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Running head: HYPERTENSION

Health Impact Framework: Hypertension

Amy Angell

Delaware Technical Community College

NUR 211

Kelly Davis, EdD, MSN, RN

NOVEMBER 25, 2017


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Hypertension

Abstract

“Cardiovascular disease accounts for most of the non-communicable disease deaths at

about 17.7 million people annually, followed by cancers (8.8 million), respiratory diseases

(3.9million), and diabetes (1.6 million). Cardiovascular disease is the number one cause of

death globally more people die from this than any other disease” (Mills et al., 2016). There has

been a recent shift in deaths to non-communicable diseases due to increased life spans, and

reduction of communicable diseases. Cardiovascular disease covers a wide range of diseases

including hypertension, coronary heart disease, cerebral vascular disease, peripheral arterial

disease, rheumatic heart disease, congenital heart disease, deep vein thrombosis and pulmonary

embolism. Many of these can be prevented by addressing risk factors such as poor nutrition,

lack of physical activity and smoking cessation (Skolnik, 2016). Hypertension is the only

condition that kills more people globally than tobacco use — more than 9 million per year

(Frieden, 2015).
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Background

“Hypertension is the leading preventable risk factor for premature death and disability

worldwide” (Mills et al., 2016). Treatment and control is vitally important not only in preventing

cardiovascular disease, but also kidney disease. “The regions of East Asia and Pacific region

have the greatest absolute burden of hypertension with 439 million people with hypertension,

and the Middle East and North Africa region have the lowest absolute burden of hypertension”

(Mills et al., 2016). Less than half of the global population is aware of their diagnosis of

hypertension. The reason for the increase of undiagnosed hypertension is because of the aging

population, urbanization with its accompanying unhealthy lifestyle. This causes a great burden

on the population in expense, the risk of death or disabilities. This is a global concern and needs

to be addressed (Skolnik, 2016). “Blood pressure does not necessarily increase with age if

sodium intake, physical activity, and other factors remain in the healthy range” (Frieden, 2015).

Some of the health determinants are your genetic makeup, sex, and age which are not things that

can be changed, but it is helpful to look at the certain population that may be more susceptible.

The big factors are the social determinants such as poverty, lack of education, poor diet, tobacco

use and lack of physical activity. Hypertension is the single most preventable cause of

cardiovascular disease and the biggest risk factor for strokes and major risk factors for heart

disease (Skolnik, 2016).

The health impact pyramid is a guide to use on how best to combat hypertension. It is a

5-tier pyramid that best describes the impact of different types of public health interventions and

provides a framework to improve health. (Frieden, 2010). At the base of this pyramid, indicating
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interventions with the greatest potential impact are efforts to address socioeconomic

determinants of health. In ascending order are interventions that change the context to make

individuals' default decisions healthy, clinical interventions that require limited contact but

confer long-term protection, ongoing direct clinical care, and health education and counseling.

Interventions focusing on lower levels of the pyramid tend to be more effective because they

reach broader segments of society and require less individual effort. Implementing interventions

at each of the levels can achieve the maximum possible sustained public health benefit (Frieden,

2010). This will be the model that will be used to show how to improve health through managing

health in the Global community. The five tiers includes socioeconomic factors, changing the

context to make individuals’ default to healthy decisions, long-lasting protective interventions,

clinical interventions, with counseling and education being the top tier. The lower level to be

discussed will be socioeconomic factors.

Socioeconomic factors

What socioeconomic factors effect why people do not get treated for hypertension? First,

we look at the people who are lacking education or have low income. What is the people’s view

on preventive care? This is where you can have the greatest impact on the society. What are

some of the socioeconomic factors? There are many factors including economic development

and the increased aging population around the globe. Also, obesity is increasing with individuals

having a more sedentary lifestyle and the availability of a more westernized diet. It is well

known that lifestyle factors play a crucial role in the development of hypertension and future

steps need to be taken to provide interventions that improve lifestyle factors (Frieden, 2015). The

prevalence of obesity is increasing, possibly due to a more readily available westernized diet.
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Another factor in this equation is the increase in individuals now living a sedentary lifestyle.

These factors may have contributed to the increased burden of hypertension in some world

regions. It is well known that lifestyle factors play a crucial role in the development of

hypertension and future steps need to be taken to provide interventions that improve lifestyle

factors in economically developed and developing countries. Interventions can include educating

the public on the effects of hypertension and importance of life style changes (Frieden, 2015).

Providing healthy foods and educational programs could help with the prevention of

hypertension. The next tier in the pyramid is changing the context to make the individuals default

to decisions of health.

Changing the context to make individuals default to decisions health

This tier of the pyramid focuses on changing the environment of the person to make it

easier to make healthier lifestyle choices, the default choice regardless of social status or

educational (Frieden, 2010). This can be achieved by providing healthier food options such as

limiting salt in foods provided eliminating Trans fat in food. High sodium intake is a leading

contributor to hypertension, and Americans consume an average of 3500 mg of sodium per day,

far more than recommended. Reducing average sodium intake by a third could save up to half a

million lives and nearly $100 billion in health care costs over the next 10

years(Frieden,2015) Sodium reduction is probably the most feasible lifestyle intervention, in

part because it can be implemented without substantive change in societal structure or consumer

behavior (Frieden, 2015). In the United Kingdom a nationwide reduction of sodium was put into

placed with significant results obtained average British sodium intake fell by 15% between 2003
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and 2011, and there was a substantial reduction in average blood pressure, a 40% drop in the

number of deaths from heart attacks, and a 42% decrease in deaths from stroke, with reduced

sodium intake estimated to account for a quarter to a third of the mortality reduction (Frieden,

2015). Another way would be to encourage a healthy lifestyle such as walking or bicycling

instead of mass transit or cars giving incentives for increasing activity

Long- lasting protective interventions

The third tier of the health impact pyramid including Long-lasting protective intervention this is

usually a one-time or infrequent interventions this could include smoking cessation which would

be a risk factor for Cardiovascular disease. Infrequent intervention could be yearly screenings

that occur to monitor for possible hypertension.

Clinical interventions

The fourth tier clinical interventions can have significant impact on hypertension and its risk

factors. The ongoing interventions such as blood pressure monitoring and reporting. Instruction

on medications and monitoring for adherence. Better implementation of the “ABCS” — daily

aspirin use for people at high risk, blood-pressure control, cholesterol management, and smoking

cessation — could save 100,000 lives yearly in the United States if rates of clinical service

utilization increase to those achieved by high-performing systems (Frieden, 2015). “Every 10%

increase in the number of people effectively treated for hypertension would lead to prevention of

an additional 14,000 deaths — a greater impact than that of any other intervention

studied. Nationally, just over half of adults with hypertension have it under control, up from
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slightly over 40% 15 years ago” (Frieden, 2015).Clinical interventions are very important in the

control of hypertension. Interventions in the monitoring of the blood pressure to hopeful catch

those undiagnosed cases of those that do not receive regular preventive care

Counseling and Education

The fifth tier in the health impact pyramid is counseling and education. Education is a big part of

prevention and treatment of hypertension, the patient needs to be educated on the consequences

of hypertension, it is not just the elevated blood pressure that is a concern, but all of the affects

and the accompanied risks, if left untreated, such as kidney failure, heart disease, and stroke. It is

important to educate on this with each patient. If the patient is fully aware of the risk factors and

possible complications they may choose to live that healthier lifestyle, take medications as

prescribed and receive follow-up care as needed. As we look at the health impact pyramid we

can look at how each of these tiers build on each other and to be successful each of the steps

needs to be looked and implement. It was noted that even with effective community intervention

the only 1 in 7 people with hypertension have it under control. Future recommendation for

improvement include including through standardized protocols that simplify availability,

delivery, and use of core blood-pressure medications and allow tasks to be delegated to nursing

and nonmedical staff, could save a million or more lives worldwide each year; a reduction of

sodium intake in conjunction with treatment could save even more( Frieden,2015). Educational

programs need to be in place to educate the public on what hypertension is lifestyle

modifications and prevention. Many low-income countries lack regular health care to screen for

hypertension. This is starting to be addressed, the United Nations meeting in Sept 2011 they
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developed an international political commitment to reduce the burden of non-

communicable diseases 25% by the year 2025. This is hoping to be achieved by focusing on

prevention, increasing funding and engaging governments (Skolnik, 2016).

Nursing implications

As the nurse, caring for the patients each day it is important to educate the patient. To

view that patient with a holistic approach to not just see the task that need to be completed and

check them off. As the nurse we need to fully inform and educate our patient on the risk of

disease and complications of not getting follow up care and life style changes. In global health

there are many roles for a nurse it could be such as a researcher in developing new strategies to

promote global health. There are also opportunities in developing countries to work in outreach

programs or clinics. In the United States there is a Global Nursing Caucus (GNC) it is a nursing

organization that has global interests they facilitate mentoring, education and programs of global

interest. The group was created to improve collaboration and disseminate information in the

growing field of global health. The World Health Organization (WHO) reports that nurses

deliver 90 percent of all healthcare services worldwide in many of the rural areas and poverty

stricken nations it is the nursing caring for these patients ( Frieden, 2015).There are possibilities

for the nurse as the leader in global decision making, education, researching, and caring for those

in need around the world are all roles of the nurse in the global community. As it applies to the

topic of hypertension the most important role is that of educator. The nurse can impact the lives

of the patient and families. The nurse can educate on the hypertension, what the long term effect

are the importance of taking medications and follow-up care.


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Conclusion

Hypertension is the only condition that kills more people globally than tobacco use — more than

9 million per year. Blood pressure does not necessarily increase with age if sodium intake,

physical activity, and other factors remain in the healthy range (Frieden, 2015). This is of

increasing global impact and something that will need to be addressed on a global scale. That as

nurses we can play a big role in prevention and the education of the patients we care for.
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References

Frieden, T. (2010, April). A Framework for PH Action the Health Impact Pyramid.pdf. Retrieved

from https://drive.google.com/file/d/0B8caG7WVJ4d4Z3g1S1FXVW95UEE/view

Frieden, T. (2015, October 29). The Future of Public Health — NEJM. Retrieved from

http://www.nejm.org/doi/full/10.1056/NEJMsa1511248?rss=mostEmailed

Mill, K.T., Bundy, J.D., Kelly, T.N., Reed, J.E., Kearney, P.M., Reynolds, K., HE, J. (2016,

August 09) Global Disparities of Hypertension. Retrieved from

http://www.cmaj.ca/content/181/9/605.full#ref-14

Mohan, S., Campbell, N. R., & Willis, K. (2009, October 27). Effective population-wide public

health interventions to promote sodium reduction. Retrieved from

http://www.cmaj.ca/content/181/9/605.full#ref-14

Skolnik, R.(2016). Global Health 101 Third Edition. Burlington, MA: Jones & Bartlett learning

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