Evaluation of Epidemiological Problem (Hypertension)
Instructions:
This paper should clearly and comprehensively identify the disease or population health problem chosen. The problem must be an issue in your geographic area and a concern for the population you will serve upon graduation with your degree. The paper should be organized into the following sections:
1. Introduction with a clear presentation of the problem as well as significance and a scholarly overview of the paper.
2. Background of the disease including definition, description, signs and symptoms, and current incidence and/or prevalence statistics current state, local, and national statistics pertaining to the disease. (Include a table of incidence or prevalence rates by your geographic county, state, and national statistics.)
3. A review of current surveillance methods and any mandated reporting or methods for reporting the disease for providers.
4. Conduct descriptive epidemiology analysis of the disease including who is more frequently affected and characteristics of the population that might help in creating a prevention plan. Include costs (both financial and social) associated with the disease or problem.
5. Review how the disease is diagnosed, current national standards for screening or prevention, and pick one screening test and review its sensitivity, specificity, positive predictive value, cost and any current national guidelines for conducting which patients to conduct this test on.
6. Provide a brief plan of how you will address this epidemiological disease in your practice once you are finished with school. Provide three actions you will take along with how you will measure outcomes of your actions.
7. Conclude in a clear manner with a brief overview of key points of the entire disease,
PREPARING THE PAPER
• Page length: 7-10 pages, excluding title/cover page
• APA format 6th edition
• Include references when necessary.
• Include at least one table to present information somewhere in the paper.
Solution.
Evaluation of Epidemiological Problem (Hypertension)
Studies have been conducted on blood pressure, and they show that it is vital to keep it as low as possible for someone to enjoy good health. They show that blood pressure can be reduced below the recommended levels with many benefits to the body such as reduced risk of strokes and heart attacks. Research conducted by the National Institutes of Health on systolic blood pressure suggest that people who are older than 50 ought to maintain a systolic blood pressure of 120 mm Hg(“High Blood Pressure Facts | cdc.gov”, 2017). It is clear that most of the diseases that affect people today are mainly lifestyle diseases that could be mitigated by proper diet, exercise and general health living. This paper will look at hypertension in greater detail with emphasis on South Florida as well as on a national level.
When the blood pressure elevates to chronic levels, it is referred to as hypertension. Chronic levels are when the recorded blood pressure is more than 140 over 90mm Hg. If hypertension is left unchecked, it increases the risk of conducting other conditions like peripheral artery disease or even a stroke. Blood pressure, as the name suggests, is the force that blood exerts against the walls of vessels like veins and arteries. The magnitude of the force is dependent upon the resistance of the blood vessels as well as the cardiac output. One of the main dangers of hypertension is that most people don’t know that they have the disease. In fact, almost one-third of people suffering from hypertension are not aware that they have it. The most efficient way of determining whether you have blood pressure is by going for regular tests and check-ups. It is even more important to get checked if there is a history of high blood pressure in your family since it has some traits that are hereditary. Some symptoms may be observed, but that is only because the blood pressure is extremely high. They may include severe headaches, laboured breathing, constant fatigue and confusion, blood in the urine, chest pains, vision problems and an irregular heart beat amongst others.
One of the leading causes of death in the United States is stroke and heart disease which are brought about by acute hypertension (Izzo, Black, & Goodfriend, 2003). Roughly 75 million Americans, about one in every three adults, are suffering from high blood pressure. In the United States, women are as likely to contract hypertension as men however it affects more men than women for people aged 45 years and younger (“High Blood Pressure Facts | cdc.gov”, 2017). Hypertension is most likely to affect more women than men only when the age bracket is 65 years or older.
Blood Pressure Statistics in Florida
| GENDER | Blood Pressure(%) | Population Affected(‘000) |
| Male | 37.2 | 2794.8 |
| Female | 32.1 | 2580.2 |
| AGE | ||
| 18-44 | 13.9 | 917.2 |
| 45-64 | 41.0 | 2171 |
| 65+ | 62.6 | 2286.7 |
| RACE/ETHNICITY | ||
| White | 38.4 | 3365.1 |
| Black | 33.7 | 682.7 |
| Hispanic | 28.3 | 965.9 |
Source: CDC, Behavioral Risk Factor Surveillance System, 2013
National Prevalence Statistics by Age
| Age | Men (%) | Women (%) |
| 20-34 | 11.1 | 6.8 |
| 35-44 | 25.1 | 19.0 |
| 45-54 | 37.1 | 35.2 |
| 55-64 | 54.0 | 53.3 |
| 65-74 | 64.0 | 69.3 |
| 75 and above | 66.7 | 78.5 |
| All | 34.1 | 32.7 |
Source: Centre for Disease Control (CDC) 2017
Hypertension also varies across different ethnic communities, and it is important to realise that so as not to generalise only by age and gender. The table below shows how hypertension is distributed across different ethnic communities.
Prevalence According to Ethnicity
| Race/Ethnic Group | Men (%) | Women (%) |
| African Americans | 43.0 | 45.7 |
| Mexican Americans | 27.8 | 28.9 |
| Whites | 33.9 | 31.3 |
| All | 34.1 | 32.7 |
Source: Centre for Disease Control (CDC) 2017
Monitoring and surveillance of situations that increase the risk of cardiovascular diseases and blood pressure are critical if we are to stem the incidence of the disease. Many countries don’t have the necessary capacity for conducting adequate national surveillance on the disease. One of the key reasons why there is the lack of the ability is because the indicators of hypertension are reported in are reported in different ways hence making it difficult to assess and compare progress. The World Hypertension League assembled a committee to draft a standardised set of the leading indicators to assist with the reporting. Methods of reporting the disease are based on the surveillance conducted. Reporting of the disease is done by referring to the core indicators involved with hypertension.
Distribution of Blood Pressure
Distribution of systolic and diastolic blood pressure within the adult population in association with their standard deviations is one of the ways of conducting surveillance. Standard deviation could be influenced by outliers and hence the first and third quartiles as well as the median ought to be reported (Gee et al., 2014).
Prevalence of Hypertension
There are two main estimates of the prevalence of high blood pressure. One is the percentage of the adult population with DBP≥90mm Hg or SBP≥140mm Hg and has reported taking medication for high blood pressure after self-diagnosis. The other estimate involves adults who have a DBP≥90 mm Hg or SBP≥140mm Hg and have already been diagnosed with hypertension by a physician (Gee et al., 2014).
Prevalence of Hypertension Awareness
It is the part of the adult population that have been diagnosed by a physician or those who are taking medication for blood pressure.
Prevalence of Treatment of Hypertension
The percentage of the adult population wit hypertension like the first description above and are reported to be taking medication for high blood pressure.
Prevalence of Controlled Hypertension
Percentage of adults who have hypertension and have reported to be taking medication with a DBP<90mm Hg and SBP <140mm Hg. Awareness, treatment, control and prevalence ought to be expressed as percentages (Gee et al., 2014). It is important to report the sample size as well as features of the sample used in obtaining these statistics.
Hypertension is a condition that could affect anyone, but it mainly affects adults. On the other hand, it is a lifestyle disease, and hence there are various factors determining people who face the highest risk of getting high blood pressure. The people affected depend on many different factors:
Age
As people age, the risk of high blood pressure goes higher. In America, 65% of individuals above the age of 60 have issues of high blood pressure.
Weight Issues
Obese/overweight people are at an increased risk of developing high blood pressure as opposed to lean individuals who exercise.
Race/Ethnicity
Our table showed us that the prevalence of hypertension is also influenced by the ethnicity of the person. High blood pressure in Caucasians and Hispanics is considerably lower than that of the African American population. The figures show that high blood pressure mostly affects the African American community most severely.
Gender
Our table also showed us that gender is a major determinant when it comes to high blood pressure. Men are more likely to develop high blood pressure than women when the age bracket is 55 and below (“High Blood Pressure Facts | cdc.gov”, 2017). Above that, women are at a higher risk than their male counterparts.
Lifestyle Habits
Unhealthy ways of living might increase the risk of developing high blood pressure. Some of the practices that constitute poor lifestyle habits include stress, drinking excessive alcohol, poor diet and lack of physical exercise.
Family History
Another group that is at a very risk of developing blood pressure is those who have a history of cardiovascular diseases in their families. Genetic causes are a significant factor in this condition.
Economic and Social Impact of Hypertension
In America, high blood pressure is one of the original chronic medical conditions that necessitate people to visit their health care, providers. There are roughly 75 million Americans with high blood pressure, and a significant chunk of these are those that do not have their blood pressure at the recommended level of <140/90mm Hg. It implies that the huge percentage consists of Americans that are at the risk of developing severe conditions brought about by high blood pressure. The medical, human and economic costs associated with inadequately controlled and untreated blood pressure are high. The economic impact is huge, and a good example is that in 2011, the total costs in association with high blood pressure in America were $46 billion. The figure accounts for medication, healthcare services as well as missed days of work. Out of every six dollars involved in healthcare, one dollar goes towards cardiovascular ailments.
When considering the cost of hypertension in the U.S., we must remember that high blood pressure is the gateway to other serious cardiovascular diseases like strokes and diabetes among others (Weir, 2005). These diseases affect people thus limiting their contribution to society and lowering the quality of life. If someone happens to suffer a stroke due to hypertension, they may become paralysed, have speech impairments or other disabilities as well as emotional problems. All these factors add up to the enormous social cost of hypertension. In the United States, one out of every three deaths is as a result of some cardiovascular disease, and hence it means that working people are no longer able to contribute to the economy. Most of the deaths that are brought about by hypertension-related ailments occur in people below the age of 65, and that is a big blow to the economy since that accounts for lost productivity.
Diagnosis and Screening
Diagnosis of hypertension is performed by taking the blood pressure readings at a clinic over some visits. It is done with the use of a sphygmomanometer (Weir, 2005). A single isolated reading that is high is not taken to imply that the patient has hypertension since several readings must be done to come up with an accurate diagnosis. Apart from using the sphygmomanometer, the doctor will also inquire about the patient’s history with cardiovascular conditions and perform a physical examination before forming a diagnosis.
The U.S. Preventive Services Task Force or (USPSTF) is in charge of recommending the best possible clinical preventive services for patients. The benefits of medical screening when it comes to high blood pressure are well documented. Studies by the body have shown that screening has minimal negative impacts on the patient but the benefits are substantial. USPSTF also found out that when adults undergo screening for blood pressure, the incidence of cardiovascular diseases is reduced significantly. Three primary testing methods were used: office blood pressure measurement, home blood pressure monitoring and ambulatory blood pressure monitoring.
Office Blood Pressure Measurement
Office analysis is mainly done using a manual or automated sphygmomanometer. In hypertension treatment, most clinical trials use the average of two measurements that were taken while the patient was sitting down. The patient is allowed into the office, and blood pressure measurements are made five minutes later (“Final Recommendation Statement High Blood Pressure in Adults: Screening – US Preventive Services Task Force”, 2017). During measurement, an arm cuff of appropriate size is placed on the patient at the level where the right atrium is. Multiple measurements conducted over time will give us a clearer picture as opposed to a single measure. Automated office blood pressure is the average of several other automated tests taken while the patient is in a room alone.
Various short-term factors like pain, stress, emotions, drugs and physical activity will affect the blood pressure. Epidemiologic data has shown that 15-30% of people who suffer from hypertension will record low blood pressure while they are outside the office setting. The significant drawbacks associated with making measurements within the office environment include the limited number of tests that could be conducted, errors in measurement and the tendency for isolated clinic hypertension. USPSTF recommends all adults that are above the age of 40 to go for an annual screening as well as people who find themselves at significant risk of developing high blood pressure. People aged between 18 and 39 with regular blood pressure measurements (<130/85mm Hg) should be rescreened after every 3-5 years if they are not at a high risk of hypertension (“Final Recommendation Statement: High Blood Pressure in Adults: Screening – US Preventive Services Task Force”, 2017).
When I begin my practice, I am going to maintain a keen interest in matters of hypertension and how to mitigate it. One is that I will advise my patients to keep a low intake of salt throughout the day. I will recommend that they maintain a salt intake that is 5g or less so as to reduce their blood pressure. Another is education concerning hypertension since most of the people tend to ignore it because it poses no symptoms. I will educate my patients about the condition and ask them to give me some feedback so as to assess their comprehension of the situation. Thirdly, I will recommend a good exercise regime, and balanced diet then conducts follow-up on other visits to ensure that they adhere to it.
Conclusion
We
have seen that hypertension is a lifestyle disease that could be easily
mitigated if people had sufficient information. Hypertension in itself is not
dangerous, but if left unchecked, it may give rise to serious cardiovascular
problems and hence it is important to ensure that blood pressure is maintained
at the recommended level (Weir, 2005).
References
Final Recommendation Statement: High Blood Pressure in Adults: Screening – US Preventive Services Task Force. (2017). Uspreventiveservicestaskforce.org. Retrieved 7 February 2017, from https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/high-blood-pressure-in-adults-screening
Gee, M., Campbell, N., Sarrafzadegan, N., Jafar, T., Khalsa, T., & Mangat, B. et al. (2014). Standards for the Uniform Reporting of Hypertension in Adults Using Population Survey Data: Recommendations From the World Hypertension League Expert Committee. The Journal of Clinical Hypertension, 16(11), 773-781. http://dx.doi.org/10.1111/jch.12387
High Blood Pressure Facts | cdc.gov. (2017). Cdc.gov. Retrieved 7 February 2017, from https://www.cdc.gov/bloodpressure/facts.htm
Izzo, J., Black, H., & Goodfriend, T. (2003). Hypertension primer (1st ed.). Philadelphia: Lippincott Williams & Wilkins.
Weir, M. (2005). Hypertension (1st ed.). Philadelphia: American College of Physicians.