Hypertension

HYPERTENSION

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Hypertension

Introduction

By description, hypertension (also high blood pressure) is a condition where

blood in the blood vessels exert a lot of force on the tubes, and therefore, the individual

risks suffering from other health complications. The normal blood pressure should range

between 120/80 mmHg ad 130/80 mmHg, and high blood pressure is when that range

is surpassed (MacGill, 2018). Mayo Clinic Staff (2018) supposed that primary

hypertension develops gradually and naturally over years, while secondary

hypertension could be as a result of various underlying conditions, such as chronic

kidney diseases, certain medications, stress, and some illicit drugs. That way, almost

everyone is at risk of suffering from the condition since its causes are numerous, and in

most cases, its causes are unknown (MacGill, 2018). According to the World Health

Organization (n.d.), primary hypertension often goes undiagnosed in its early stages as

it does not cause any significant signs. If not managed, hypertension may lead to

adverse conditions such as stroke, heart diseases, and chronic kidney diseases, among

others (MacGill, 2018; Yao, Konan, Sanogo, Diopoh, and Diallo, 2018; Watson, 2016).

Therefore, the condition is quite risky.

Statistically, hypertension affects 1.13 billion people in the whole world.

According to the 2015 statistics, Africa is the most prevalent continent in the globe with

Niger leading at 33.4% prevalence rate. There is no country in Africa that has a

prevalence rate of less than 20, which implies that at least one in every group of five

Africans suffers from hypertension.Côte d'Ivoire has a prevalence rate of 27.2% among

people aged above 18 years. Her borders, Burkina Faso, Mali, Guinea, and Sierra

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Leone all have prevalence rates of slightly above 30%. It is only Ghana whose

prevalence rate is slightly lower at 23.7%. Across the globe, the lowest prevalence rate

is 11%, which is only seen in The Republic of Korea (World Health Organization, n.d.).

In the United States of America, approximately 85 million people suffer from

hypertension (MacGill, 2018). Therefore, hypertension is a global issue, not just a local

issue for Côte d'Ivoire and other African countries.

Also, it is prudent to acknowledge that hypertension has numerous risk factors.

Age is one of the risk factors as people aged above sixty are more likely to suffer from

the condition than all other age groups (MacGill, 2018). Race is another factor, Africans

are more prone to the condition that other races (Mayo Clinic Staff, 2018).Body size and

weight is also a risk factor, obese people are more likely to suffer from the condition as

they need to pump more blood to the tissues (Mayo Clinic Staff, 2018; MacGill, 2018).

Consumption of some products such as alcohol, excess salt, and tobacco could also

increase risk of suffering from the disease (Mayo Clinic Staff, 2018; MacGill, 2018). Sex

is another factor; males are more prone to the condition at young ages, while women

are more likely to suffer from hypertension at old age (MacGill, 2018). Henceforth, there

are numerous risk factors that are associated with high blood pressure.

In light of that information, the current study explores the physiology of the

condition and available pharmacological interventions. As aforementioned, hypertension

is a global health challenge, and it is needful to understand its physiology as that would

be helpful in sensitizing people on what signs to watch out for in relation to the

hypertension. A critical review of the available pharmacological interventions would

equally be assistive, more so to professionals who should be cognizant of all the

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treatment options that they could recommend for their clients. Therefore, the current

study would be quite relevant to all affected populations, as it would sensitize them on

the condition at hand.

Critical Analysis

Symptomatic Physical/Psychological Presentation

As aforementioned, there are no specific signs of hypertension. However, there

are some associated signs, such as “severe headache, fatigue or confusion, vision

problems, chest pain, difficulty breathing, irregular heartbeat, blood in the urine, and

pounding in your chest, neck, or ears” (Steinbaum, 2018). Similarly, Mayo Clinic Staff

(2018) stated that hypertension could cause nose bleeding alongside breathing

difficulties and severe headaches. On the other hand, MacGill (2018) argued that

“sweating, anxiety, blushing, and sleeping problems” are some of the symptoms of high

blood pressure. In other studies, difficulty in speaking and general body weakness are

also considered symptoms of hypertension (Nall, 2018). As such, studies have not

settled on the specific symptoms of high blood pressure. For example, while Steinbaum

(2018) maintained that severe headache is a sign of hypertension, some studies have

come out to show absolutely no relationship between the two (Watson, 2016). That only

confirms the hypothesis that there are no specific symptoms that are associated with

hypertension (MacGill, 2018). Nonetheless, it is essential to appreciate the fact that

extreme levels of hypertension could lead to malignant hypertension, which causes

headache (Nall, 2018; Watson, 2016). Therefore, there are numerous signs to watch

out for, but none of them is specific to high blood pressure, and hence, one cannot

reach a conclusion by merely observing the symptoms.

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Short Potential Causation

Noteworthy, hypertension could cause various undesired health conditions to the

body. One, hypertension could lead to stroke as it damages blood vessels, more so in

the brain, which leads to the risk of them blocking or bursting, and therefore, causing

stroke (Stroke and hypertension, 2017). Low range prehypertension, prehypertension,

and high-range prehypertension are all associated with 44%, 66%, and 95% increased

risk of stroke, respectively (Alexander, Madhur, Dreisbach, and Riaz, 2019).Besides,

hypertension could cause heart attack and heart failure (Felman, 2019). Moreover, high

blood pressure could increase risks of suffering from chronic kidney disease.Yao et al.

(2018) for instance, found hypertension to be the most common cause of chronic kidney

disease in most African countries. Further, hypertension could amount to an aneurysm,

a condition where the arteries enlarge as their walls are weakened (Felman, 2019). In

men, hypertension could contribute to erectile dysfunction as it causes the blood

vessels to harden, and thus, hold less blood in the sexual organ (Mayo Clinic Staff,

2019). Still, choroidopathy, a condition where fluid accumulate in the retina due to leaky

blood vessels, could occur due to hypertension (Mayo Clinic Staff, 2019). Therefore,

without proper treatment, hypertension could amount to numerous undesirable

outcomes as captured in literature.

Diagnostic Testing for Hypertension

The only diagnostic test for hypertension is by measuring the blood pressure.

The device used for this purpose is a sphygmomanometer, which comprises of a gauge

and a rubber arm cuff. It is a simple painless process that involves placing the cuff

around the arm, inflating it, and then observing the gauge readings. As aforementioned,

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normal blood pressure equal to or less than 120mmHg systolic and 80mmHg diastolic

(120/80mmHg). A systolic pressure that ranges between 120 and 129mmHg and a

diastolic of below 80mmHg is considered elevated level of blood pressure. Further, a

systolic of 130-139mmHg and a diastolic of 80-89mmHg represents the first stage of

hypertension. The second stage of hypertension is when the systolic and diastolic

pressures are above 140mmHg and 90mmHg, respectively (Beckerman, 2018; Mayo

Clinic Staff, 2018). Noteworthy, both the diastolic and systolic readings matter in

diagnosing hypertension; however, it is more crucial to watch out for the systolic reading

for a patient aged above 50. Such people could suffer from isolated systolic

hypertension, where the diastolic reading is normal (80mmHg or below), but the systolic

reading is above 129mmHg (Mayo Clinic Staff, 2018). So, the most important factors to

watch out for are the diastolic and systolic pressures, which are gauged using the

sphygmomanometer.

Differential Diagnosis

Remarkably, a sphygmomanometer reading of above 130/90mmHg does not

necessary imply that one should be diagnosed with high blood pressure. Body pressure

may vary at different times of the day, which could bring forth white coat hypertension.

Consequently, it is needful to test both arts to check for any variations in the readings.

Moreover, ambulatory blood pressure monitoring could be necessary to record changes

in blood pressure over a 24-hour period as that would give a true picture of one’s blood

pressure. In case of high blood pressure, the doctor would go a step further to assess

the patient’s medical history and do a physical examination on the same (Mayo Clinic

Staff, 2018). Once the presence of hypertension is confirmed, further test should be

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conducted to assess the cause and impact of condition. Blood tests, such as

electrolytes and creatinine levels check for the involvement of the kidneys in the

condition. Lipid profile, urinal analysis, and hormone tests are equally important. An eye

examination and ultrasound of the kidney may also help in assessing the damage

caused to the eye and the kidneys, respectively. Also, in case of suspected damage to

the circulatory system, electrocardiogram, echocardiogram, doppler ultrasound, and

plain chest x-ray tests could be conducted to ascertain the same (Beckerman, 2018).

Hence, the full diagnosis of hypertension requires a series of tests that check into the

severity and causes of the condition as well.

Morbidity and Severity of the Condition

As already mentioned, hypertension is quite a dangerous disease. It increases

risk of cardiovascular disease (Naidu, Yusoff, Abdullah, Musa, Yaacob, Mohamad,

Sahril, and Aris, 2019). A study by Jackson, Zhang, Wiltz, Loustalot, Ritchey, Goodman,

and Yang (2018) confirmed the hypothesis by showing a positive correlation between

adolescence hypertension and cardiovascular disease. The prevalence of hypertension

is slowly increasing, more so in the developing countries with low standards of living;

consequently, there is the risk of having a population of incurable high blood pressure

(Naidu et al., 2019). Further research shows that prevalence among the youths in on

the rise across the globe, a sign that Naidu et al. (2019)’s postulation is valid (Jackson

et al., 2018). A study by Westerdahl, Zöller, Arslan, Erdine, and Nilsson (2014) found

that severe hypertension does not respond to treatment; it amounts to “increased

mortality, cardiovascular morbidity, and incident diabetes” even in situations where

drugs are administered to manage the situation. That only reaffirms Naidu et al. (2019)

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stand on the possibility of developing a community of incurable hypertension. Truly,

hypertension is a very dangerous condition.

Critical Understanding of Pharmacological Interventions

When to Apply

Most literature advocate for non-medical interventions for hypertension.

However, there is some point where pharmacological intervention is required. Ideally,

medical interventions are necessary “if blood pressure lowering is to be substantial and

sustainable” (National Clinical Guideline Centre (UK), 2011). Medical interventions, if

used sustainably, could lower chances of “stroke, coronary heart disease, heart failure

and mortality” (National Clinical Guideline Centre (UK), 2011). Sustainability in medicine

refers to the situation where a medication is affordable and harmless to the patient

(George, Coffin, and George, 2013; Thompson. and Ballard, 2011). That is, medicine

should work towards ensuring quality health in the long-term, not just maximizing health

in the short-run (Rastogi and Kaphle, 2011; Thompson. and Ballard, 2011). That is to

imply, pharmacological interventions should be considered if they not only help the

patient to recover from the condition, but also ensure health in the long-run.On the other

hand, sustainability is effectiveness in dealing with the condition at hand. To that effect,

it is needful to look into the possible medical interventions for hypertension, and

therefore, choose the best option based on their sustainability and substantiality. Any

pharmacological intervention that does not meet the requirements stated above is

should not be accepted.

Available Options

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Noteworthy, there exist numerous pharmacological remedies for hypertension.

These include the “thiazide-type diuretics, beta-blockers, angiotensin-converting

enzyme (ACE) inhibitors, angiotensin receptor blockers, calcium-channel blockers,

vasodilators, renin inhibitors,aldosterone antagonists, and alpha blockers,” among

others (National Clinical Guideline Centre (UK), 2011; Mayo Clinic Staff, 2018;

Alexander, Madhur, Dreisbach, and Riaz, 2019). Alpha blockers work by suppressing

the chemicals that narrow the blood vessels. Beta-blockers, on the other hand, not only

reduce the pressure with which the heart pumps blood, but also widen the blood

vessels. Elsewhere, thiazide diuretics improve the functioning of the kidney, and

therefore, enhances the elimination of sodium and water from the body, which in return,

decreases the volume of blood in the body. Alongside the thiazide diuretics are the

aldosterone antagonists, which inhibit the functioning of the enzyme aldosterone and

anti-diuretic hormone that could cause fluid and salt retention in the body (Scott and

Dunn, 2019). Still, the option of ACE inhibitors stops the secretion of the natural

chemical that narrows the blood vessels, and thus, causes a relaxation in the tubules as

to reduce the pressure of blood from the heart (Kostis, 2010). Unlike ACE inhibitors,

angiotensin receptor blockers inhibit the functioning, not the secretion of the natural

chemical that narrows blood vessels. They lower both systolic and diastolic pressure by

more than 5mmHg (Chaturvedi, Lipszyc, Licht, Craig, and Parekh, 2014). In other

instances, calcium channel-blockers could be a good option as they not only slow the

heart rate but also reduce strain on the blood vessels’ muscles (Chaturvedi et al., 2014).

Likewise, vasodilators prevent the blood vessels’ muscles from tightening, and thus,

averts the narrowing of blood vessels (Mayo Clinic Staff, 2018). Elsewhere, renin

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inhibitors act on the kidney by slowing the secretion of enzyme renin, which initiates

numerous body reactions that lead to hypertension (Campbell, 2009; Mayo Clinic Staff,

2018). So, there are numerous antihypertension medications that could be

administered.

Ideal Option

The most ideal pharmacological treatment option for hypertension is the use of

thiazide-type diuretics. These diuretics include “hydrochlorothiazide (HCTZ),

chlorthalidone, and indapamide,” all of which are approved to perform different functions

in the body (Akbari and Khorasani-Zadeh, 2019). HCTZ and chlorthalidone are used to

manage primary hypertension and other associated conditions such as “therapy in

edema that is associated with chronic heart failure (CHF), hepatic cirrhosis,

corticosteroids, and estrogen therapy” (Akbari and Khorasani-Zadeh, 2019).

Indapamide, on the other hand, helps in dealing with salt and fluid retention that comes

with chronic heart failure (Akbari and Khorasani-Zadeh, 2019). As Williams (2019)

observed, thiazide diuretics function by stopping the reabsorption of water and salts

from the urine by the kidney. Wile (2012) attempted to explain how diuretics limit the

reabsorption of water, and in his view, the drugs hamper “renal tubular sodium

reabsorption,” and that reduces the osmotic gradient in the tubules, which results in the

minimal reabsorption of water in the proximal convoluted tubule.Akbari and Khorasani-

Zadeh (2019) restated David’s view by explicating that thiazide diuretics block sodium

chloride channels in the distal convoluted tubule, and that leads to the low diffusion

gradient. Henceforth, diuretics reduce the volume of extracellular fluid in the body, and

therefore, reduces the pressure exerted in the fluid vessels (Ellison, 2019). Despite their

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effectiveness, these medications also have given side effects. Such include

“hypokalemia, hyponatremia, metabolic alkalosis, hypercalcemia, hyperglycemia,

hyperuricemia, hyperlipidemia, and sulfonamide allergy,” among others (Akbari and

Khorasani-Zadeh, 2019). Nonetheless, it is most popular intervention for the condition

(Mayo Clinic Staff, 2018). Surely, it is commendable to use thiazide-type diuretics to

treat hypertension.

Reasoning

Thiazide-type diuretics would be the most ideal pharmacological intervention for

hypertension due to many reasons. Head-to-head drug comparisons by National

Clinical Guideline Centre (UK) (2011) ranked thiazide-type diuretics the best out of six

possible options. The medication as compared to ACE inhibitors, and the researchers

found that rates of stroke, revascularization, myocardial infarction, and withdrawal for

patients using the latter was higher than those using thiazide-type diuretics. The results

were not in any way different on comparing thiazide diuretics to beta-blockers; the latter

had more adverse effects than the former. On the other hand, calcium-channel

blockers, had higher cases of heart failure than thiazide diuretics, but the latter were

associated with more cases of withdrawal than the former. Therefore, thiazide-type

diuretics were much better and safer than most drugs that it was compared to. Other

studies have come out to show that ACE inhibitors could put the patient at risk of

suffering from lung cancer, and thus, making them unsustainable (Hicks, Filion, Yin,

Sakr, Udell,andAzoulay, 2018). Besides, calcium-channel blockers are not the safest

medications for the condition since their interaction with grapefruit juice would lower

their effectivity (Mayo Clinic Staff, 2018).Further, beta-blockers only have an effect on

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systolic pressure, not diastolic (Chaturvedi et al., 2014). Need to note, despite the

preference for thiazide-type diuretics, sometimes it is necessary to use more than one

pharmacological intervention to the disease: “many patients need more than one

medication to control their BP” (Kostis, 2010). Therefore, medication should only be

administered with the guidance of a professional to avoid adverse impacts.

Critical Reflection

The study on hypertension applies much to the Advanced Clinical Practice (ACP)

in terms of both clinical practice and research. Noteworthy, ACP requires nurses to

have basic skills that are needed for clinical practice. Such include collaboration, acting

as a role model, professional judgment, quality communication skills, and compliance to

professional codes of conduct (Health Education England, 2017). From the research, it

is evident that hypertension is quite risky, and therefore, ACP nurses need to judge the

right intervention for their patients. Moreover, it is needful to communicate risk factors to

one’s patient as that would empower them to care for themselves. Still, ACP nurses

should collaborate with other people both in the facility and outside to ensure proper

diagnosis as seen in the literature review. That way, it is necessary to follow a routine of

testing both arms so that all junior nurses can follow the same in the triage section.

In terms of research, it is ACP nurses’ duty to conduct extensive research to

ensure evidence-based practices within their units. From some of the contracting

literature met in the course of the current study, it is evident that ACP nurses should

reassess literature to ensure that the practices they engage in are sound and

sustainable. Besides, with the information on pharmacological interventions, it is the

duty of all ACP nurses to research the side effects of all the available treatment options

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and make sound decisions on the same. Still, the literature shows that hypertension

quite prevalent in most African countries; so, it is the duty of an ACP nurse to look into

possible interventions to the problem. So, an ACP nurse should work towards ensuring

an environment free from hypertension, and that is only possible through research work

(Health Education England, 2017). Surely, the current literature review has provided a

lot of insights as far as future medical research in concerned.

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