Life expectancy has grown over the last 100 years. This leads to a variety of health issues and problems that affect these elder generations quality of life. According to the United States CDC, one in three American adults suffers from hypertension. With so many Americans having high blood pressure it is no surprise that hypertension is one of the most dangerous conditions, leading to death, in the elderly. Doctors often skip directly to subscription, medications to help control elevated blood pressures, but other problems can arise from these medications, like dementia. The earlier the hypertension is diagnosed, the faster doctors can help create a treatment plan individually tailored to help the sufferer.
Hypertension is one of the most common chronic health problems seen in the primary-care setting. Hypertension in adults age 18 and older is defined as a systolic blood pressure (SBP) of greater than 1400 mm Hg and or a diastolic blood pressure (DBP) of greater than 90 mm Hg, based on the average of two or more properly measured seated BP readings on each of two or more office visits. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure cites the following three categories for adults age 18 and older: (1) prehypertension (SBP 120 to 139 mm Hg / DBP 80 to 89 mm Hg); (2) Stage 1 hypertension (SBP 140 to 159 mm Hg / DBP 90 to 99 mm Hg); and (3) Stage 2 hypertension (SBP ≥ 160 mm Hg / DBP ≥ 100 mm Hg) (Sisson, Rastegar, Rice, Prokopowicz, & Hughes, 2010).
Ross, S., Walker, A., & MacLeod, M. J. (2004). Patient compliance in hypertension: Role of illness perceptions and treatment beliefs. Journal of Human Hypertension, 18(9), 607-613. Retrieved from http://dx.doi.org/10.1038/sj.jhh.1001721
The two major types of hypertension are primary and secondary. Primary hypertension accounts for more than 90% of all cases and has no known cause, although it is hypothesized that genetic factors, hormonal changes, and the altercations in sympathetic tone all may play a role in its development. Secondary hypertension develops as a consequence of an underlying disease or condition. The prevention and treatment of hypertension is a major public health issue. When blood pressure is controlled, cardiovascular, renal disease, and stroke may be prevented. The JCN, reported more than 122 million individuals in American are overweight or obese, consume large amounts of dietary sodium and alcohol, and do not eat adequate amounts of fruits and vegetables; less than 20% exercise regularly. Both modifiable and non-modifiable factors play a role in the development of hypertension
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.
According to JNC 8 guidelines, close monitoring is essential when patients start on new hypertensive medication. Therefore, Mr. Hightower will require frequent visits to the clinic to ensure improvement in his health condition. His blood pressure will be monitored at each visit and blood work will be done to monitor his kidney and liver functions and to determine his adherence to treatment. In case of noncompliance, a third category of antihypertensive must be added to improve hypertension outcomes and prevent cardiovascular disease.
Some African American, especially those in low resource communities, do not know how routine visit to the doctor and taking their medication on a regular basis can be beneficial to their health. Missing appointment are often time associated with increased risk of hospitalization. By missing appointment, doctor are not able to provide the proper care to their patient, which is often time result in poor control of chronic illness, hospitalization and sometime death if proper medical care is not given in time. Often time African American in low resource community have a hard achieving normal blood pressure as appose to other ethnic group. Even though several intervention programs are set in place to improve appointment adherence, many individual still missed schedule appointment, which remain a problem because proper healthcare and treatment is not given. Many individual does not know about the importance of appointment adherence, but despite its importance, not much information or data exist about the risk factors associated with non-adherence among hypertensive African American. “Therefore, to fill this gap, this study examined factors associated with patient-reported appointment adherence among African-Americans with severe, poorly controlled hypertension, using data from the Inner City Hypertension and Body Organ Damage (ICHABOD) - a cross-sectional survey of urban African-Americans hospitalized with severe, poorly controlled
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
Hypertension related research could be assessed using meta-analyses and randomized control trials. A combination of both will be used for this narrative review, since all three have been useful in determining JNC guidelines. Much of the research conducted has been on different interventions that include lifestyle and pharmacological treatment that have been used to reduce blood pressure and control hypertension. JNC 6 focused its efforts on improving dietary habits to avoid developing hypertension or manage it once diagnosed. JNC 7 appears to be an intermediate of the other two guidelines. It contains information on the lifestyle modifications as well as pharmacological treatment. JNC 8 is formatted quite differently that the other two and appears to be geared towards proper and prompt diagnoses of the disease, as well as forms of treatment.
According to the Centers for Disease Control and Prevention (CDC) (as cited in Kear, 2015), hypertension is a common, long term health condition that affects over one billion people worldwide and 76.4 million adults in the United States. Hypertension is classified as having a systolic blood pressure of or greater than 130 mmHg and a diastolic blood pressure of or greater than 90 mmHg (Kear, 2015, p. 182). As a nurse you will encounter many patients that are hospitalized with hypertension and co-morbidities related to. As this is a chronic disease, patient compliance, prognosis, and future healthcare cost are contingent upon treating this issue as it can significantly affect the patient overall health status. Hypertension is a “silent killer” as many people are living with hypertension and are unaware of having this disease process. The cause of hypertension may be multi dynamically related to lifestyle risk factors such as, diet, exercise, familial history, stress, occupation, and the list goes on. Managing hypertension is a multifaceted approach as it consists of a collaboration with multiple healthcare providers the doctors, nurses, dietitian, the patient, the family, as well as other environmental factors that affect compliance and adherence (Kear, 2015). Hypertension can lead to several debilitating diseases such as heart attack, stroke, blindness, kidney failure just to name a few and it should be monitored and treated early to prevent any
Hypertension is exceedingly common in the United States and can lead to heart attack, stroke, kidney disease, and eye disease. Given the importance of this condition, it is critical for patients to recognize its causes, diagnosis, and treatment. By the end of this article, you will know the
Regarding the barriers of non-adherence, (Table 5). The commonest reasons reported by respondents for non-adherence to medication taking were forgetting their medication (86.7%)in control group followed by complexity of therapy 76.7% in both group . This finding is in accordance with that Bernardino et al. (2006), who found that, hypertensive patients may fail to take their medication due to forgetting, followed by complexity therapy. At the end of the study after educational intervention and 12-week follow-up, improvements in metabolic parameters and diet, exercise, and drug therapy compliance could be the result of increased disease awareness, lifestyle modifications, and regular follow-up. We think that educational program in combination with telephone follow-up contributes to this awareness and improvements.. In the present study, barriers of compliance to follow up were markedly due to difficult transportation 76.7% in both groups This finding goes in accordance with that of Finnerty, Mattie and Finnerty (2003), who reported that the causes of poor compliance to follow up clinic were Difficult transportation, long waiting time, overcrowded clinics and inconvenient place for waiting was considered another barrier of compliance. Another barrier of compliance to diabetic diet was the family could not serve special food representing 80% of control group and 26.7% in study. this might be due to the beneficial role of health education to patients and their families about the importance of social support in diabetic treatment treatment. This finding was in accordance with that reported by Korhonen et al.
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.