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A public health problem in a population at risk
High blood pressure or hypertension is a major public health concern among African-Americans residing in the city of Overtown Miami. It is an endemic condition in this segment of the Miami population (High Blood Pressure, 2015). Hypertension is usually characterized by an elevated level of blood pressure. It is a metabolic syndrome accompanied by other intrinsic and extrinsic health factors such as obesity and stroke. About 20% of the Miami population has already been diagnosed by hypertension while 50% of the obese persons suffer from high blood pressure. Hypertension may occur when blood arteries undergo some kind of resistance. The vessels consequently lose the ability to contract and dilate. When the volume of blood vessels expands, it may also interfere with effective circulation throughout the body. Currently, hypertension is a leading cause of death worldwide since it can trigger a series of other chronic diseases.
The contraction and expansion of the heart facilitates effective circulation of blood throughout the body. Consequently, blood vessels experience some degree of force when the blood is being pumped. The process is referred to as systolic blood pressure. Its normal value is 120 mmHg (millimeters of mercury). An individual is said to be hypertensive when a value of 140 or more is reached in terms of pressure. However, when the value is less than 80, it implies that the heart is at rest. When the latter is less than 90, it is categorized as a hypertensive condition (Sundström et al., 2015).
Hypertension is a major risk factor in the occurrence of other serious health conditions. Cases in point include stroke, hemorrhagic fever, acute myocardial infarction, blood aneurysm, and peripheral artery disease. Long-term failures of the kidney and heart are mainly caused by the aforementioned condition. Even moderate and increased arterial blood pressure is associated with reduced life expectancy. According to the American Heart Association, hypertension is a chronic disease that causes the greatest number of consultations in healthcare systems. The condition also presents several economic and social impacts.
The occurrence of hypertension in children and adolescents among African-Americans is common between 2% and 9% of individuals depending on age, sex, and obesity. It is also associated with the risk of suffering from long-term clinical complications. As it stands now, it is recommended that children should be taken for routine medical checks. There is need to always consult a doctor or undergo tests. However, the results should be confirmed after several visits before final diagnosis of the presence of hypertension can be established. During childhood, blood pressure increases in proportion to age. The blood pressure changes may either be systolic or diastolic and it is affected by the sex, age and height of a child. When the condition is referred to as pre-hypertension, it implies that the systolic or diastolic blood pressure is equal or greater than the 90th percentile but less than the 95th percentile (Rakotz et al., 2014). Both adults and adolescents should be diagnosed in a similar manner when suspected to be suffering from high blood pressure.
The occurrence of hypertension among newborns is rare among African-Americans living in the city of Overtown, Miami. Between 0.2% to 3% of the subjects experience the condition. In addition, it is crucial to mention that blood pressure measurement is not part of routine tests among African-American children in this city. Nonetheless, instances of high blood pressure are ubiquitous in children who have other serious pre-medical conditions. When assessing the normal blood pressure among children, aspects such as weight of the body and age should be considered.
From a patho-physiological point of view, hypertension is classified into two types. The first category is the essential or idiopathic arterial hypertension. This type of high blood pressure has no identifiable medical cause and often corresponds to 90-95% of all the diagnosed cases. In this class of hypertension, there is a marked family tendency but as in many other diseases, the possibility of heredity factors cannot be ignored in the discussion. The remaining five to ten percent corresponds to the secondary type of hypertension which is caused by other disorders affecting the kidneys, arteries, endocrine system and iatrogenic factors.
Measures of risk and prevalence rates
Hypertension is inherited from parents in 90% of the cases. In few instances, it may be caused by related diseases such as thyroid disorders and infection of the endocrine glands (like the adrenal glands). However, there are several other factors that influence blood pressure levels. These include smoking, alcohol consumption, obesity, stress, excessive intake of salt, high level of cholesterol, lack of physical exercise, diabetes and inadequate sleep (Rakotz et al., 2014). In addition to these risk factors, it is also known that the occurrence of hypertension increases with age. This is because as blood arteries age up, they are calcified and eventually lose the ability to dilate. Several less compliant blood vessels are prevalent among older people. Owing to the latter, high blood pressure is more likely to happen. For example, about 70% of African-American adults who are over 60 years have been diagnosed with the disease within the city of Overtown (High Blood Pressure, 2015).
As already hinted out, obesity is a major measure of risk for hypertension. It refers to the accumulation of fat in the body and usually caused by excessive consumption of calories in food substances. The fat intake is higher than the value required by the body for normal maintenance and performance of activities. Hence, obesity occurs when food intake is higher than the corresponding energy expenditure.
Cardiovascular diseases and hypertension are related. African-Americans in the city of Overtown have also been diagnosed with cardiovascular diseases owing to hypertension. It is among the leading causes of mortality within this segment of the population. The community has a population of about 9000 people who are made up of approximately 74% African Americans. Its population is predominantly urban (78.7% of the population). The demographic aging process of the population depicts a future increase in the incidence and prevalence of chronic diseases such as high blood pressure and cardiovascular complications. The effect of hypertension in the development of cardiovascular diseases demands recognition of actual distribution of the African American population within the city (High Blood Pressure, 2015).
This segment of the population has been worst affected by several cases of high blood pressure even at tender ages. For example, hypertension is manifested in about 8 to 10% of cases of pregnant African-American women within the city of Overtown (High Blood Pressure, 2015). In most cases of hypertension during pregnancy, there must be a prior existing medical condition. High blood pressure among expectant mothers may be the initial symptom of pre-eclampsia. The latter is common during the postpartum period. The period lasts for about six weeks until the uterus recovers its normal dimensions. From recent statistics, it is evident that hypertension is a common condition among pregnant African-American women. The pre-eclampsia phase is the first stage of pregnancy. It may proceed for a long time. Its etiology is unknown. Prenatal mortality is also aggravated by the condition. Generally, the disease has no specific symptoms at the beginning and can only be detected through routine tests. Edema, headache, vomiting, and poor vision are some of the initial symptoms of the onset of high blood pressure. During childhood, newborns and infants also demonstrate symptoms such as stunted growth, seizures, irritation, exhaustion and respiratory difficulties. These symptoms in newborns are associated with hypertension. Thereafter, head pains may be occasioned by a restricted flow of blood. Patients may feel tired and irritated. In some cases, the condition may lead to paralysis of the face, bleeding from the nose and blurred eyesight.
As part of the measures of risk, it is also crucial to highlight factors that affect blood pressure. First, increased peripheral resistance in the flow of blood is a major risk in the etiology, growth and development of hypertension. In most individuals with essential or primary hypertension, increased total peripheral resistance enhances a rise in blood pressure while maintaining the cardiac output standard.
Some young African-American adults in the city of Overtown who have been diagnosed with pre-hypertension usually experience a high cardiac output (High Blood Pressure, 2015). Their heart rates are elevated beyond the normal peripheral resistance. The latter is referred to as peripheral hyperkinetic hypertension. This medical condition falls within the hyperkinetic syndrome of cardiovascular diseases and often related to anxiety especially among adolescents. It is still debatable whether this pattern is common to all individuals who eventually develop hypertension.
A program to address this problem
Intervention
In order to address the challenges posed by hypertension in the African-American community living in the city of Overtown, an intensive program should be set up. This program ought to entail a systematic process that begins with diagnosis and culminates with treatment. In other words, the community should be sensitized on the importance of regular screening for hypertension. The entire program should entail diagnosis, prevention, and treatment of the condition among all age groups.
To begin with, diagnosis of hypertension must be carried out among individuals who experience persistent high blood pressure. Traditionally, this implies screening of patients using sphygmomanometer in hospital settings. After a patient has rested for at least 10 minutes, the procedure should be performed in a sitting position and repeated at regular intervals depending on the severity of blood pressure increase. In case a pressure limit is attained, the interval may be stretched to one month. In the event of severe hypertension, a patient should be immediately medicated in order to avoid the white coat effect in which blood pressure increases owing to anxiety. This implies that patients should make a mapping for a period of 3 to 7 days. This mapping should be evaluated by a doctor. The measurements should be made on the first day on both arms. If there is a difference of more than 20 mmHg in systolic pressure, the process should always be made in the arm with a higher pressure.
The initial diagnosis of hypertension should also consider physical examination and any medical history of the affected patient. The pseudo-hypertension condition among the elderly may also be a factor during diagnosis. The latter is caused by arteries that undergo the process of calcification. In other words, blood is compelled to flow with a lot of friction owing to fatty blood vessels and subsequently leads to unwarranted high levels of pressure. The hardening process of artery walls is progressive with aging. Systolic blood pressure is also increased as an individual ages (High Blood Pressure, 2015).
Other symptoms can be used by physicians to establish the condition of a patient after the diagnosis of high blood pressure is over. Secondary hypertension is most common during the childhood and adolescent stages. In most cases, it is caused by complications of the kidney. Most adults encounter primary high blood pressure. This category of hypertension presents myriads of health dangers to the affected persons. Family history, excess intake of salt, and instances of overweight are some of the risk factors of primary hypertension. In the case of secondary hypertension, adequate laboratory tests should be part of the diagnosis process. For example, high level of cholesterol and diabetes may significantly contribute towards the onset and development of secondary hypertension. Therefore, additional tests are necessary in order to come up with conclusive findings. Tests should also be carried out in serum so that any possibility of a renal complication can be ruled out in advance. The serum creatinine alone may overestimate glomerular filtration rate (GFR). Recent guidelines recommend the use of predictive equations to assess the rate.
Prevention
After diagnosis, this segment of the population in the city of Overtown should be educated on preventive measures against high blood pressure. In fact, prevention is part and parcel of a rigorous intervention program for the condition. Most of the conditions that may agitate the onset of hypertension are common among persons who have not encountered any of the above symptoms. Before starting any treatment, it is highly recommended that individuals should change their lifestyles in order to reduce instances of blood pressure (Warren, 2014).
As a means of primary prevention of hypertension, both the 2004 guidelines of the British Society of Hypertension and the already defined Educational Program for High Blood Pressure in the United States should be adopted by this African-American community in Miami. A thorough public awareness campaigns and education on how to live healthy lifestyles should be incorporated in the intervention program. In the education program, the community should be sensitized on how to maintain normal weight by calculating their individual Body Mass Indices (BMI). They should reduce sodium intake to less than 2.4 grams per day. In addition, aerobics and physical activities such as walking on foot should be promoted on a regular basis. Physical exercises ought to be carried out without waiting for specific seasons. The community should also be informed about the importance of limiting alcohol consumption to 3 units per day in men and 2 units per day among women. If possible, alcohol consumption should be avoided at all costs. Maintaining a diet rich in fruits and vegetables for at least five portions per day is also another viable preventive measure.
When changes in habits and lifestyle are done correctly, blood pressure can be significantly lowered to values similar to those obtained with medication. Impressive results can be obtained when multiple methods are used in the intervention and prevention programs. Owing to the evolution of research on the genetics of hypertension, it will be possible in the future to genetically study the population and detect risk factors related to the disease.
Statistics obtained from the African-American community residing in Overtown indicate that a large number of residents are already suffering from the disease burden of hypertension. In such cases, the most effective intervention measure is the use of available drugs to treat the condition. Even after a patient has been diagnosed with hypertension, a positive change in diet is highly recommended. Other treatment options under this category include exercise and weight control. All these measures can significantly reduce blood pressure in hypertensive individuals. Nevertheless, an extremely rapid flow of blood necessitates the need to seek special attention from a doctor (High Blood Pressure, 2015). Even if medication is recommended for individuals suffering from high blood pressure, a change in lifestyle is still a major preventive measure against the onset of hypertension. In most programs that seek to reduce hypertension, patients are usually advised to reduce psychological stress. This can be achieved by embracing and inducing relaxation techniques and meditation. However, the efficiency of such techniques have not been confirmed by scientific studies, and the few that exist are of dubious quality and methodology.
The affected population should also be taught about the importance of changing eating habits. For example, adoption of a low-salt diet is beneficial. It has been indicated by previous research studies that a low-salt diet for a period of only four weeks offers benefits both in hypertensive patients and in people with regular blood pressure. On the same note, food substances such as green vegetables, fruits and whole grains are suitable for patients diagnosed with hypertension. Nevertheless, even those who are free from this condition should be advised to take a healthy diet comprising such foodstuffs. Protein and calcium should also be incorporated in the daily diet of patients and people who are still healthy.
The department concerned with health in conjunction with the central government should provide effective drugs for the treatment of hypertensive individuals. Owing to the expensive nature of these drugs, the government should seek ways of subsidizing the cost. First, it is crucial to mention that multiple classes of drug are available for treating hypertension. They are referred to as anti-hypertensives. The nature and quantity of drugs given to a patient should be compatible with the medical condition of the latter. For instance, some drugs might pose gross risks to patients instead of curing the condition. Before any drug is advanced to a patient, it is crucial for a physician to understand the medical profile of the healthcare recipient. Wrong prescription is a common medical practice that can pose serious harm in the health of a hypertensive patient. A physician should also identify the side effects that may occur. According to a report by CDC, lowering the rate of blood flow by a small margin can indeed minimize the onset of other terminal conditions such as stroke and heart-related complications.
The aim of treating patients diagnosed with hypertension is to reduce blood pressure values that are less than or equal to 140/90 mmHg. Some practitioners recommend maintenance values that are below 120/80 mmHg but always take into consideration each particular case. If this segment of the African-American population cannot attain this objective, there might be need to adjust the treatment method since the nature of some healthcare settings may act as setbacks in the prevention and management of hypertension. The guidelines in the selection of drugs and determining the best way to treat various subgroups have changed over the years and between individual countries (Warren, 2014). The best first-line drug is still controversial. The guidelines offered on hypertension by the World Health Organization and other agencies tend to differ a lot. There seems to be no consensus on the best medicinal products to use in the treatment of hypertension. However, several agencies unanimously agree in the use of angiotensin converting enzyme inhibitors and angiotensin II receptors. The affected patients in this community should start their treatment process with any of the six classes of drugs including ACE inhibitors, calcium channel blocker, diuretics, beta-blockers and alpha-blockers.
Steps for implementing and evaluating the program
In order to implement the above program, it will be crucial to make a thorough follow-up campaign on the intervention measures that were adopted earlier. In fact, it is not possible to implement the above program without linking the intervention measures. Second, prevention measures for hypertension should be clearly communicated to members of the public within this segment of the population. This implies that the public should be sensitized through awareness creation (High Blood Pressure, 2015). By organizing free medical camps to the affected population, it will be possible to distribute educational posters and flyers to the targeted group. This process should be a regular exercise. Media campaigns through television, radio, billboards and social networks can also be instrumental in educating the public about the demeaning effects of high blood pressure (Sundström et al., 2015).
Besides, it can be observed that therapeutic treatment and medication are options that may be used to address the effects of hypertension. Since quite a large number of the older African-American population is already affected by incidences of hypertension, it is vital to offer alternative medication and treatment for the condition. Hence, this will call for a collaborative approach between healthcare agencies at the local level and the federal agencies so that appropriate drugs can be supplied to the affected individuals. It is also prudent to mention that additional specialized healthcare clinics should be set up within the geographical region of the affected population. The clinics can specifically focus on the therapeutic intervention, prevention and treatment of persons diagnosed with high blood pressure (Rakotz et al., 2014).
In regards to evaluating the program, a number of measures and procedures ought to be put in place. First, the needs of the program should be assessed and re-evaluated on a periodical basis. In other words, it will be crucial to re-examine whether the program is still sticking to its core goals and objectives at any given time. Needs assessment also entails exploring a particular segment of a population that the program wishes to impact. Second, assessing program theory is part of the evaluation process. This refers to an impact pathway or a logical model being pursued by the key tenets of the program. Third, evaluation should also focus on whether every stage of the program is being implemented as stipulated within specific timelines. Other evaluation procedures include measuring program outcomes and assessing the impact or robustness of the entire initiative (Warren, 2014).
Research and literature search
For this piece of work, narrative review should be used to discuss and support information presented in the paper. The literature review refers to searching for information and data available in publications such as books, journal articles, and dissertations. It is the assessment process and analysis of what has already been published on the subject of selected research study. It allows a mapping process of what has been written. Any form of literature review does not generate a new kind of knowledge. It only supplements a researchers knowledge regarding a research topic being discussed.
The literature search was performed in a number of electronic databases such as Proquest, PubMed, and Ebscohost. Internet sources were also consulted in the course of conducting this research study. A case in point is the Center for Disease Control (CDC) website. The inclusion criteria used during the search process included availability of full-text electronic media and published national journals. The latter were used for searching scientific articles with the following keywords: hypertension, primary prevention and cardiovascular disease (Sundström et al., 2015). A pre-selection process was carried out for the articles found. This was later followed by a close and systematic reading. The data related to the subject were analyzed and the main information used in preparing the literature review.
A literature review carried out between 2008 and 2015 using Medline and complemented by manual search was done on the statistical study of hypertension. From the research study, it was concluded that about one billion people suffer from high blood pressure across the world. This corresponds to 26% of adults globally. However, other studies show that the rate varies in different regions. It stands at 0% in Kalahari Desert among the Bushmen (due to the absence of salt in the diet) and 3.4% among men and 6.8% (women) in rural India. The alarming prevalence rate of 34% is found in the American population. Most of the victims are comprised of African-American adults. The latter group accounts for the highest rates of hypertension in the world at 44% (Warren, 2014).
Implementation plan and the role of advance practice nursing.
In order to implement the activities and program in the management of challenges posed by hypertension, an effective plan should be put in place. The table below summarizes the implementation plan for the program.
Advanced practice nursing plays a major role in the delivery of extensive and sensitive healthcare services to the affected segment of the population. From the outset, healthcare settings such as hospitals, schools, and community clinics are well endowed with acute care services and front-line primary care offered by nurse practitioners. This category of nurses handles a number of chronic health problems such as diabetes, high blood pressure, and cancer. They also conduct physical examination of patients, provide immunization services, offer treatment services to injuries and other acute sicknesses by diagnosing patients suffering from diverse conditions.
On the other hand, postpartum care follow-up services, healthy delivery of babies, and gynecological care services are advanced by certified midwives. In addition, specialty healthcare services such as obstetric/gynecological nursing, pediatric, neonatal and oncology are provided by clinical nurse specialists. Finally, certified registered nurse anesthetists largely deal with the provision of anesthetics to patients (Warren, 2014).
Evaluation tool, reliability and validity
The following chart shows an evaluation tool that can be used to assess the above program. As can be seen from the diagram, it will be vital to engage stakeholders so that they can provide different and diverse views on the prospects of the program. Stakeholders are also a major source of funding and knowledge required to initiate and sustain the program. Second, it is necessary to describe the program. Unless the programs profile, mission and vision are clearly known, it might not be possible to articulate and pursue the desired goals and objectives. In addition, the program managers are required to focus on the projected evaluation design. This evaluation tool also indicates that program managers should gather credible evidence from the targeted community and justify the final deductions.
The above evaluation tool is reliable and valid because it encompasses all the standards of effective program evaluation. These standards include accuracy, feasibility, utility and propriety
References
High Blood Pressure. (2015). Web.
Rakotz, M. K., Ewigman, B. G., Sarav, M., Ross, R. E., Robicsek, A., Konchak, C. W., && Masi, C. M. (2014). A Technology-Based Quality Innovation to Identify Undiagnosed Hypertension Among Active Primary Care Patients. Annals of Family Medicine, 12(4), 352-358.
Sundström, J., Arima, H., Jackson, R., Turnbull, F., Rahimi, K., Chalmers, J., && Neal, B. (2015). Effects of Blood Pressure Reduction in Mild Hypertension. Annals Of Internal Medicine, 162(3), 184-191.
Warren, E. (2014). Hypertension: why we measure it, why we treat it. Practice Nurse, 44(12), 14-19.
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