Beruflich Dokumente
Kultur Dokumente
Amy Angell
NUR 211
Hypertension
Abstract
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
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
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
clinical interventions, with counseling and education being the top tier. The lower level to be
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.
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
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
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
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
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
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
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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communicable diseases 25% by the year 2025. This is hoping to be achieved by focusing on
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
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,
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
http://www.cmaj.ca/content/181/9/605.full#ref-14
Skolnik, R.(2016). Global Health 101 Third Edition. Burlington, MA: Jones & Bartlett learning