The objective of the PREMIER research was to study the effect of two multicomponent lifestyle interventions on estimated coronary heart disease (CHD) risk compared to advice alone intervention.1 The study also evaluated whether the differences can be detected in the effects of the lifestyle interventions among subgroups defined by baseline variables.1 The results from the study can help future researches to focus on the intervention that has proven to be effective in reducing the heart disease risk.
The PREMIER study was a National Heart, Lung, and Blood Institute (NHLBI) sponsored, multicenter, 3-group, parallel-arm randomized trial conducted in the United States.1 For the study, a total of 810, of which 62% were women and 34% were black, healthy adults with untreated prehypertension or stage 1 hypertension who met the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure criteria for a 6-month trial of nonpharmacological BP treatment, were recruited.1 The participants were randomized to 1 of 3 intervention groups: An “advice-only” group, an “established” group (EST) that used established lifestyle recommendations for blood pressure control (reduced sodium intake, weight loss, and increased physical activity), or an “established-plus-DASH” group (EST+DASH) that combined established lifestyle changes with the DASH (Dietary Approaches to Stop Hypertension) diet.1 The mean age of the participants were 50 years, the mean systolic/diastolic
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.
Although the term cardiovascular disease refers to a disorder of the cardiovascular system, it is usually associated with atherosclerosis, also known as arterial disease. It is considered the leading cause of deaths in the world, taking 17.1 million lives a year. There are only a few factors that are non-modifiable, these being the persons age, gender, family history and their race and ethnicity. Although there are non-modifiable risk factors, there are multiple multiple risk factors that are modifiable that anyone can use to prevent getting any type of cardiovascular disease. These people just need to have the motivation to be able to change themselves and their lifestyles in order to better
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).
Hypertension is predominantly a major problem for African Americans whose occurrence percentages are amongst the highest in the world (Heckler, Lambert, Leventhal, Leventhal, Jahn, & Contrada, 2008). Even though there have been meaningful progress in treatment of hypertension, the number of patients with well managed high blood pressure condition remain worryingly low, with the latest trends suggesting a high rise in the number of uncontrolled high blood pressure cases. This is
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
In Monmouth County, it has been documented that the stroke mortality rate among older adults “between 2011 and 2013 was 32.3 deaths per 100,000 population”, which is comparable to the statewide rate (“2016 Community Health Assessment,” 2017). Buonacera, Stancanelli, & Malatino (2017) have stated that “hypertension is the leading modifiable contributor to stroke.” Therefore, it is important to focus on monitoring the blood pressure (BP) and detect early signs of hypertension, due to high BP, to prevent the development of stroke. One of the Leading Health Indicators (LHI) priorities from Healthy People 2020 that I will concentrate on is “HDS-5.1 Reduce the proportion of adults with hypertension” (“Heart Disease and Stroke,” 2014). Researchers have indicated that 35.9% of older adults have been diagnosed with high blood pressure in 2015. It indicates a significant increase since 2011 than the desired target of 26.9% suggested by Healthy People 2020 (“2016 Community Health Assessment,” 2017; “Heart Disease and Stroke,” 2014). The prevalence of hypertension in Monmouth county is alarming. Health promotion and preventative measures should be implemented to reduce the percentage of older adults with hypertension, accounting for more CVD mortality than other modifiable
According to a systematic review by James et al. (2014) on several RCT, there is strong evidence of the advantage of treating people aged 60 above with a blood pressure threshold of 160/90 and people aged less than 60 years with a threshold of 140/90 mmHg. This study also reported that there is moderate evidence to support HCTZ, ACE or ARB as the first line therapy for the nonblack hypertensive population to control hypertension and prevent cardiovascular events. This study also concluded with a strong evidence of starting thiazide diuretics as first-line therapy for black hypertensive patients (James et al., 2014). An RCT study by Krones et al. (2008) demonstrated that shared decision making (SDM) increased patient satisfaction and lowered decisional regret.
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.
Machado et al. did not address the scope of the problem or consequences of the problem in the problem statement. However, these items were identified in the introduction leading up to the problem statement as complications of uncontrolled HTN with low rates of adherence to treatment associated with advanced age and disparaging public health factors (Machado et al., 2017). The problem is identified as systemic arterial hypertension (SAH) requiring treatment changes that might be difficult to institute or maintain for the elderly population due to various factors (Machado et al., 2017). Machado et al. briefly address the background and knowledge gaps as aspects related to culture, the health environment and individual capacities (2017). A proposed solution is introduced in the problem statement to build a relationship with the HTN patient to with the patient in corroborating on a plan of care that the patient is able understand and will follow through with (Machado et al.,
Incidence, prevalence, morbidity, and mortality reports are crucial when planning a hypertension prevention program in a target community. Incidence and prevalence allow for a better understanding of exactly what diseases are present and if those numbers are growing or declining at a specific time (Grossman & Porth, 2014). Morbidity and mortality “statistics are useful in terms of anticipating health care needs, planning of public education programs, directing health research efforts, and allocating health care dollars” (Grossman & Porth, 2014, p. 8). Before planning a comprehensive prevention program it would be pertinent to have an idea of the amount of individuals suffering from hypertension, the frequency of newly diagnosed individuals, the effects of the disease process on the individual, and statistics related to survival and/or
American Heart Association quotes that Hypertension is an important public-health challenge worldwide. Importance should be focused on its detection, treatment control and prevention. The infectious diseases such as malaria and tuberculosis which once were the reasons for leading the causes of deaths have been replaced by non –infectious diseases which are mostly the NCD’s such as diabetes, heart diseases, and other vascular conditions. Hypertension is an important worldwide public-health challenge because of its high frequency and concomitant risks of cardiovascular and kidney disease [78][79]. Heart attacks and strokes are major–but preventable–killers worldwide. More than 80% of cardiovascular disease related deaths take place in low-and
Preventive measures are imperative in reducing the risk of cardiovascular disease (CVD). De Backer mentions that having a lifestyle incorporating poor diet, lack of physical activity, and smoking greatly contributes to the risk factors of individuals with CVD (2017).
Cardiovascular disease does not care how old one is although the chances of developing it increase with age. Many factors, both societal and environmental influence ones risk for developing cardiovascular disease from birth to adulthood. Health promotion is an important aspect of primary prevention. Incorporating a healthy lifestyle promotion campaign on the risk factors for cardiovascular disease within the health clinic will be important for optimizing the effectiveness of the campaign in order to expand it community wide. A quasi-experimental design will be used incorporating an intervention group which will be those who are being treated at the clinic for cardiovascular disease or have risk factors for cardiovascular disease, and a reference group consisting of random people throughout the community. Health promotion campaigns will be provided for the
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).
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