To peruse and examine the theoretical and research perspectives on hypertension.


Objectives:

To peruse and examine the theoretical and research perspectives on hypertension.

Discern the epidemiology of hypertension.

Identify at risk population for hypertension.

To understand the implications on hypertension based on legal, ethical, and health policies.

 

Brief content outline

In this discussion, the authors examine the theoretical and research perspectives on hypertension, particularly the caring process and how it affects patient outcomes in better blood pressure control. It was also discussed different approaches to population involved were used to help them control hypertension. It also makes discernment of the epidemiology of hypertension, giving magnification on the prevalence of the disease in men over women and the lopsided difference seen in non-Hispanic blacks compared to other racial groups. It was widely discussed on the epidemiological part how prevalent hypertension in a wide range of population worldwide including the affected population of different races. The author talked about ethical issues when clinicians are providing care to patient most often time the clinicians are the one making decision and do not involve the patient.

Theoretical and research support

In the age we live in today, there are numerous pharmacological treatments for hypertension despite this, patient outcomes have remained suboptimal. Non-Hispanic black and Hispanic adults have yet to obtain better outcomes in terms of blood pressure control. Could this be because other factors such as medication adherence and patient counseling play a vital role on blood pressure control? In 2018, a research team lead by Dr. Jennifer K. Carroll, developed clinician training sessions that focused on how to approach their patients regarding hypertension counseling. The approach is the integration of the 5As framework: Ask, Advise, Agree, Assist, and Arrange, which is already widely used for smoking cessation. The team also incorporated the principles of Self-determination theory (SDT). SDT provides a solid theoretical foundation for the less strictly defined concept of patient-centered care. The theory hypothesizes that the fulfillment of three intrinsic psychological needs is what drives human motivation. The three intrinsic needs are: perceived autonomy or self-volition, competence and growth and lastly, relationship and connection with others. The team also emphasized the importance of monthly visits for patients with uncontrolled blood pressure at the clinic. Monthly visits may improve patient outcomes by engaging in the patient’s hypertension management and adjusting treatment along with working towards a patient-centered approach (Fontil, 2015). Patients play a key role in determining health outcomes. The Patient Protection and Affordable Care Act have incorporated approaches for increasing patient engagement. Patient engagement and patient activation have become a major focus for policy makers, with the latter being defined as having the confidence, knowledge, and skills to take care of one’s health. A patient’s activation level is correlated with patient outcomes. This predicts outcomes over several years. When activation levels change, many outcomes change in the expected direction (Greene, 2015).

Epidemiological considerations

According to the World Health Organization, in 2019, the prevalence of hypertension worldwide is an estimated whopping 1.13 billion people. In the United States 108 million people or 45% of the total population have hypertension, according to the CDC in 2017. That is nearly half of the country’s total population. The American College of Cardiology together with the American Heart Association, has modified the criteria of hypertension and now defines it as a blood pressure at or above 130/80 mm Hg. There are different factors that come into play on the prevalence and epidemiology of this widespread disease. Factors such as race and sex have shown varying numbers of the groups that are affected. Hypertension is a national and global health problem; however, certain groups have better outcomes over blood pressure control over others. Based from the CDC fact sheet of 2020, men have a greater percent of hypertension at 47% as compared to women with 43%. Prevalence is higher in men than in women before 45 years of age, equal from the ages of 45 to 64, and higher in women than in men from 65 years of age (Mozaffarian, 2016). In 2016, The National Health and Nutrition Examination Surveys (NHANES) released data that non-Hispanic black women have the highest prevalence of hypertension. It also found that they develop hypertension at a younger age than other groups. On the basis of race, there is an even more disproportionately lopsided difference. Non-Hispanic blacks have the highest affected numbers with more than half of its adult population having hypertension at 54%. 46% of non-Hispanic white adults, while 39% of non-Hispanic Asian adults have hypertension. Hispanic adults have the lowest number affected with hypertension at 36%. When it comes to age, the incidence of hypertension increases in all races and sex. In 2017, when the ACC and AHA changed its criteria for the diagnosis of hypertension, prevalence nearly tripled among all men 20 to 44 years of age, increasing from 11% to 30%. Women younger than 45 years of age on the other hand, had an increase from 10% to 19% (Whelton, 2018).

At risk populations  

Hypertension can affect anybody but there are certain groups in the population that are

more vulnerable and at risk of developing hypertension and these are people     with family members who have high blood pressure, smokers, African-Americans, pregnant women, women who take birth control pills, those over the age of 35, folks who are overweight or obese, inactive people, those who drink alcohol excessively, folks who eat too many fatty foods or foods with too much salt, people who have sleep apnea. (Jaliman, D. 2017).

Hypertension can affect anybody but there are certain groups in the population that are

more vulnerable and at risk of developing hypertension and these are people with family

members who have high blood pressure, smokers, African-Americans, pregnant women, women who take birth control pills, those over the age of 35, folks who are overweight or obese, inactive people, those who drink alcohol excessively, folks who eat too many fatty foods or foods with

too much salt, people who have sleep apnea. (Jaliman, D. 2017).

Hypertension can affect anybody but there are certain groups in the population that are

more vulnerable and at risk of developing hypertension and these are people with family

members who have high blood pressure, smokers, African-Americans, pregnant women, women who take birth control pills, those over the age of 35, folks who are overweight or obese, inactive people, those who drink alcohol excessively, folks who eat too many fatty foods or foods with

too much salt, people who have sleep apnea. (Jaliman, D. 2017).

 

Legal, ethical, and health policy implications

When benefits are greater than the risks and burdens then medical intervention usually justified. In a study of the ethics of interventions for mild hypertension, the discussion is about what is the best treatment especially if the side effects and complications of treatment is very low, and the intervention may result in long-term morbidity. (Julian E. Mariampillai, J.E. et al. 2017). There are studies reporting a large reduction in the incidence of serious outcomes, but which may only benefit a very few numbers of patients. Thus, interventions for common medical problems, such as mild hypertension, may be beneficial for the community at large but are far less likely to benefit each person. Clinicians make decisions for a particular patient based on the medical literature that addresses outcomes for a population, not for an individual patient. Moreover, most studies do not report on an individual’s personal qualities that may affect the positive or negative effects of the intervention. Patient preferences are often not part of this decision-making process. The physician often makes the treatment plan without the participation of patient and then attempts to make the therapy acceptable to the patient to achieve compliance. (Julian E. Mariampillai, J.E. et al. 2017).

 

 

Reference

Carroll, J.K., Fiscella, K., Cassells, A., et al. (2018). Theoretical and Pragmatic Adaptation of the

5As Model to Patient-Centered Hypertension Counselling. Journal of Health Care for the Poor and Underserved. Retrieved from https://muse.jhu.edu/article/700996

Fontil, V., Bibbins-Domingo, K., Kazi, D.S., et al. (2015). Simulating strategies for improving

control of hypertension among patients with usual source of care in the United States:

the blood pressure control model. J Gen Intern Med. Retrieved from

https://link.springer.com/article/10.1007%2Fs11606-015-3231-8

Informed Medical Decisions Foundation. Affordable Care Act. Retrieved from

http://www.informedmedicaldecisions.org/shared-decision-making-policy/federal- legislation/affordable-care-act/

Greene, J., Hibbard, J.H., Sacks, R., et al. (2015). When patient activation levels change, health

outcomes and costs change, too. Health Aff (Millwood). Retrieved from https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2014.0452

World Health Organization (WHO). (2019). Hypertension. Retrieved from

https://www.who.int/news-room/fact-sheets/detail/hypertension.

Centers for Disease Control and Prevention (CDC). (2017). Estimated Hypertension Prevalence,

Treatment, and Control Among U.S. Adults. Retrieved from

https://millionhearts.hhs.gov/data-reports/hypertension-prevalence.html.

Mozaffarian, D., Benjamin, E.J., Go, A.S., et al. (2016). Heart Disease and Stroke Statistics—2016 Update. Retrieved from https://www.ahajournals.org/doi/full/10.1161/cir.0000000000000350

Whelton, P.K., Carey, R.M., Aronow, W.S., et, al. (2018).

ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Retrieved from https://www.sciencedirect.com/science/article/pii/S0735109717415191?via%3Dihub.

Jaliman, D. (2017). Causes of High Blood Pressure. WebMD Medical Reference

https://www.webmd.com/hypertension-high-blood-pressure/qa/who-is-most-likely-to-develop-high-blood-pressure

Mariampillai, J.E., Eskås, P A., Heimark, S., Larstorp, A. K., Fadl Elmula, F. E. M., Høieggen,

A., Nortvedt, P. Apparent Treatment-Resistant Hypertension – Patient-Physician Relationship and Ethical Issues. Epub 2017 Jan https://doi.org/10.1080/08037051.2016.1277129.

 

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