Hypertension is defined as systolic BP of at least 140 mm HG and diastolic BP of at least 90 mm Hg, self-reported use of antihypertensive medications, or both. (Ostchega, 2005-2006)
Hypertension, according to the joint national committee 6 and 7, is classified into the following stages:
Classification of Blood Pressure for Adults Aged ? 18 Years: JNC 7 versus JNC
JNC 7 Blood
JNC 6 Blood
SBP (mm Hg)
DBP (mm Hg)
(Linda Brookes, Msc, 2003)
Hypertension is a progressive and multi-factorial disease, increasing in incidence with age, affecting twenty five percent of the population in the United States, with a predisposition amongst the African-American population.
Based on etiology, it is divided into idiopathic (or essential), occurring ninety five percent of the time, and secondary hypertension, in the remaining five percent. It is classified as idiopathic hypertension when no known cause can be found, however, secondary hypertension can be due to multiple causes, for example, renal disease or pheochromocytoma.
Another classification divides it into benign and malignant. Benign accounts for the 95% cases of hypertension, with mild to moderate elevation of blood pressure over a gradual period of time. Initially it is an asymptomatic silent disease that may progress to certain complications, namely, concentric left ventricular hypertrophy, congestive heart failure, accelerated atherosclerosis, myocardial infarction, aneurysms formation, rupture and dissection, intracerebral haemorrhage and chronic renal failure (Kumar, 2007). Malignant, on the other hand, accounting for five percent of all cases, is when markedly elevated pressures (diastolic >120) cases end organ damage, that requires emergency treatment. This high blood pressure in malignant hypertension is the cause for characteristic features on the retina, namely, retinal hemorrhages and exudates, papilledema; and petechial hemorrhages on the kidney. Patients with malignant hypertension, if untreated, can cause death within two years from renal failure, intracerebral haemorrhage, or chronic heart failure (Kumar, 2007).
The pathology behind hypertension is the progressive narrowing of arterial lumen, because of the deposition of lipid resulting in intimal thickening of large and medium sized arteries, hence forming characteristic fatty streaks and athermanous plaques. Atherosclerosis and arteriosclerosis cause hypertension and vice versa. There are major and minor risk factors for atherosclerosis; minor risk factors are: hyperlipidemia, hypertension, smoking and diabetes. Minor risk factors include: male gender, obesity, sedentary lifestyle, stress (type A personality) elevated homocysteine, oral contraceptive use, increasing age and familial or genetic factors (Kumar, 2007).
These can also be classified as modifiable or non-modifiable risk factors. Controlling the modifiable risk factors, such as smoking, obesity, sedentary life style, stress and use of oral contraceptive can greatly reduce the risk of hypertension and related complications. (Kumar, 2007). The Healthy People 2010 objectives focus a great deal on heart diseases and emphasize the need to reduce the number of people with these modifiable factors, hence reducing the number of individuals with hypertension (objective 12-09). Below is a summary of the HP 2010 objectives and its 2000 counterpart. It also includes the 1990 and 2020 objectives. A more detailed description of the HP 2010 objectives is mentioned below.
Decrease mortality: infants -- adults
Increase independence among older adults
Increase span of healthy life
Reduce health disparities
Achieve access to preventive services for all
Increase quality and years of healthy life
Eliminate health disparities
Attain high-quality, longer lives free of preventable disease
Achieve health equity; eliminate disparities
Create social and physical environments that promote good health
Promote quality of life, healthy development, healthy behaviors across life stages
HP 2010 OBJECTIVE:
'Healthy People' provides a ten-year objective for improving health of all Americans. For three decades, they have established benchmarks and monitored progress over time in order to:
Encourage collaborations across sectors
Guide individuals towards making informed health decisions.
Measure the impact of prevention activities. (Healthy People Objective Development, 2020)
Healthy People Progress Report from 2000 TO 2010:My research objective is HDS 5.1 (Reduce the proportion of adults with hypertension).
In 2005-08(age adjusted to the year 2000 standard population), the National Health and Nutrition Examination Survey (NHANES), CDC and NCHS estimated that29.9% of adults aged 18 years and older had high blood pressure (hypertension). The HD 5.1 target was to reduce it to 26.9%,by the year 2010, with a target setting method of ten percent improvement.(Thomas, 2005)
The number of adults with hypertension failed to meet the HP 2010 objective asthe prevalence of hypertension continues to climb or remains the same, nation-wide.However, there have been advances in treatment and awareness, allowing appropriate control of the disease; effectiveness of which can be measured by the following conducted studies. The first part focuses on any change ofawareness, which might have occurred during this period, whereas, the second part establishes that there has been no reduction in the prevalence of hypertension.
In the first study by NHBPPEP, less than one-fourth of the American population knew of the relationship between hypertension and stroke and hypertension and heart disease, in the year that this study began. Today, more than three-fourth of the population have sound knowledge of it. In addition, they have also understood the need to regularly monitor blood pressure. Virtually all Americans have had their blood pressure measured at least once, and three-fourth of the population have it measured every 6 months.In the last 2 decades, the number of people with hypertension, who are aware of their condition, have increased dramatically with a rise in the proportion of hypertensive patients who are on medication and are closely monitoring their blood pressures.
The second study by Egan et al. (1988-200) of the Medical University of South Carolina, Charleston, and colleagues examined changes in hypertension prevalence, awareness, treatment, and control for all adults combined and for subsets by age, race / ethnicity, and sex across NHANES 1988-1994 and 1999-2008 in five 2-year blocks, which included 42,856 adults older than 18 years, representing a sample of the U.S. population.
The researchers found that the rates of hypertension increased from 23.9% in 1988-1994 to 28.5% in 1999-2000, but did not change between 1999-2000 and 2007-2008 (29.0%). "… prevalent hypertension is not decreasing toward the national goal of 16% and will likely remain high unless adverse trends in population nutrition and body mass index occur or pharmacological approaches to hypertension prevention are adopted," they write. (Ostchega, 2005-2006)
The following is a comparison of the awareness, prevalence, treatment and control of hypertension from 2000-2008.Percentage of patients over 18 years of age with hypertension: 99-2000: 28.9%; 2005-2006: 31.7%; 2007-2008: 32.6%
STATISTICS ON THE ROLE OF RISK FACTORS RELATED TO HYPERTENSION: (National Heart and Lung Institute, 2007-2008)
Hypertension is a multi-factorial disease, which can only be prevented if the associated modifiable risk factors are eliminated. Following are a few statistics of their prevalence, in 2010, which demonstrates an increase in prevalence through the years.
1- Obesity: no state has met the Healthy People 2010 obesity target of 15%, and the self- reported overall prevalence, among U.S. adults, has increased 1.1 percentage points from 2007; with the highest occurrences in Mississippi and the lowest in Colorado. (Health United States, 2010).
2- Smoking:In Indiana, 26.0% of the adult population (ages 18+) and are current (2010) cigarette smokers, rankingfifteenthamong the states. This is significantly higher than the 20.6% nationwide in 2009.(Tobacco Control State Highlights, 2010).
3- Alcohol: In 2009, the overall prevalence of binge drinking among adults in the United States was 15.2%, being twice as higher in men than in women.The percentage of adults who had five or more drinks in 1 day at least once in the past year decreased from 21.4% in 1997 to 19.5% in 2005, and then increased to 23.7% in early 2010. (Binge Drinking United States, 2009)
4- Sodium Intake: On the basis of NHANES data, the average sodium intake is 3466 mg/day. Only 9.9% of all adults did not exceed their applicable limit of intake (CDC, January 2011).
5- Diabetes: The prevalence of diagnosed diabetes among adults aged 18 years and over increased from 5.1% in 1997 to 9.0% in early 2010 (Health United States, 2010).
Why is the prevalence not decreasing?
The above mentioned statistics clearly reasons the question, why isn't the prevalence of hypertension decreasing? With increasing life expectancy in developed countries with an associated benefit of a luxurious life, hypertension prevalence has been on the rise. For proper control and prevention, the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure (JNC 7) recommends lifestyle modification to maintain a healthy body weight. It recommends adopting a diet rich in fruits, vegetables, low-fat products with reduced saturated and total fat. Most importantly, it emphasizes on reducing sodium intake. The Dietary Guidelines for Americans, 2005, recommends an intake of no more than 1,500 mg/day. Another area of stress is in regular participation of aerobic physical activity and limiting alcohol consumption to no more than two drinks per day, for men, and one drink per…