Reducing Risk Factors for Hypertension

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Hypertension awareness, treatment and control are major health promotion initiatives spurred on by the Joint National Committee for Detection, Evaluation and Treatment of High Blood Pressure. Initiatives have improved over the last three decades but have slowed since the JNC V guidelines were published (JNC VI, 1997). Because treating hypertension almost always involves making lifestyle changes to control risk factors it is an excellent as topic for a teaching plan. In a primary care practice or other health care provider the Nurse Practitioner can have a positive impact on prevention and management of hypertension through patient education and counseling. The nurse practitioner is often the first provider seen when a new patient comes to the provider. The Nurse Practitioner performs the initial evaluation and sets up a care plan that includes primary and secondary prevention strategies.

Learning Need

Cardiovascular disease accounts for a large portion of morbidity and mortality in developed countries. With the current focus of cardiovascular research it has become broadly accepted that recognition and treatment of high blood pressure and high cholesterol have a much greater impact on the development of disease than was previously recognized. (Murray, 2003) Epidemiologic data suggests that a five mmHg reduction in systolic BP on average, in Americans would reduce stroke mortality by 14%, heart disease mortality by 9% and overall mortality by 7% (Duluth, 2003).

Primary prevention of hypertension is an essential component to reduction of morbidity and mortality of cardiovascular disease. According to the JNCVI guidelines: Effective population wide strategies to prevent blood pressure rise with age and to reduce overall blood pressure even by a little would effect overall cardiovascular morbidity and mortality as much if not more than only treating those with established disease (JNC IV, 1997). This theme is repeated throughout the cardiovascular literature. Hypertension is one of the most important and reversible risk factors for cardiovascular disease. Prevention is key and it has become clear that there are very effective ways to accomplish this (Duluth, 2003).

Risk factors for developing hypertension include smoking, dyslipidemia, diabetes, age greater than 60 years, family history of cardiovascular disease that occurred early (under age 65 in women, under age 55 in men), and any signs of clinical cardiovascular disease. (JNC VI, 1997). An additional risk factor clearly identified in the literature is obesity. Two out of three adults in the United States are classified as overweight or obese (Manson, 2003). Weight reduction has been shown in many studies to reduce blood pressure. Recent studies also demonstrate a relationship between the weight loss, decrease in blood pressure and insulin sensitivity (Reaven, 2003).

Every geographical area has it’s own idiosyncrasies. For example the Lehigh Valley - Pennsylvania area, is rich with Pennsylvania Dutch culture and the untoward consequences of the dietary habits associated with it. Review of risk factors specific to this area indicate that 45% of the population are greater than age 55, 35 % of the population are more than 10% above ideal body weight, and less than 25 % of the adult population admits to participating in moderate physical activity at least three days per week.

Many practices see a large proportion of overweight patients with multiple risk factors for the development of hypertension. Patients were interviewed with identified risk factors or with already diagnosed hypertension in the early part of this clinical rotation I found a mix of awareness regarding their own risk factors, and potential strategies to reduce risk. Interestingly many patients that were already being treated with antihypertension agents and lipid lowering drugs responded to risk management questions, saying they were already being treated so it was of little importance to...
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