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Hypertension Management

Etiology, Measurement, Stages, and Prevention of Hypertension

Hypertension is a medical condition that results in abnormally high blood pressure in the arteries of the patient. It poses a further risk of stroke, cardiovascular disease, and heart failure, which makes it a significant cause of concern in the realm of health care. Hypertension management refers to the care and treatment of individuals with hypertension through lifestyle changes and medication. This paper discusses hypertension from a two-fold perspective, namely the characteristics of the medical condition and its management. It also describes factors surrounding hypertension and its management. The management of hypertension is essential because this condition affects 16-37% of the global population. Thus, the high incidence of hypertension globally poses a threat to every individual's health, which draws focus to how healthcare professionals carry out the treatment of hypertension and how they can improve their services. The thesis of this article proposes that hypertension, for the most part, is a lifestyle disease that can be countered through public awareness, proper nursing practices, and general hypertension management.

Hypertension is described as a long-term medical condition that is characterized by high blood pressure in the arteries and its persistent elevation. Projections on high blood pressure indicate a worldwide incidence of over 1.5 billion of the global population by 2025; this high prevalence will result in the risks of heart disease and stroke rising to 50% and 75% respectively (Carter, Bosworth, & Green, 2012). There is sufficient evidence indicating that lowering blood pressure through lifestyle changes and medication is consequential in reducing the individual risk of cardiovascular disease (Carter et al., 2012). In nursing, hypertension is a widespread concern, especially due to its causal relation to other more serious health conditions like cardiovascular problems. The availability of treatment challenges nursing professionals to design patient-centered models to deal effectively with hypertension in patients. Part of the hypertension management equation is lifestyle intervention that presupposes promoting healthier habits amongst patients; the second part is through the medical prescription. To ensure proper management, there is a need to devise proper nursing practices to ensure that patients sufficiently benefit from hypertension management.

Etiology

Hypertension results from genetic factors, environmental factors, and preexisting conditions. The causes of hypertension are varied and thus there are two types of hypertension, namely primary and secondary hypertension. The occurrence of primary hypertension is more common and about 95% of hypertension cases are primary cases (Poulter, Prabhakaran, & Caulfield, 2015). Secondary hypertension has an incidence of about 5% and results from identifiable causes that include endocrine disorders, kidney diseases, and the use of certain birth control pills (Poulter et al., 2015). Primary hypertension is often associated with the interaction of environmental and genetic factors. An individual is more likely to suffer from primary hypertension if there is a family history of the condition; hence, the genetic factor predisposes them to the condition. Environmental factors linked to hypertension generally include diet, alcohol and drug use, lack of physical activity, and emotional stress (OConnell, 2014). In terms of diet, malnutrition, obesity, high salt intake, and low intake of dietary calcium, magnesium, and potassium are linked to hypertension.

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There is an 85% incidence of cases of hypertension in individuals who are considered obese those with a body mass index exceeding 25 (Poulter et al., 2015). Drug use encompasses the use of anabolic steroids, cocaine, and ecstasy, as well as smoking and drinking alcohol (Nandhini, 2014). The lack of adequate and consistent physical activity is believed to augment the risk of hypertension development in a patient by 20-50%. Primary hypertension is more common and affects black patients more severely than their white counterparts (Nandhini, 2014). Prevention and accurate measurement of hypertension are essential in the management of the condition.

Measurement of Hypertension

There are two main measurements that indicate blood pressure: systolic and diastolic measurements. The systole phase is when the heart muscle contracts and pumps blood into the arteries, and the diastole phase indicates the relaxation of the heart muscle, which occurs between heartbeats (Nandhini, 2014). The systolic is the maximum measurement while the diastolic is the minimum measurement. Blood pressure is measured in terms of millimeters of mercury (mmHg). Normal blood pressure is also referred to as normotension and entails a systolic pressure of 100-140 mmHg and a diastolic pressure of 60-90 mmHg. The occurrence of hypertension is when an individuals blood pressure is constantly above normotension, that is above 140/90 mmHg (Padwal, Hemmelgarn, & Khan, 2009). Hypertension strains the heart and consequently other organs in the body, thus increasing the risk of other conditions. Hypertension occurs in a series of stages as indicated by the patients blood pressure measurement; higher stages of hypertension indicate greater levels of risk of other health conditions.

Stages of Hypertension

The stages of hypertension are threefold and named numerically as stage 1, stage 2, and severe stage. At the first stage, the clinic blood pressure is above the normotension 140/90 with a home blood pressure monitoring (HBPM) of more than 135/85. During the second stage, the clinic blood pressure is above 160/100 and a subsequent HBPM daytime average is 150/95. At the third stage, severe stage, the clinic systolic blood pressure is above 180 or the clinic diastolic blood pressure is above 110 (OConnell, 2014). As individuals blood pressure continues to rise, they advance through the stages of hypertension and face higher medical risks. However, the severity of hypertension is determined based on the level of risk of the occurrence of adverse clinical conditions such as stroke, renal failure, and coronary artery disease (OConnell, 2014). The more advanced the stage of hypertension, the more probable the occurrence of other conditions in a patient. Thus, this is an adequate cause to prevent hypertension through various lifestyle practices.

Prevention of Hypertension

A significant proportion of the causes of hypertension relates to the lifestyle of individuals, which suggests that it is possible to reduce the risk of hypertension. First, lowering sodium intake to recommended proportions 6 grams of salt daily is a good measure for lowering blood pressure. It can be achieved through a 50% reduction of salt used in cooking, choosing natural foods over processed foods that contain high levels of sodium, and avoiding snacks full of salt (Nandhini, 2015). Habitual smoking and excessive alcohol intake result in sustained high blood pressure. Therefore, making positive modifications of these habits is another useful technique in avoiding hypertension (Padwal et al., 2009). Numerous studies have evidenced the causal association between excessive weight and hypertension. Consequently, maintaining weight through regular exercise and proper diet is essential to avoid hypertension (Padwal et al., 2009).

Prevention of hypertension constitutes the observance of healthier habits to maintain a normal blood pressure. Understanding causes, stages, measurement, and prevention of hypertension is essential for every individual. Knowing this information will allow people to assess their risk of having the condition and make necessary lifestyle modifications. The prevention techniques are only practical for an individual whose aim is to prevent hypertension. However, for hypertension patients, there are more requirements in terms of the proper health management of hypertension.

Management of Hypertension

As mentioned above, hypertension is a health condition that increases the risk of other severe conditions. Therefore, to reduce this risk, there is a need for hypertension management. Hypertension that goes untreated results in hypertensive heart disease due to the significant amount of strain on the heart muscles (Nandhini, 2014). The process of management is usually focused on the prevention of organ damage through heart failure and stroke that occur as a result of the strain that high blood pressure puts on the heart and other organs. To avoid the occurrence of other medical conditions due to hypertension, it is imperative for individuals to live healthier lifestyles and seek medical attention in case they suspect they may suffer from hypertension. The main building blocks in hypertension management are lifestyle interventions for patients and pharmacological treatment.

Lifestyle Intervention

Making lifestyle changes reduces blood pressure by up to 10mmHg; these changes include incorporating healthier diet options, for instance, high fruit and vegetable intake and low fat intake, and increased activity through regular exercise (OConnell, 2014). Promoting a healthier body status through diet and exercise is effective in reducing high blood pressure. According to OConnell (2014), lowering salt intake is also effective in the reduction of blood pressure. Smoking also exposes people to the higher risk of hypertension as it is linked to the ankle brachial pressure index. Thus, chain smokers should aim at breaking this habit and individuals prone to high sodium consumption should choose healthier options. The use of lifestyle interventions is effective in the earlier stages of hypertension management. However, there is still a need for patients to seek medication to reduce the risk of heart failure and stroke.

Pharmacological Management

The common initial treatment for hypertension patients less than 55 years old is the ACE inhibitor. The ACE inhibitor is used to stop the process through which angiotensin I is converted into angiotensin II, resulting in vasodilatation and consequently a fall in blood pressure (OConnell, 2014). In the case of individuals over 55 years old or people of African and Caribbean origin of any age, the initial option should be calcium channel blockers. The medical perception is that for these groups, the ACE inhibitor is less effective due to lower renin levels in these patients (OConnell, 2014). Calcium channel blockers inhibit calcium ions from moving into the arterial wall cells causing vasodilatation. In the case of resistant hypertension, the recommendation is to use both the ACE inhibitor and calcium channel blockers (OConnell, 2014). A holistic approach to hypertension management incorporates both lifestyle intervention and pharmacological management for better results. The two elements of hypertension management, however, require a partnership between healthcare professionals and the patient, which entails proper and effective public health practices.

Effective Public Health Practices

Factors Affecting Success of Treatment

The treatment of hypertension is an extensive process that is affected by a number of factors. According to Carter et al. (2012), treatment of hypertension is evidently beneficial; however, only the half of individuals who suffer from the condition are adequately in control of their situation. It means that about 50% of people suffering from hypertension are not managing the condition effectively. In the nursing practice, there are supplementary factors that promote poor blood pressure. They include the failure of clinicians to intensify therapy, as well as the low adherence of patients to medication (Carter et al., 2012). Thus, the treatment of hypertension in a patient might fail due to the clinical inertia because of poor nursing practices. Another reason would be that patients might falter in taking their medications and thus would not adequately benefit from the treatment. These factors can be remedied through modifications in nursing practices concerning providing nursing care to hypertension patients.

The Process of Measuring Blood Pressure

Nurses should conduct the process of measuring blood pressure cautiously to obtain accurate results and consequently make relevant inferences. The nurse should ensure that patients rest in a standardized setting, such as on a clinic chair, before measuring their blood pressure. The patients pulse should also be checked before using an automatic blood pressure monitor because if the patients pulse is irregular the measurement of blood pressure could be read inaccurately (OConnell, 2014). It is essential to use a correctly sized cuff, as a smaller one would give a higher reading and a bigger one could give a lower reading. Thus, the right-sized cuff is important for obtaining true readings. The arm with the higher reading should be used for the measurement of blood pressure (OConnell, 2014). The process of measuring blood pressure is seemingly simple but a vital one and it is important for healthcare professionals to follow set procedures while conducting this process for accurate readings. Therefore, having a team of healthcare professionals is another important consideration in the care for hypertension patients.

Team-Based Models

The contributing factor to effective hypertension management is team-based models of care. They entail all round care for patients suffering from hypertension, especially the elderly who can benefit from medical homes with patient-centered nursing services (Carter et al., 2012). A number of earlier studies on the significance of team-based care models show that systolic blood pressure of patients averagely decreases by 4-10 mmHg as compared to the results from common care techniques (Carter et al., 2012). Recent research has shown that teams consisting of nurses, pharmacists, and other medical professionals are an important factor in promoting hypertension management, especially with regard to enhancing blood pressure control (Carter et al., 2012). Thus, the team-based model of care is an effective nursing practice; however, there is a need for more interactive avenues between nurses and their patients.

Nursing Interventions

Nurses can remedy the aforementioned concerns regarding hypertension management through effective intervention. Nursing interventions through phone calls, patient web portals, and social media are an effective way to avoid problems associated with hypertension management such as poor adherence to medication by patients. Nurses who have adequate skills and knowledge about hypertension management are vital in this process as they are capable of informing and counseling patients and making recommendations on the dosages and medications to use (Carter et al., 2012). Proper treatment of high blood pressure improves the life expectancy of patients.

The high incidence of deaths factored by hypertension 9.4 million deaths in 2010 evidences the need for health care professionals to divulge relevant information to the public to promote proper prevention and management of hypertension (Poulter et al., 2015). Nurses should communicate consistently with their patients and assist them in the hypertension management process because this process requires motivation, morale, and relevant information to be completed successfully.

Conclusion

Hypertension refers to a medical condition characterized by a prevalent high blood pressure. The high incidence of this condition is a cause for alarm as there is a risk of the occurrence of other conditions such as cardiovascular and renal diseases. The causes of hypertension result in two groups of hypertension primary and secondary hypertension. They include genetic and environmental factors, as well as preexisting conditions. There are two measurements of blood pressure the maximum (systolic) and minimum (diastolic). The normal blood pressure is between 100-140 mmHg/60-90 mmHg. The higher blood pressure is considered hypertension. To prevent hypertension, lifestyle modifications such as reducing salt intake, avoiding alcohol and smoking, and maintaining body fitness and health are essential. These methods of prevention also apply to the process of hypertension management that is complemented by the pharmacological management to reduce the risk of other conditions. Various nursing practices can be employed to improve the process of hypertension management for patients. The first is to ensure accurate measurement of blood pressure. In particular, for the nurse to obtain accurate readings there are necessary procedures to follow. Secondly, numerous research studies have proven that working in teams is successful as it incorporates the participation of nurses, pharmacists, and other medical professionals in assisting hypertension patients in receiving proper treatments. The last practice is nursing interventions because nurses are vital in the treatment process of patients as they offer important information and are well-skilled to care for patients.