Hypertension and Its Impact on U S Population

HYPERTENSION AND IMPACT ON US

Hypertension and Its Potential Significant Impact on U.S. Population

Thomas Fuller, an English churchman, and historian, said: \\\\\\\"Health is not valued till sickness comes.\\\\\\\" Hypertension is one of the most life-threatening diseases in the U.S., which is present in almost one out of four adults. Almost half of the U.S. deaths were primarily because of hypertension in the year 2017 (Centers for Disease Control and Prevention, 2020a). This paper is aimed at analyzing the historical development of this issue, evaluation of roles of public health organizations in dealing with the issue, demonstration of understanding of the epidemiology of hypertension, identifying determinants of health in terms of this problem, examining the concepts of prevention and its future implications. Each section would be discussed in detail in light of the authentic sources.

Description and Analysis of Public Health In Light Of the Issue

Hypertension or high blood pressure- what is its historical background? Hypertension was considered a disease in official clinical terms when its first measurement machine was invented called a \\\\\\\"sphygmographic\\\\\\\" device (Kotchen, 2011). Some initial cases of high blood pressure were reported by U.S. medical insurance companies in 1906. With the help of this device, it was verified that the persistence of systolic and diastolic blood pressure was there. Standardized conditions were developed for the measurement of blood pressure by the year 1918; however, between 1925 and 1979, the Actuarial Society of America noted some factors related to hypertension in the U.S. population that needed to be studied closely. There was an age-related increase in hypertension since the study in 1925 showed that at younger ages, women had lower blood pressure as compared to men. The pulse pressure was found to be increasing in both genders with age. There was another interesting finding that mentioned the increase of blood pressure with the increase in the body size of men and their average weight. As the data was limited, the results came out to be the same for women. In further years to come, studies were based on better measurements of blood pressure, and better results were obtained. In a 1939\\\\\\\'s report, systolic blood pressure was predicted to be a greater reason for deaths among individuals aging more than 40 years as compared to diastolic blood pressure. The studies conducted in 1959 again came consistent with the previous researches that blood pressures are on the increase with the increase in age and weight of both genders. It was also made clear with the help of this research that mortality was higher with higher blood pressure. Women aging more than 40 years had higher hypotension rates but lower mortality rates. In subsequent studies of the year, 1979 stated that mortality with overweight aspects among men was the borderline for hypertensive men.

Further, excessive mortality also resulted from hypertension due to ailments like coronary disease, cerebral hemorrhage, kidney, and heart disease. These studies increased with time so that other factors could be taken into consideration, such as ethnicity and racial groups. It was confirmed that if blood pressure is detected among children, then it is more likely to maintain through adolescent and adult years. In 1993, more than 350,000 men participated in the Multiple Risk Factor Intervention Trial, which showed that 120mm Hg of systolic blood pressure had a great influence on coronary heart disease and end-stage renal disease. These conclusions were confirmed with the study in 2001 when it was evident that excess deaths were due to high blood pressure or even with stage 1 hypertension in men.

An important achievement in this issue\\\\\\\'s history is the success of pharmacological treatment of hypertension that affects more than a billion human fellows (Saklayen & Deshpande, 2016). This success was just associated with antibiotics, vaccinations, and oral hydration of infectious or diarrheal diseases in the previous medicinal history. Researches over time have given great insights into the treatment of this common human illness with the identification of genetic variants and strategies. The setbacks include failure of prescription of the right medicine for hypertensive patients, especially if they have other illnesses as well. Various other reasons for uncontrolled blood pressure in the past include costs of drugs, negligence of clinicians to understand the benefits of antihypertensive therapy, lack of patient instructions, \\\\\\\"white coat\\\\\\\" hypertension, uncontrolled obesity, and complex drug combinations having adverse effects on the patient\\\\\\\'s body (Oparil & Calhoun, 1998).

Evaluation of Roles of Public Health Organizations

Everyone has a role to play when it comes to preventing and controlling high blood pressure or hypertension involving government, policymakers, health workers, an academic research body, civil society, and private sector (World Health Organization, 2020a); private sector firms, particularly food and beverages giving rise to hypertension, mainly alcohol. Although hypertension is deemed to be the easiest chronic non-communicable disease to be treated but has the tendency of killing 9.4 million people worldwide and only 13 percent to be controlling it globally (Angell, Cock & Frieden, 2016). In this study, it was deducted that low-income and middle-income were capable of handling diseases like HIV, and therefore would be able to regulate hypertension as well. For that, health systems need to have approaches like standardization through public health approach with standard schedules, simplification through a focus on core involvements, and centralization to ensure delivery of treatment with the help of community workers, nurses, etc. In the same research, it was mentioned that with the collaboration of the Pan American Health Organization (PAHO) and US Centers for Disease Control and Prevention, a framework was created for hypertension treatment, which is supple enough to be used worldwide. Also, PAHO strategic fund was established for making purchase agreement through which people can now buy prescribed five of the six drugs. With the help of the same fund, the consumption of combination pills was enhanced with the application of quality assurance throughout the pharmaceutical procurement processes at the national level. The global Standardized Hypertension Treatment (GSHT) project makes sure that delivery elements are taken care of, such as patient registries, standardized treatment guidelines, task sharing within the teams, etc. Hypertension registries were made in the U.S., and an improvement in system-levels for six lacs patients was observed. World Health Assembly authorized a group of global voluntary targets for non-communicable diseases in 2013, and a reduction in blood pressure was seen by 25 percent. If this continues until the year 2025, half of the people with uncontrolled or untreated cardiovascular diseases due to high blood pressure would be further reduced worldwide.

Governments around the world are further making policies with the inclusion of which there would be a possibility of less addition of salt in food intake for citizens of their respective countries, as high sodium intake is associated with high blood pressure. In the U.K., the government has collaborated with the food manufacturers (including the private sector) to lower salt content in 85 categories of processed and packaged foods (Angell et al., 2014). Countries like the US, Canada, Australia, Brazil, and Columbia have been using the same strategy as well since small steps make a big difference, and results show that reducing salt from 2 percent to 1.4 percent in bread has reduced blood pressure levels among the citizens.

A study conducted by Allen et al. (2016) among the underserved populations of the U.S. revealed that community health workers\\\\\\\' role is crucial in preventing and controlling blood pressures in the patients. They work closely with the health providers and assist in delivering important information to the patients, especially in defeating the obstacles to medication adherence. They communicate with patients through individual clinical meetings or home visits if needed.

The role of academia and professionals would be climacteric in preventing hypertension as well since the educational training of physicians, nurses, and health workers would improve the control of this disease. This is corroborated with the study that was conducted by Zweifler et al. (1998), showing that education with simulated patients (SPIs) was beneficial in enhancing the counseling skills of the physicians to the hypertensive patients. Their medical communication skills were better than the students who were still in the preparation stage and could positively affect the testing, treatment techniques, and follow-ups.

The role of civil society is equally important in the prevention of hypertension, especially the family members, since they are the closest to the patient. A study was conducted in Western Nigeria among 360 hypertensive respondents via questionnaire to see the support of their family members (Ojo, Malomo & Sogunle, 2016). The B.P. control rate was medium among the study respondents but was 46.4 percent higher than the former local studies. In addition to that, personal education of the patient about hypertension and knowledge of lifestyles have encouraging effects on blood pressure control (Beigi et al., 2014). Changes in lifestyle and increased physical activity are reported to reduce blood pressure along with home B.P. monitoring, reinforcement of health behaviors such as eating more fruits and vegetables and reducing the intake of sodium, and continuous follow-ups.

Demonstration of Epidemiology

Despite various modern interventions of the medicinal field for the prevention of hypertension, high blood pressure remains the reason for disease and disabilities globally. World Health Organization (WHO) analyzed that hypertension was more predominant in low and middle-income countries, its highest prevalence in the WHO African region with 27 percent and 18 percent in the WHO American region (World Health Organization, 2019b). The existing trend was observed to be increasing from 1975 to 2015, from 594 million to 1.13 billion in low and middle-income countries. The percentage ratings of people who were recommended antihypertensive medicines for their high systolic or diastolic blood pressure in the U.S., counting Whites, Blacks, Asians, and Hispanics, were calculated by the ACC/AHA guidelines 2017 (Muntner et al., 2018). The overall percentage consisted of 31 percent of the U.S. adults for being prescribed antihypertensive pills, out of which men were 32 percent and women 30 percent. The age groups that were conspicuous in this representation were 20-44 years being 14 percent, 45-54 years being 22 percent, 55-64 years being 41 percent, 65-74 years being 87 percent, and 75 years and above were the highest, being 100 percent. The racial categorization was as follows: 32 percent Whites, 27 percent Blacks, 27 percent Asians, and 33 percent Hispanics.

Blood pressure is considered as a risk factor for several diseases, primarily for cardiovascular disease (Rahimi, Emdin & MacMahon, 2015). It was proved that a log-linear relation was present between blood pressure and vascular mortality at all levels of blood pressure. 20mm Hg lower systolic blood pressure (SBP) was linked to a hazard ratio of 0.60 for mortality. The causes for vascular mortality were studied, and a 20mm Hg reduction in SBP was there. According to sex, there were modest differences in mortality per 20mm Hg of lower SBP since it was slightly lower in men as compared to women. Based on ethnicity, the risk of heart disease was higher and was more prevalent in Australian and Asian older generations as compared to younger ones. The strength of stroke was greater in Asia in comparison to Australia. However, the type of strokes would be varied in every region, such as Europe, the U.S., Australia, and Asia.

Moreover, the connections between measured blood pressure and serious events were studied through Cardiovascular Research using Linked Bespoke Studies and Electronic records (CALIBER) project. According to this, the age group of 30 to 59 years was linked to stable angina or chest pain and ischemic stroke, while people above 80 years had chances of the same fatalities. Some other factors were identified which were responsible for high blood pressure; for instance, black men have a high rate of hypertension (43%) as compared to white men (34%), and black women had high rates (45%) as compared to white women (31%)- the reason is mainly the difference in antihypertensive therapy and environmental pressures (Rahimi, Emdin & MacMahon, 2015). Socioeconomic status, education, income, race, and rural and urban areas are also inclusive of the factors determining high blood pressure.

Other major risk factors are the consumption of an unhealthy diet, excessive use of sodium in food intake, a diet high in saturated fats, eating fewer fruits and vegetables, stress, low physical activity, excess intake of alcohol and tobacco, and obesity (World Health Organization, 2019b). The disease determinants include morning headaches, irregular heart rates, changes in vision, nosebleeds, and ear buzzing sounds. Serious determinants can entail nausea, vomiting, exhaustion, worry, chest pain, and muscle trembles.

The predictive powers of systolic and diastolic blood pressures have been anticipated in the same research (Rahimi, Emdin & MacMahon, 2015). For mortality of stroke, SBP has higher predictive power as compared to DBP. It has been observed that different studies have different results since the age distribution of participation has a great effect on the results. Among men aging from 45 to 57 years, there was a growing risk of cardiovascular mortality at a given SBP rate. On the other hand, men of the ages 35 to 45 years had decreased pulse pressure at a given SBP rate. Hence, there was an increased cardiovascular risk in the old age of men as compared to the younger ones.

According to WHO, hypertension can be prevented by reducing the intake of salt, which is consuming less than 5g daily (World Health Organization, 2019b). Reducing alcohol and tobacco, increasing the consumption of fruits and vegetables, and being physically active daily are more preventive measures one should take for controlling this disease. Likewise, personal management steps should be known to the hypertensive patient, such as managing mental stress, regular monitoring of blood pressure, and personal adherence to the antihypertensive medications. Prevention of hypertension is ongoing on a worldwide scale by giving antihypertensive medicines at a low rate so that they are affordable for all income groups and arrangements of antihypertensive therapies are made; However, these preventive measures were studied to be highly dependent on income groups of various countries (Rahimi, Emdin & MacMahon, 2015). Globally, hypertension is seen mainly among African Americans, middle or old age individuals, and socially disadvantaged. When regional differences were studied, it was identified that the south-eastern region in the U.S. comprised the highest rates of hypertension cases (Whelton, 2015). In China, the northern states were spotted to have a higher number of hypertension cases as compared to southern ones. Other regions such as Europe, Africa, the Arabian peninsula, and North-Africa were investigated as well, and it was proclaimed that hypertension rates were depending on factors like body mass index, diet, physical activity, and environmental factors. Awareness, treatment, and control strategies have upgraded over time with the advancement of medicine and technology. However, still, there needs to be more intervention on a country-wide basis in the US, England, and Japan. The age groups 35 to 84 years have seen improvements in hypertension control between 1980 and 2009; the improvement rates were 59 percent, 32 percent, and 25 percent, respectively.

Identification and Comprehension of Global Factors

Hypertension has been regarded as one of the most complex diseases since there is a diversity of global factors that affect it in various ways. The environmental determinants of health concerning hypertension are noise, especially during the night time, and air pollution (Basner, Riggs, Conklin, 2020). People need peace at night when they are sleeping since this is one of the major reasons for health and well-being. In the same study, it was also confirmed that noise plays less part if levels of air pollution are high, which leads to hypertension and cardio diseases.

The social determinants of health are income and education level. There is seen an inverse relationship between hypertension and both of these factors (Mill 2019). With low education and income, high blood pressure is seen in the Brazilian population, especially among adults aging from 20-59 years. In another study, it was learned that racial disparities affect several other factors of hypertension as well, such as salt sensitivity, body mass, and resistance to hypertension (Lackland, 2014). Salt sensitivity was seen in African American and Caucasian women, but their magnitude of blood pressure was increasingly different. Body mass is said to affect blood pressure, and since African Americans were seen as more obese, their blood pressure measurements did not explain any disparity in other racial groups. The resistance to hypertension was also weak among African Americans and refractory hypertension, which is defined by the intake of five or more antihypertensive medicines with blood pressure more than 90mm Hg, was still high as compared to other racial groups.

Moreover, if blood pressure is detected at earlier years of age, then there are high chances that at later stages, this disease would be inevitable. Blacks with ages above 30 years were observed to have higher blood pressure as compared to Whites. To mitigate the disparities in racial and ethnic groups regarding hypertension prevention and control, a study was conducted entailing mostly African Americans, and the results showed that no significant disparities were reduced since many groups are understudied (Mueller et al., 2015). Thirty-nine interventions were conducted, out of which 27 showed slight improvements in B.P. control but rigorous evaluation of practical, maintainable, and multi-level intervention is required.

The cultural determinants of health in regards to hypertension are the knowledge, beliefs, and attitudes in self-management. A study was conducted in African-American men living in South Eastern U.S., and the results revealed that there was an increased awareness among this population since they were highly exposed to this problem themselves (Long, Ponder & Bernard, 2016). Increased use of medication was observed due to their own perceived severity of the disease. Further, it was observed that African-American people were more susceptible to hypertension, and this was low if they observed any health event in the later stages of their life. The perception of low susceptibility was in a specific age group, 18-49.

Moreover, the dietary patterns and eating behaviors passed down to them generation to generation were also included in the determinants of hypertension in the same population, who agreed that their cardiovascular diseases were more related to their eating habits as compared to Whites. Likewise, their belief played an important role in controlling hypertension, especially after it was diagnosed. They were determined to make unhealthy food choices themselves, and for that, they took antihypertensive medications. They believed that they were forced to eat healthily and thought their identity is affected when the disease took control over them in this way. Their use of medication was deemed as their struggle to take control of their bodies again and discontinued treatment when they felt better. This showed that culture and behaviors had a great impact on the use of medicines and how one individual allows the disease to react to his body.

The behavioral determinants include consumption of alcohol and tobacco, unhealthy eating habits, stress, and lack of physical activity. A study proved that stress is directly related to increased cardiovascular diseases, which has repercussions in the form of low physical activity and unwholesome diet (Sabzmakan et al., 2014). The participants of this study belonged to Iran, and they disclosed that stress made them eat more and made unhealthy choices in such cases, along with being demotivated to remain physically active. This study also discussed that people who had positive attitudes towards a healthy diet and being physically active did not change their behavior. Having less knowledge about the health determinants and the disease did not have as much impact on the control of blood pressure as own perception of barriers, motivations, perceived benefits, and goals had.

The biological determinants of health concerning hypertension include the genetic background of the families and also if the siblings are twins (Mill, 2019). The commencement of hypertension in this regard is from 34 to 64 percent. Even the individual values are highly dependent and extremely variant in each person\\\\\\\'s case due to the diversity of organs, systems, and mechanisms. Blood pressure is also greatly affected by non-genetic factors such as physical exertion, nourishment, alcohol, and tobacco, obesity, and insulin resistance.

Examination and Analysis of Impact of Concepts Related To Prevention, Detection, and Control

Hypertension is a global issue and can be controlled and prevented by the use of population-based strategies. A multi-level approach could be established with the collaboration of the patients and health providers, also known as the Chronic Care Model, for the control of hypertension (Carey et al., 2019). A team-based care strategy has to be adopted, and for this, the organizational interventions helpful in creating such teamwork are clinicians, health care firms, and communities. The team-based strategy is suitable for detecting and controlling hypertension since a group of nurse practitioners and doctors would be responsible for home telemonitoring, as the patient would be self-monitoring his blood pressure, which is a good sign for personal adherence to the treatment. The readings can then be transferred to the concerned doctors and health care professionals for the prevention of this disease. Further, masked hypertension and white coat blood pressure are more dangerous than normal blood pressure, but in the U.S., there are no proper clinical measures for detecting it. Ambulatory B.P. monitoring needs to be made effective in the country so that its knowledge training could help prevent the disease.

The role of community is fundamental in detecting and controlling the disease since partnerships with community groups like religious and senior citizen organizations, civic and philanthropic groups could be beneficial in influencing local food orientations in diverse and ethnic groups of the country (Carey et al., 2019). These organizations can deliver messages to the patients by educating them about the lifestyle support services and establishing referral programs for the screening of cardiovascular disease risk factors.

The role of health workers is very cost-effective since their intervention is affordable for low and middle-income groups. It was observed in a study in Argentina that patients who participated in health-worker led programs had more decreased hypertension as compared to the patients who received usual medical care (Carey et al., 2019). Cost-effectiveness can also be observed with the use of advanced technology. High-speed communications can aid in quick detection of the problem on the patient\\\\\\\'s side. They can be directed to the doctors through telephone-based interactions or even on video calls. In remote primary care, telemedicine has been reported to be productive in monitoring patients at home and providing control solutions within time.

The financial consequences of the delivery of detection, prevention, and control of hypertension are different for short-term and long-term costs concerning diagnosed and undiagnosed hypertension in the U.S. (Nuckols et al., 2011). The care payers are concerned about the potential costs and the benefits they would reap in preventing and controlling hypertension. The study deduced that $187 per person annually as required, including $213 for hospitalization of hypertension patients. If improved care was requisite, then $449 annually and $122 for hospitalization was in need. In actuality, only half of the patients get the achieved goals for improved control of the disease with these cost interventions. If the costs are incurred by $170 per patient, then 20 percent of the population would be able to achieve those goals. These estimates would increase the annual costs from the U.S. $29.5 billion to the U.S. $42 billion.

Identification and Comprehension of the Role of Public Health If This Becomes an Emergency

The national Hypertension Control Roundtable (NHCR) has already set a goal until 2025 that needs to be achieved in regards to controlling hypertension. The organization aims to achieve at least an 80 percent control rate until 2025 (Centers for Disease Control and Prevention, 2020b). For this purpose, public health associations, professional health care providers, health plans modifications, and managed care organizations are working in collaboration.

This public health issue might become a public emergency in the United States if hypertension is not treated adequately or monitored poorly either at the hospitals or homes personally by the patents. Non-adherence to the medications being one of the factors leading to heart diseases, strokes, renal failure, or organ damage. Certainly, this would increase the costs of cardiovascular diseases in the hospitals, and managing expenditures for such patients would skyrocket. It was estimated in the year 2010 that hypertension is one of the most costly diseases of cardiovascular damages accounting for up to $69.9 billion (Kirkland et al., 2018). The national costs over the 12 years, from 2003 to 2014, have been tallied up to $131 billion in annual health expenditure. The individual hypertension expenditures are higher than the non-hypertensive patients, which are $2000 greater; similarly, the costs related to hypertension emergency visits from the years 2006 to 2013 were $1800 in 2013 from being $956 in 2006 (Janke et al., 2016). The in-patient hypertension cases are shifting towards out-patient cases, and the out-patient clinical settings have to be shaped to accommodate the increased hypertension cases if this health issue becomes an emergency. Additionally, the in-patient costs are 2.5 times higher than the out-patient ones, but if the patient is shifted to home care, then home-based expenditures are expected to increase as well.