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Hypertension or high blood pressure is a global health problem that currently impacts a multitude of people. It continues to be a primary cause of avoidable deaths due to failure of recognizing initial symptoms or risk factors. The shocking disease progression is attributed to the escalating regard of processed foods that contain high levels of sugars or salts. Other contributors and risk factors that promote hypertension include alcohol intake, high cholesterol levels, obesity, genetic factors, organ damage and lifestyle. It is estimated that 1.2 billion individuals have hypertension globally. In part A, this paper provides an overview of the disease, shows why it is crucial in nursing, how the disease is viewed in US and Japan, and gives guidelines that define the disease in US and Japan. In Part B, it further evaluates four studies on the hypertension providing the findings that each study made.

Overview

Hypertension (high blood pressure) is a global health problem that currently impacts a multitude of people. It continues to be a primary cause of avoidable deaths due to failure of recognizing initial symptoms or risk factors. The shocking disease progression is attributed to the escalating regard of processed foods that contain high levels of sugars or salts. Other contributors and risk factors that promote hypertension include alcohol intake, high cholesterol levels, obesity, genetic factors, organ damage and lifestyle. According to a recent study conducted by World Health Organization (WHO) in 2010, 43 million individuals in the USA were diagnosed with essential (idiopathic) hypertension. In general, 65 million Americans were diagnosed with both idiopathic and secondary hypertension. It is estimated that 1.2 billion individuals have hypertension in the entire world (Murray & Belgrave, 2010).

Hypertension can be defined as constant elevation of blood pressure in systematic arteries. Renin-Angiotension-Aldosterone System (RAAS) fails followed by lessened nitric oxides that facilitate peripheral receptors and vascular resistance, endothelial damage and vasoconstriction resulting in elevated blood pressure. It can be categorized as isolated systolic or essential (idiopathic) hypertension and secondary hypertension. Essential hypertension is characterized by systolic blood pressure above 140 mm Hg and diastolic blood pressure above 90 mm Hg following at least two consistent readings, intake of medication categorized as hypertensive agents and organ damage attributed to cardiovascular disease resulting in end-organ harm. This type tends to encompass a recognizable predisposition. Secondary hypertension, on the other hand, is caused by core disease processes.

The disease causes end-organ damage that affects vision, renal status, peripheral perfusion and damage of endothelium resulting from increased levels of cholesterol. The main complications include myocardial infarction, renal failure and stroke.

Importance to Nursing

Hypertension research is important for nursing, because on detection and diagnosis the nurses will take all appropriate chances to assess blood pressure of individuals to enable early detection. They will use the suitable techniques and proper equipment, they will be knowledgeable on process involving its diagnosis, and will educate people on target blood pressure. On medications the nurses will be knowledgeable on medication classes that clients may be prescribed to and will offer pharmacological management education on hypertension to clients.

How it is viewed in US and Japan

In US, hypertension is a neglected disease, yet it is the second-leading death cause in the region. Doctors often deal with the disease in-aggressively and the government has not made it a priority either. For this reason, the Center for Disease Control and Prevention has launched campaigns to push doctors to better deal with the disease. In Japan, it is no longer viewed as an adult disease. Japanese transformed from believing that one can tell his blood pressure by feeling their heartbeat rate to applying current knowledge of taking their blood pressure using stethoscope. For this reason, hypertension in Japan is relatively low.

Guidelines for defining hypertension in US and Japan

In US, the guideline defines hypertension as hypertension with and without compelling indications. Without compelling indications, stage I hypertension is classified within systolic blood pressure (SBP) of 140-159 mm Hg and/or diastolic blood pressure (DBP) of 90-99 mm Hg. Stage 2 hypertension is defined as SBP above 160 mm Hg and or DBP above 100 mm Hg. In Japan, guidelines of hypertension define it as SBP above 140 mm Hg and DBP above 90 despite treatment with three hypertensive medications (Izzo, 2008).

PART B

Study #1: Moser, M. & Franklin, S.S., (2007). Hypertension Management: Results of a New National Survey for the Hypertension Education Foundation: Harris Interactive.

Purpose of study

The initial purpose of the study was to get opinions of hypertensive people above 45 years of age in US regarding their awareness of the risk, treatment and control of hypertension. The study further aimed to get data on BP control degrees in different populace groups in order to better determine the reasons for inadequate BP control and obtain client opinions regarding management of BP.

Qualitative or quantitative

The study was both qualitative and quantitative. Understanding people’s beliefs and opinions using interviews qualifies it as a qualitative study while generating numerical data on BP control to degrees make it a quantitative study.

Study sample

The study interviewed 1245 respondents who were above 45 years of age and had been detected to have hypertension. The weighting variables of the study included sex, age, religion, education, income, and race/ethnicity. Of the entire 1245 respondents, 56% were females, 67% were above 55 years old, 78% was occupied by Caucasian, 13% African-American, 43% earned $25,000-$75,000, and 56% had completed high school and had gone to college.

Study findings

The study found that more than 90% of the individuals in the survey correctly matched elevated BP with strokes and cardiac arrest. More than 60% correctly attributed hypertension with atherosclerosis, kidney failure and heart enlargement. In addition, more than 2/3 of the entire sample correctly noted optimal BP level to be 120/80 mm Hg. This reflected a high level of hypertension risk awareness among hypertensive individuals. However, the Whites showed greater awareness compared to Hispanics and African-Americans. Further, individuals between 45 and 59 years old were less likely to frequently see medical practitioners. However, almost ¾ of hypertensive adults see physicians to monitor BP at least half-yearly. 70% were treated by family physicians, and 90% use antihypertensive medications. The study concluded that hypertension and its cardiovascular risks awareness are high and knowledge sources appear to be increasing over years.

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Study #2:  Thomson et.al, (2005). The Impact of Implementing National Hypertension Guidelines on Prevalence and Workload in Primary Care: A Population-Based Survey of Older People.

The purpose of study

The study was aimed at comparing the prevalence of hypertension that is treatable and the potential impacts on individuals and primary care resulting from using present guidelines.

Qualitative or quantitative

The study is qualitative as it explores people’s behavior as a result of current hypertension guidelines.

Study sample

The study used a random stratified sample comprising of 4784 South East Northumberland residents above 65 years of age, who had been registered with 1 out of 27 contagious basic practices. Data was gotten from primary care medical records, screening clinics that use standardized definitions, and self-completed questionnaires. Individuals were termed hypertensive if their BP fell above optimal threshold of diagnosis as defined by NICE, JNC7, BHS3 and BHS4 guidelines.

Study findings

The study found that prevalence for treatable elevated blood pressure was extremely high. Patients in 65-74 years of age, prevalence on men were 70.4% while women were 73.3% with BHS4 guidelines with relative difference when compared to BHS3 guidelines’ prevalence. Above 75 years of age, prevalence using BHS4 was 74.4 (men) and 84.3% (women), again with relative difference for BHS3. NICE compared to BHS4, prevalence was significantly lower. When comparing JNC7 with NICE and BHS4, prevalence recorded the highest. It concluded that prevalence of treatable hypertension in elderly is high with resultant impact on cost of prescribing and performance workload that will be higher using BHS4 instead of NICE.

Study #3: Obara et.al, (2010). Home and Office Blood Pressure Control among Treated Hypertensive Patients in Japan: Findings from the Japan Home versus Office Blood Pressure Measurement Evaluation (J-HOME) Study.

Purpose of study

The aim of the study was to evaluate control of BP at home and in office among hypertensive patients, who have been treated in Japan’s primary care settings.

Qualitative or quantitative

The study was both qualitative and quantitative in the aspects that it generated numerical data and also examined factors linked with white-coat effect and morning-evening BP difference magnitude.

Study sample

The study involved 3400 patients who were selected on the basis of informed consent to participate, were taking antihypertensive medicines, had available BP data on morning home and office, and presented idiopathic hypertension regardless of BP levels, age and sex.

Study findings

The study found that morning, evening and office BP were controlled properly in 34%, 53% and 42% respectively. However, proportion of individuals with BPs that are properly controlled decreased as age increased. It further found that morning home BP was greater than evening home BP by approximately 5.9/4.8 mm Hg. It concluded that control of BP at home and office is poor, indicating that habitual smoking, lower and higher beta-blockers prescription rates and overweight are among the factors that are affecting BP control in both situations.

Study#4: Burt et.al, (2010). Prevalence of Hypertension in the US Adult Population

Purpose of study

The study aimed at estimating current hypertension prevalence and distribution as well as determining status of its awareness, control and treatment amongst adult population in US.

Qualitative or Quantitative

The study was quantitative as it generated numerical data regarding hypertension in US adult population.

Study sample

The study consisted of 9901 adults above 18 years old, who were interviewed in their homes and in mobile clinic examination sites. Individuals above 60 years of age and are non-Hispanic black and Mexican America, together with 60-69, 70-79, and above 80 years of age and are non-Hispanic white were oversampled in order to enhance estimate precisions in old age group.

Study findings

The study found that 23% of adult population in US had hypertension. This was reached after recording individuals with hypertension as follows. Non-Hispanic black took 32.4 %, non-Hispanic white 23.3%, and Mexican American 22.6%. It further found that 2/3 (69%) of the entire hypertensive population were aware of diagnosis and 53% were taking medication. However, only 1/3(35%) of Mexican American were receiving treatment while 14% attained control in comparison with 25 and 24% non-Hispanic black and white respectively. 51% reported adherence to changes in lifestyle with the aim of controlling the disease. The study concluded that the disease continues to gain popularity in the US population. However, awareness, treatment and its controls have improved reasonably over the past four years, but it is becoming suboptimal particularly in Mexican Americans.        

Code: Sample20

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