Hypertension (Hystolic Blood Pressure (SBP)

ASSESSMENT:

Hypertension is a general disease that is basically defined as continual elevated arterial blood pressure (BP).1 Blood pressure measurement for adults in the absence of acute end organ damage are classified as follows: Normal blood pressure is indicated if Systolic blood pressure (SBP) is less than 120mmHg and Diastolic blood pressure (DBP) is lower than 80mmHg and required to be rechecked in two years, Prehypertension is defined if SBP is between 120-139mmHg or DBP within 80-89mmHg and required to recheck in one year, stage 1 hypertension is defined as SBP between 140 -159mmHg or DBP of 90-99mmHg and need to be proven within 2 months and Stage 2 hypertension is SBP of 160mmHg or higher or a DBP of 100mgHg or higher and need to

be re-evaluated within 1 month or within 1 week if the SBP is greater than 180mmHg and DBP is greater than 110mmHg.2 Most patient with hypertension have Essential hypertension, more evaluation is required but not normally necessary except when blood pressure control is not achievable. While elevated Blood pressure was supposed to remain “essential” for sufficient perfusion of essential organs in the early and middle 1900s, it is currently recognized as one of the most relevant risk factors for cardiovascular (CV) disease. Intensify recognition and diagnosis of hypertension, and educating of control of BP with suitable treatment are considered important public health initiatives to reduce rate of cardiovascular morbidity and mortality. The prevalence of hypertension in the United States was similar for women and men and at almost one-third. The prevalence of hypertension among 18 years of age and above was 29.1% in 2011-2012 and was similar among women (28.5%) and men (29.7%).3 There was notable increase prevalence with age and was highest among Elderly. 7.3% increase among age 18-39, 32.4% increase among age 40-59 and 65% among age 60 and above. The prevalence of hypertension was seen to be highest among non-Hispanic black adults (42.1%) when compared with non-Hispanic white (28.0%) and Hispanic (26.0%) and Asians (24.7%) adults. In 2011 to 2012, roughly about 82.7% of adults with hypertension were aware of the disease and about 75.6% were reported taking prescription drug to treat the condition and about 51.8% had their blood pressure controlled. Hypertension is the first and fourth leading cause of death in United States of America.4 Approximately seventy million American Adults (29%) have high blood pressure which implies that 1 in every 3 adults have high blood pressure. Record from CDC also shows that approximately one in three American Adults has prehypertension and merely about half (52%) of the people with HBP have their conditions under control. In 2013, HBP was the main contributing root of death for about 360,000 American which implies that almost 1,000 death daily. The cost of High blood pressure to the nation each year is about 46 billion dollars. This includes the cost of medication to treat HBP, cost of health care services render and missed days at work. Blood pressure monitoring and control among individuals with hypertension can decrease the risk and chances of cardiovascular disease. For majority of the people with hypertension, the causes is unknown.2 However, hypertension is mostly common in people with a positive family history of the disease. The risk for the disease cannot be removed but lifestyle medication can greatly reduce the risk.

Certain factors contribute to the chances of having this disease. The risk factors include the following, Advance age, gender, the disease is generally common in men than women up until age 45 years.2,5 Within the ages of 45 and 65 years of age the number of women and men with hypertension is almost the same.5 Other contributing risk factors are disease states such as diabetes, hyperlipidemia, family history with cardiovascular disease or early death of cardiovascular disease, too much consumption of salt in diet, smoking, sleep apnea, obesity, high carbohydrate intake, high calories consumption, and fatty diet with low essential nutrients.5 Excess alcohol intake, physical inactivity and psychological factors such as stress are also risk factors for hypertension. Never the less certain prescription such as corticosteroids, anti-depressants (especially buspirone or venlafaxine) , Non-steroidal anti- inflammatory drugs, and non- prescription drug such as herbal products can also cause an elevated blood pressure. Our Patient JJ has some risk factors that may have contributed or predisposed him to this disease called hypertension. His father died of heart attack at the age of 50, mother alive with hypertension, diabetes and hypocholesteremia, brother died of heart failure at

the age of 50. He also like to eat out and a lot of frozen package food which most time contains a lot of sodium as a form of preservatives, he eats a lot of fast food and drinks bear daily. He is 58 years old and male in gender with some disease state that may be a contributing factor for the disease he has a current medical history of dyslipidemia and he is also taking self prescribe Naproxen which also contains sodium salt and have tendency to elevate his blood pressure. JJ claimed his job is stressful, stress is one of a contributing factor to elevated blood pressure and he may not be having enough rest or sleep. Hypertension is classified based on
Hypertension is a risk factor for other cardiovascular disease such as coronary artery disease (CAD), heart failure, stroke, transient ischemic attack(TIA), peripheral artery disease.5 Complications from hypertension is not only limited to cardiovascular disease alone, other complications include dementia, Benign nephrosclerosis, Chronic kidney disease, hypertensive retinopathy, vitreous hemorrhage, arteriolosclerosis and aneurysm and even death.

JJ faces the risks of complications of heart failure, stroke, coronary artery disease and death if not well monitored, managed or treated. There is no cure for hypertension but hypertension can be properly managed. According to JNC 8 classification of hypertension JJ ,can be classified as a stage one hypertension patient since his blood pressure is 159/90mmg .The primary goal of therapy for Hypertension is to lower the blood pressure back to normal to avoid progression of the disease to the next stage and decrease hypertension-related morbidity and mortality.1,6Based on the 8th National committee (JNC) , the guideline for the management of hypertension recommends a target goals of less than 140/90 mmHg for patient less than 60 years of

age.6
The main goal of therapy for jj, will be to normalized his blood pressure to less than 140/90mmHg, improve his quality of life and reduce any chances of other cardiovascular disease such as stroke and peripheral artery disease. Decreasing Blood pressure goal is linked to decreasing the risk of hypertension- related target organ damage. Decreasing cardiovascular risk is the ultimate objective of hypertensive therapy and the choice of drug is determined based on the stage of the disease and any other cardiovascular disease or cardiovascular risk reduction.