decrease overall mortality. Patient education is often overlooked in its role in the control and prevention of high blood pressure. This paper analyzes the causes and physiology behind high blood pressure as they relate to the current nursing interventions. The role of nurses is discussed in relation to patient education regarding high blood pressure, and educational approaches are analyzed.

Hypertension is the leading cause of cardiovascular diseases, and its prevalence rate is approximately 1 billion in 2000 people around the world (Hanus, Simões, Amboni, Ceretta, & Tuon, 2015). Additionally, HTN is a major risk factor for kidney, brain, and eye complications. Complications from HTN cause an estimated 9.4 million deaths per year (Kjeldsen et al., 2014). To reduce high morbidity rates and complications related to uncontrolled high blood pressure, pharmacological therapy is warranted. Despite available medications, the compliance with HTN medications remains subpar (Polinski, Kesselheim, Frolkis, Wescott, Allen-Coleman, & Fischer, 2014).

The concern on whether anti-hypertensive’s should be withheld in patients who are hypertensive has been debatable in the recent past. Generally, the treatment of hypertension among hospitalized patients is basically an opportunity to enhance the recognition and treatment of blood pressure (Axon, Nietert & Egan, 2011, p.246). This is mainly because hypertension is a basic risk factor for heart diseases, stroke, and death whose impact is widespread to nearly 70 million adults in America. There have been numerous educational initiatives and publication of treatment processes to address this condition in the past few decades. Despite these measures, nearly 39 million Americans are at risk of hypertension because they have not reached their desired or optimal blood pressure.

Human health and theIR quality of life have been improving in the past 100 due to changes in medicine and in public health (Mattes et al., 2013). Patients are placed on multiple medications at the same time and it important to understand their safety, efficacy, drug interaction, and toxicity (Mattes et al., 2013). As Mr. Cynthia Nurse practitioner, my job is to understand what affect her prescribing medication is having on her body. I have place Mrs. Cynthia on Lisinopril for her hypertension and metformin for her type II diabetes.

Hypertension is a developing problem worldwide associated with an increased risk of cardiovascular morbidity and mortality. In 2020, the world population will be approximately 7.8 billion people, and there will be 1 billon people who may be affected by hypertension (Tomson & Lip, 2005). One in three adults in the United States has high blood pressure. According to the report “Health, United States, 2010 with Special Feature on Death and Dying,” the prevalence of hypertension among adults 20 years old or older increased from 24% to 32% during 1988-1994 and 2005-2008. The African-American population has a higher prevalence of this health condition than white Americans do. In 2005 to 2008, the prevalence of hypertension among black males (41.4%) was more than 10%,

The major health problem selected for this project was hypertension (Harrison et al, 2011). It is identified as a cardio vascular disease risk factor such as dementia, chronic kidney disease, coronary heart disease, and stroke (NICE, 2011). It can be missed easily, as in various instances it is asymptomatic as well as it is also known as a silent killer. The Hypertension is thought to be a disease of vascular regulation ensuing from arterial pressure control mechanisms malfunction (extracellular fluid volume, rennin-angiotensin-aldosterone system, and CNS) that results in elevation of BP by means of enhanced peripheral vascular resistance, and cardiac output. There are 2 basic hypertension types. Around 90 to 95 percent of the individuals have primary hypertension which is linked with change in lifestyle as well as needs medical treatment. On the other hand, 5-10% has secondary hypertension which is linked with various other diseases for instance pregnancy, thyroid, and renal (Haslam and James, 2005). It is estimated that around 1 in 20 adults will have increased BP of 160/100 mmHg and above that results in either more than one predisposing aspects (Gemmell et al, 2006).

Drug therapy always carries risks, but in older populations, that risk is at times amplified due to normal physiological variations. When considering drug therapy for an older

JNC 8 has a hypertension guideline algorithm. Patients older than 60 should be placed on pharmacological treatment if SPB is 150 mm Hg or higher and DBP is 90 mm Hg or higher. Target goal is 150/90 Patient less than 60 should be placed on pharmacological treatment if SPB is 140 mm Hg or higher and DBP is 90 mm Hg or higher. Target goal is 140/90. Initial drug of choice for nonblack patients is an ACEI, ARB, thiazide or CCB alone or in combination. Black patients should be started on a thiazide or CCB alone or in combo. It is recommended to start one drug titrate to maximum dose and then add another drug if target goal has not been achieved. Combination therapy is recommended if BP is greater than 20/10 mm Hg from target. I also gives a guideline for all ages if the patient is diabetic without kidney disease or the patient has kidney disease without diabetes (Armstrong, 2014).

The algorithm begins with an indication that is used for adults over the age of 18 and noted that lifestyle interventions should be continued throughout management. Goal blood pressures are separated by age and presence of chronic disease. The goal for patients over 60 is SBP < 150 mmHg and DBP < 90 mmHg. The goal for patients under 60 is < 140 mmHg and DBP < 90 mmHg. Different goal values are presented for patients with chronic conditions. Treatment with medication is categorized by: general population nonblack, general population black, chronic conditions black, and chronic condition all races. Based on the algorithm black patients should only be prescribed thiazide type diuretics and/or calcium channel blockers. While non-black patients can take all of the medications listed in JNC 8 (thiazide type diuretics, ACEI, ARB, and/or CCB). If patient does not reach goal blood pressure then three strategies are listed, along with lifestyle adherence. The algorithm also explains not to use ACEI and ARB together. The final option for patients not at goal blood pressure includes additional medications and/or referral to physician with an expertise in hypertension

Well written paper on beta blockers in controlling hypertension. In my experience, I had seen more than 80% of patients are prescribed with antihypertensive drugs in their medical chart. A beta blocker is one of the most common drugs in a geriatric setting especially atenolol. Beta blockers are the standard of therapy for many cardiovascular conditions and it is the main line of treatment in decreasing risk of stroke. According to Ladage, Schwinger, and Brixius (2013) beta blocker was more effective in decreasing mortality and morbidity rate in acute coronary syndrome patients. Atenolol is a water soluble and had longer half-lives with non-metabolized actions and excreted via the kidneys (Ladage et al., 2013). The exercise capacity increases in patients who are on beta-blockers, like bisoprolol, nebivolol, carvedilol (Ladage et al., 2013). A recent meta-analysis study showed patients who are untreated with hypertension, they are at risk of developing chronic kidney diseases, cardiovascular complications, and cerebrovascular complications (Butt & Harvey, 2015). In one study, mainly geriatric population who are taking atenolol had shown greater mortality rate and increase arterial pressure (Testa et al., 2014).

Some key observations that we found throughout these clinical reports are that patients are offered numerous treatment options when diagnosed with heart failure. However, these treatment options are often restricted due to comorbid disorders/diseased the patients

Hypertension is one of the leading risks for heart disease and stroke. Your physician may advise dietary or lifestyle changes, or specific medications to lower your blood pressure.

The report describes the visits to the primary care physicians made by adult hypertensive adults during 2013-2014, with their demographic, state and regional differences in hypertension control and pharmaceutical treatment. Hypertension is a leading risk factor for cardiovascular disease and stroke in the United States. Hypertension as defined as an elevation of systolic greater or equal 140mmHg and diastolic greater or equal 90 mmHG. 2011- 2014 from the recent study, estimated that 53% of hypertensive adults had their hypertension controlled. The data obtained by National Ambulatory Medical Care Survey (NAMCS) can be utilized to make national, regional and some state based estimates of office –based physician health care utilization. This

The antihypertensive effects of Atacand was similar in men and women in patients older and younger than 65 (www.rxlist.com). Atacand HCT or the combination (Candesartan celexetil and hydrochlorothiazide) resulted in placebo adjusted decreases in sitting systolic and diastolic blood

Approximately one in every three adult’s ages 20 years old and older are diagnosed with high blood pressure or hypertension. Hypertension affects 78 million people in the United States and is equally prevalent in both men and woman (Crabtree et al., 2013). Hypertension is a major risk factor for cardiovascular disease (Hajjar & Kotchen, 2003). It can lead to stroke, myocardial infarction, renal failure, heart failure, neurological issues, and death if not detected early and not treated properly (James, Oparil, Carter, & et al., 2014). Approximately 9.4 million deaths in 2010 were attributed to high blood pressure (Angell, De Cock, & Frieden, 2015). About 54% of strokes, 47% of coronary heart disease, and 25 % of other cardiovascular diseases are attributed to high blood pressure (Arima, Barzi, & Chalmers, 2011).