Healthy People Reduce the Proportion of Adults With Hypertension

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

Pressure Category

JNC 6 Blood

Pressure Category

SBP (mm Hg)

and/or

DBP (mm Hg)

Normal

Optimal

< 120

Pre-hypertension

Or

Normal

< 130

High-normal

Or

Hypertension:

Hypertension:

Stage

Stage

Or

Stage

Or

Stage

Or

Stage

Or

(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.

Target Year

1990

2000

2010

2020

Overarching Goals

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 day for women. It also provides treatment guidelines for hypertension. The Dietary Guidelines for Americans, 2005, recommends an intake of no more than 1,500 mg/day. (Seventh Report of Join National Committee on Prevention, Detection, Evaluation and Treatment, 2003)

Despite various campaigns and an increase in awareness on the effects of hypertension, there still seems to be a deficit in the knowledge of, who is included in the high risk group. Effective legislatures need to be implemented to control the risk factors. Media and educational institutes can also help in building enough motivation amongst the public in avoiding these potentially harmful factors that prevent appropriate quality of life. Moreover, educational institutes can impart rules to prevent in campus smoking. They can also keep students focused on extracurricular activities, along with a functional student councilor body to prevent them from indulging in smoking and binge drinking. Governments and support groups need to address to other aspects, such as unemployment, to reduce the amount of stress in an individual's life.Cheap fast food restaurants and easy availability of tobacco smoking are also associated factors that increase hypertension, effects of which are seen years later.

Role of Government, Support Agencies, and Health Care Personnel:

The following bills have been passed by the government in relation to hypertension affirming the importance of controlling obesity, participating in regular physical activity, reducing chronic disease, as key components of a healthy lifestyle, including combating obesity, reducing chronic disease and lowering health costs. However, these bills have not been implemented as yet and no specific law for Indiana currently exists.

Latest Title: Heart Disease Education, Analysis, Research, and Treatment for Women Act

Sponsor: Senator Stabenow, Debbie [MI] (introduced 3/2/2011)

Latest Major Action: 3/2/2011 Referred to Senate committee. Status: Read twice and referred to the Committee on Health, Education, Labor, and Pensions.

OFFICIAL TITLE AS INTRODUCED: A bill to amend the Public Health Service Act to improve women's health by prevention, diagnosis, and treatment of heart disease, stroke, and other cardiovascular diseases in women.

Latest Title: A resolution affirming the importance of exercise and physical activity as key components of a healthy lifestyle, including in combating obesity, reducing chronic disease, and lowering health care costs.

Sponsor: Senator Casey, Robert P,. Jr. [PA] (introduced 3/9/2011) Latest Major Action: 3/9/2011 Passed/agreed to in Senate. Status: Submitted in the Senate, considered, and agreed to without amendment and with a preamble by Unanimous Consent. (Bill Summary and Status)