Hypertension is one of the major public health concern in the US and internationally. The prevalence of condition is higher among the adults, especially above 55-years old. It has also been the primary cause of other chronic illness like heart and kidney failure. This research was in pursuit of the prevalence and control of hypertension among the elderly in the case of the USA. It has used the available evidence-based research papers and statistical information from various sources to examine the prevalence hypertension. The presentation of the findings followed the PICOT format in ensuring that facts about hypertension in the USA are covered. This research considered high blood pressure as the pressure exceeding 140/90, and the normal pressure was considered to be 180/20. The research has also highlighted the appropriate intervention for the people suffering from hypertension mentioning rationale for each intervention. Finally, the research has provided the timeline for the expected outcome.
Keywords: hypertension, systolic pressure, cardiovascular, blood pressure.
Hypertension has been identified as one of the most controllable chronic diseases that affect the elderly people, especially in the USA. The symptoms are not easy to detect, and this aspect has made it difficult for the elderly people to know they suffer from hypertension. Hypertension is also commonly referred to as high blood pressure that comes because of tension placed on the walls of arteries making the blood flow at high pressure. The normal blood pressure for an adult is supposed to be 180/20. The individuals having blood pressure above 140/90 are considered as hypertension patients (Frohlich & Ventura, 2009).
Frohlich and Ventura (2009) have also stated that the higher the systolic pressure is, the more the increase in pressure in arteries is when the heart pumps blood, making the arteries bulge. This condition is most prevalent among the adults 55 years of age (Nwankwo, Yoon, Burt, & Gu, 2013). It happens because as an individual grows old, the blood vessels become more rigid, hence unable to dilate when the blood cells enter the heart (Nwankwo et al., 2013). Therefore, this aspect makes the systolic pressure to increase as an individual’s age increases. However, the condition can be relieved either by medical or surgical treatment. The objective of this research is to evaluate the prevalence, awareness, and control of hypertension in the USA.
The size of the elderly population has been estimated to increase in the developing nations, and the USA is one of them. Therefore, developing nations are likely to experience the burden of chronic diseases in the future. Hypertension has been identified as one of these chronic diseases that are treatable during the cause of mortality, especially for the aged. Nwankwo et al. (2013) have acknowledged that hypertension accounts for most of the cardiovascular diseases among the old people. Despite the fact of being rated as the highest risk factor in the USA, another research established that only 27% of the patients control it (Nwankwo et al., 2013). Another aspect that triggered this research is that hypertension is more likely to affect the women rather than men. Therefore, the researcher was in pursuit of the reasons why hypertension is more prevalent in the elderly women.
Another significant reason for researching this topic is that most of the patients suffering from hypertension want an assurance about the BP treatment, while the physicians need an appropriate evidence-based solution to apply in hypertension management. However, there is a significant evidence available that the prevalence of hypertension can indeed be treated.
A survey conducted in 2011-2012 in the USA established that most adults over 50 years-old suffer from hypertension, yet they are not aware of the risks, causes, and treatment (Nwankwo et al., 2013). The findings of the research also established that most of the adults are ignorant about the symptoms of hypertension (Nwankwo et al., 2013). Another source has revealed that hypertension has the potential to cause other chronic diseases like kidney failure, heart disease, and stroke (Black & Elliot, 2007). It also affects an individual’s physical well-being. Additionally, treatment of hypertension in the old people can significantly reduce the cardiovascular morbidity and mortality (Grinspun, 2005).
The population under study for suffering from hypertension is the elderly people in the USA above 50 years of age. The researcher will use quantitative data obtained from the available literature that critically evaluates the prevalence of high blood pressure, especially in the US communities. The research done by the American Heart Association (2013) established that in 2009 alone, approximately 348, 102 people out of more than 2 million people in the USA lost their lives due to high blood pressure. The same research also predicted that the number of death would gradually increase by 7.2% by 2030. Kaplan and Victor (2010) have pointed out that the primary reasons for the high level of hypertension among the high level of sodium intake mostly found in salt and psychological stress. However, hypertension can also be hereditary (Kaplan & Victor, 2010). The research also established that the number of elderly women suffering from high blood pressure is higher as compared to that of the male counterparts (National Academy on Aging Society, 2000). The following graph shows the distribution prevalence of hypertension according to ages of people in the USA as of 2012.
Table retrieved from (Nwankwo et al., 2013)
This population in the USA has also been identified as the most vulnerable victims of hypertension because of psychological stress usually experienced by them.
The application of nursing intervention for patients with hypertension requires the nursing practitioners to be knowledgeable about the treatment plan. The implementation of a standardized hypertension treatment protocol is necessary in this case. Nurses are advised to take an ample time to assess the blood pressure levels of adults to facilitate detection of the early stages of hypertension. They should be careful and use the significant techniques with properly maintained and calibrated equipment when measuring the patient’s blood pressure. The first intervention that can be executed once the patient has been diagnosed with hypertension is educating them about the dietary risk factors and optimal dietary approaches.
It would be liberal to conduct an assessment of the patient’s current eating habits before giving them an appropriate diet advice. The nursing practitioners can refer to the Registered Dietitian for an appropriate diet counseling because there are several dietary approaches for patients with hypertension that require expertise depending on the level of the blood pressure. Research has shown that maintenance of eating habits that incorporates lower levels of sodium can lower mild hypertension by 11.5/5.7 mmHg (Grinspun, 2005). These changes can be the same as the changes achieved in the antihypertensive medications.
The nursing practitioners should encourage the hypertensive patients to maintain a diet that incorporates most fruits, low-fat dairy products, and vegetables. According to Grinspun (2005), this strategy can significantly reduce the blood pressure for patients with grade 1 and those with high-normal blood pressure. Another significant advice that can help the patient is restraining from taking processed foods. They should also be aware of the salt content in the foods they take from the restaurant. Nurses should also educate the patient’s on the significance of self-blood pressure monitoring strategies while at home. This strategy has the potential of ensuring that hypertension is monitored and it can assist in the medication process.
On the lifestyle interventions, the nurses should work with the patient to identify how the patient’s lifestyle can affect hypertension management. They should be in a position to identify the behavior for change and create a unanimous management plan that will guide the patient in achieving the treatment goals. For instance, in a situation where the patient is an alcoholic or smokes high level of tobacco the nurse can advise the patient to quit. The nurses can assess the patient’s alcohol consumption considering the frequency, and the quantity by utilizing a validated tool and collaboratively agreeing on the quitting methods. This method will be significant in the prevention of further complications that may sabotage the efforts of hypertension management.
The nurses should also observe the medication history of the patient, including the history about the prescribed over-the-counter medicine and other herbal medicine. Regarding the medications, the patients should be informed about the effects of each prescribed drug and the appropriate dosage plan to follow. Grinspun (2005) has pointed out that it is also a requirement for the nurses to make the patients aware of the pharmacological management of high blood pressure in collaboration with pharmacists and the physicians. The rationale for this strategy is that it forces the patient to make informed choices about the treatment plan. It will also help the nurses to establish a significant working relationship that will facilitate a significant therapeutic response by the client.
It also advisable that nurse should assess the patient’s expectations and beliefs regarding the hypertension management plan. This strategy will help the nurse to have an idea of how a therapeutic relationship can be enhanced. It will also help the nurse to ascertain the patient’s adherence capabilities to the treatment plan. The patient will also know about the appropriate visit time for the assessment of changes and adaptability to the designed treatment plan. In case hypertension came because of stress, the nursing practitioner can help the patient to comprehend significant strategies that will help to cope with stress effectively.
Hypertension can be treated by utilization of both surgical and oral medical methods. Pharmaceuticals have played a significant role in researching for the most suitable treatment plan and reduction of hypertension. Researchers have frequently sought information on high blood pressure management from medical consultants and the inpatients. This section will compare the medical and surgical interventions that apply to hypertension management. The use of antihypertensive agents has been proven appropriate and recommended for the treatment of high blood pressure.
The patients are usually encouraged to start with the prescribed small amounts and the dose should include long-acting agents. According to the recommendation by Toth and Sica (2010), an inclusion of lower secondary agents would be more effective than utilizing the first agent. They have pointed out that the significance of using the second agent is that it provides the additional antihypertensive efficacy, hence reducing the chances of experiencing the dose-independent side effects. It has also been suggested that an excessive reduction in the diastolic pressure where the coronary flow is dependent on increasing the aspect of myocardial infarction. The study researched on this phenomenon was evaluated in patients with an underlying left ventricular hypertrophy. However, systolic hypertension should be treated, and diastolic hypotension should highly be avoided.
Thakral (n.d.) has also pointed out that the pharmacologic agent usage for the control of blood pressure is an effective method of hypertension management. The recommendation of their research emphasized on choosing a diuretic and a beta-blocker when to incase another drug class in not indicated. They acknowledged that the use of these pharmacologic agents had the tendency to reduce morbidity and mortality for the hypertension patients (National Academy on Aging Society, 2000). It happens because the elderly people, especially the African-Americans have a lower rate of renin concentration; hence, they are more responsive to medicine that does not suppress renin. In a situation where the initial agent was not a diuretic one, adding another agent usually increases the effectiveness of the initially used one.
Angiotensin-converting enzyme inhibitor (ACE inhibitors) usage has also been proved to be a significant strategy in hypertension and cardiovascular risk management. The most common examples of the ACE inhibitors are the captopril, trandopril, quinapril and perindopril (British Hypertension Society, 2008). The use of ACE inhibitors has been recommended since it caters for risk factors such as diabetes. However, the usage of ACE inhibitors has other side effects such as increased levels of potassium. Therefore, the patients on ACE inhibitors should have their blood tested on a regular basis to measure the levels of potassium in their blood. Excessive potassium prevalence in the body can be identified when symptoms such as irregular heartbeat, increased levels of confusion, and difficulty in breathing are present (British Hypertension Society, 2008).
ACE inhibitors can help in the protection of kidneys but they have been identified to be the reason for kidney failure in some individuals. The usage of ACE inhibitors has also been identified to vary in duration of action with some patients but suitable for some patients when administered once on a daily basis. For instance, captopril has been identified as ACE inhibitor with the shortest duration of action; hence, it has to be administered more than once within 24 hours (British Hypertension Society, 2008). To avoid an impulsive initial fall in the blood pressure, it is usually advisable to start the therapy process with the low dosage, especially in the elderly people. This strategy can also be adopted for patients with a compromised renal function and heart failure.
Some of the patients usually show some resistance to the oral medical treatment for hypertension. Such patients are usually taken through the surgical operation using a medical procedure that is referred to as renal sympathetic denervation. The method usually entails the act of cauterizing the arterial nerves found in the kidneys. This procedure primarily aims at lowering the level of blood pressure by reducing the activities of some nerves in the kidney. It is usually done by inserting a special equipment into the arteries through the groin. The procedure for inserting is done using the simplicity catheter system. Weir (2005) has pointed out that the method has been used in most of the countries, and it has worked for patients resistant to the oral dosage scheme.
To determine the most suitable intervention, the analysis of the results of the mentioned interventions is critical. The nursing practitioners dealing with the patents should be knowledgeable about the standardized blood pressure measurement because incorrect classification of a patient as hypertensive might result in unintentional exposure to treatment-related harm. In the context of healthcare, the level of blood pressure is measured using the sphygmomanometer and the stethoscope. An oscillometric sphygmomanometer is significant in determining the arterial pressure in the upper limb. The diastolic and systolic pressures are calculated basing on the choice of algorithm used. The assessment of the patients’ progress should be done on a regular basis to ensure that the diagnosis phase is completed effectively.
In the case where diagnostic algorithm has been used, the initial visits where the blood pressures are recorded should not be considered as initial hypertension related visit. The results from the clients self-test done at home are also necessary for monitoring and measuring the pressure levels. Patients should be informed and advised to buy the self-test equipment for they are significant in determining the outcome.
Some of the significant plans that can help the nurses implement the evidence-based approach in hypertension management are about ensuring that the patient’s pressure is monitored. They are also required to maintain and create an interpersonal relationship with the patients that facilitate cooperation. The plan should also favor the aspect of collaboration between the physicians, clinicians and the pharmacists. They should consult the patients on a regular basis on the contentious issues about hypertension management. Some of the challenges that the nurses might experience in the application of evidence-based approach include the cardiac failure. This challenge usually hinders the nursing practitioners from achieving their objectives whenever sticking to a particular treatment plan. Another challenge that can be experienced includes lack of adequate cooperation in adherence to the treatment plan. The majority of the old people usually have the issue of memory lapse that comes because of cognitive issues. This problem usually hinders the adherence to strict treatment and hypertension management plan.
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It can be concluded that nurses play a significant role in the management of hypertension. Despite being a widespread disease among the elderly in the USA, hypertension can be controlled if the patients cooperate with the clinicians. The commitment from the clinicians, physicians and pharmaceuticals also has an impact on the control of hypertension management. Overall, the patients have the greatest role to play as far as hypertension is concerned. Firstly, all people should be careful about lifestyles, particularly when there is a history of hypertension in the family. People should regularly exercise to get rid of the cholesterol that may cause the blockage of blood veins. Furthermore, proper diet is also essential in this case.
People should avoid foods that contain great amounts of fats and manufactured food as well. These have been known to be some of possible causes of hypertension. Avoiding these foods helps the heart pump blood as it should. People should also strive to ensure that they reduce the stress that has also been known to be a risk factor for hypertension. People should seek counselors whenever they have disturbing issues that may advise them on the way forward. All these are issues to do with lifestyles, and paying attention to them would play a vital role in the control of hypertension. Additionally, people should seek immediate medication once they realize that they are at risk of suffering hypertension.
For instance, if a family has had a history of hypertension, they should have a doctor who can advise them on reducing the attack. Moreover, if one suffers from the disease, they should see a physician as soon as possible. They can also have ready drugs in the house that may help during such emergencies. If the situation gets worse, the patient can also opt for surgical methods that may be successful. People should be aware that hypertension is not a death sentence. Some people have lived with the condition for a long time and have led a normal life.