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Topic:
Hypertension/Blood Pressure
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I will upload files to use them for the papers. You will find 8 sources that i need you to use then. That mean you do not have to make a search for sources/references. Also, other files show the way to write introduction and also the way to write the rest of the papers. Please, read the instruction in files called 3.20 Notes, Unit III Paper Assignment and Intro and Planning Outline Template very careful. Also, there is Planning Outline Template needs to fill-out in short answer. Last, file called Hypertension has table with 8 sources and topics that some sources share in the same problem or treatment.
Thank you
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Hypertension/Blood Pressure
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Introduction
In the past decade, medical officers and researchers have realized and recognized that hypertension is one of the ill health conditions which record the highest rates of mortality and is also a major cause of disability in the world. This is in spite of the fact that medical researchers have been able to bring in new and modernized methods of assessing and controlling blood pressure (BP). In actual fact, some of these methods are ineffective in the sense that they lead to diverse results which hamper effective decision-making regarding the treatment to be administered on the patients. Dissimilar medical practitioners in various countries apply different techniques with regard to assessing and controlling BP, proving that notwithstanding being used, most of these techniques are not accurate and may not be effective in providing their results to the physicians. For instance, techniques that do not effectively take into account factors such as arm position, body position, cuff size, inter-arm differences and cuff placement could lead to significantly different readings. Inaccurate measurement of blood pressure could result in misclassification of patients as hypertensive or normotensive as well as lead to inapt medical management.
Nonetheless, the methods of assessing and controlling BP should not be blamed for ineffectual control of hypertension particularly in Western nations. Other risk factors including body fitness and lifestyle influence the response to the treatment administered, and different people typically respond differently to treatment, for instance, exercising works well for some people while to some it does not. Therefore, physicians should not seek to make decisions on treatment solely on the evaluation results of the BP. They need to study a patient first prior to recommending the best mode of treatment. Some of the key varied techniques employed in controlling and assessing blood pressure include exercise training, preventive advise, using the right procedure and devices in measuring BP, as well as self-monitoring and adherence to treatment on the part of the patient. These techniques are important because they could lead to improved adherence to medication and BP control. In addition, they would most likely result to better management of hypertension and improved health outcome for the patient. The purpose of this paper is to discuss how the varied techniques of controlling and assessing blood pressure affect the treatment of hypertension.
Techniques for controlling and assessing Blood Pressure (BP) and their effects on hypertension treatment
Calhoun et al (2008, p. 4) stated that presently, hypertension affects 1 out of 6 people in the United States, and costs roughly $45.7 billion every year. Effective control of BP among patients who are hypertensive plays a vital role in decreasing the lifetime risk of stroke, myocardial infarction, and all-cause mortality. Regardless of the fact that nearly 90% of patients BPs could be controlled if adequate pharmacotherapy is prescribed, only half of patients have their BP treated to target levels. In spite of several available effectual therapies for managing hypertension, a vast majority of patients in the United States who have high BP are not controlled sufficiently, and this incapability to effectively manage hypertension can be credited to patient, provider, as well as system failures (Roark et al., 2012, p. 2). For the patients, hypertension is typically a silent illness with very few or no symptoms at all, until the beginning of lasting complications. Consequently, patients are less likely to monitor their BP closely or seek continuing follow-up with their medical teams. Moreover, patients also sometimes fall short with regard to the management of their illness – defined as the every day decisions concerning lifestyle as well as medicine observance to support better risk factor control (Roark et al., 2012, p. 6). This failure of patients to engage in monitoring and adherence to treatments detracts from the potential improvements of health linked with evidence-based medicine.
Some providers of healthcare services contribute to the inability to properly manage hypertension. For them, failure to control BP to the guideline-based goals might be connected to clinical inertia – recognizing a problem but failing to act (Roark et al., 2012, p. 3). A number of related factors play a role regarding the commonness of clinical inertia in the management of hypertension amongst providers. The first factor is that readings of BP from diverse patient encounters are usually not aggregated and communicated to the healthcare provider in a format which facilitates speedy assessment of a patient’s BP trajectory or effectual medical intervention. Presently, ambulatory BP care is embedded in having patients visit a heath facility to see a provider, complete a BP check, then obtain treatment. When the patient leaves the health facility, he/she hardly ever interacts with the provider until the following appointment, which often creates lags with regard to the management of BP.
Ray, Nawarskas and Anderson (2011, p. 6) observed that most BP values, even when measured from the office are concealed in a sequence of charts, electronic records with text or data fields that are unstructured, or in systems that do not allow inter-practice data exchange. Similarly, static and inefficient documentation of the present medical problems, allergies and medications of the patient limits the ability of the provider to react swiftly and effectively to an abnormal BP value within the ambulatory care setting. Thus, regular office visits for measurements of BP are practically unappealing and compel patients as well as providers into a model which relies on sporadic BP data for clinical decision-making. The lack of feedback as well as outcomes data to care providers for patients who are in their care limits progress on improving the level of BP.
According to Pickering et al. (2005, p. 5) payers, providers and the society at large expect patients to be active healthcare participants and partners through self-monitoring of the state of their disease and sharing this crucial information with providers in a timely manner. Remote or home self-monitoring helps to improve patient recognition levels of BP control, and this could lead to improved adherence to medication and BP control. In creating an impeccable continuum of care, a joint team of health care needs to support the management of BP. Particularly, there is need to move from systems requiring doctors to simultaneously monitor and manage patients. Rather, providers who are not physicians – pharmacists, nurses, physician assistants and practitioners – can augment care of BP by reviewing BPs frequently and regularly, and making timely therapeutic decisions with standardized algorithms. This integration of care helps to decrease frequencies of uncontrolled hypertension owing to failures of the care providers including clinical inertia and inadequate follow-up of data. Likewise, community health workers can help by engaging patients to make sure there is self-monitoring and observance to medicine.
Apart from the above method, another technique in the control of BP is exercise training as Hagberg, Park and Brown (2000, p. 2) observed. Hypertension is a highly widespread cardiovascular (CV) disease risk factor in industrialized nations, and treatment guidelines always stress on the significance of non-pharmacological interventions such as physical activity. Training has effects on both systolic and diastolic BP. Hagberg, Park and Brown carried out a research comprising 1284 hypertensive persons who initially had systolic BP> 140mm Hg, and these individuals went through endurance exercise training. Among these people, 76% drastically decreased systolic BP with exercise training. Prior to the exercise training, weighted systolic BP among them averaged 153mm Hg, while after the training, the reduction averaged 10.6mm Hg. This result implies that endurance exercise training or physical activity leads to a significant reduction in systolic BP in people who have systolic hypertension, and thus, it should be encouraged and promoted as a technique of controlling/decreasing systolic BP.
With regard to effects of physical activity on diastolic hypertension, Hargberg, Park and Brown (2000, p. 4) also conducted a research that involved 1261 people who had diastolic hypertension with diastolic BP> 90mm Hg, and who went through endurance exercise training. After the exercise training, 81% had substantially reduced diastolic BP. Prior to the training, they had on average a weighted diastolic BP of 97 mm Hg, and after the exercise training, the average weighted reduction was 8.2mm Hg. Moreover, there is also an effect of gender with regard to exercise training. Generally, the prevalence of hypertension is equally in women and men. Nonetheless, since estrogen modulates BP, effects of exercise training on BP differs between men and women. In overall though, hypertensive women reduce their BP fairly more and fairly more consistently with exercise training compared to men (Hargberg, Park & Brown, 2000, p. 4). This study is important since it lucidly indicates that exercise training plays an important role in controlling diastolic BP, and it should therefore, be encouraged and promoted as a technique of controlling/decreasing diastolic BP and hypertension in general.
Apart from effects of gender, further results encompassing studies from other areas such as effects of age, effects of the intensity and length of exercise training, effects of weight loss and effects of ethnicity all support the fact that exercise training indeed decreases BP in most hypertensive patients, with diastolic and systolic BP reductions averaging roughly 8mm Hg and 11mm Hg, respectively (Miranda et al., 2013, p. 9). Dependable evidence shows women and middle-aged individuals may derive higher benefits with exercise training compared to men and younger and older hypertensive patients respectively. As such, it is lucid that exercise training has significant benefits for hypertensive patients, not just in terms of decreasing BP, but also by improving several other risk factors that drastically enhance their risk of developing CV ailment. These results emphasize and support the recommendation that exercise training is vital in the treatment of people who have mild to moderate elevations in BP (Wolf-Maier et al., 2003, p. 9).
Another technique used in controlling BP is preventive advice. Commonly, smokers and hypertensive people have the highest risk for adverse cardiovascular outcomes including heart attacks and even untimely death. As such, hypertensive smokers is one of the groups that doctors need to target with the goal of lowering their BP (Caban-Martinez et al., 2010). Conversely, smokers might be an especially difficult group to get to and treat due to a number of reasons, chief among them being that they are more unwilling to stick to a doctor’s preventive advice than those who do not smoke, and are generally inclined to underestimating the health risks which are linked to smoking. Therefore, doctors might have lower expectations for smoking patients regarding the likelihood of adhering to recommendations for lowering BP for instance dietary modifications.
However, BP control advice given to hypertensive adults is indispensable towards the control of hypertension. Caban-Martinez et al. (2010, p. 8) stated that sticking to advice from healthcare provider plays a significant role with regard to lowering levels of BP in hypertensive individuals. The advice is classified into five broad categories: advice to change eating habits, salt reduction advice, alcohol reduction advice, exercise advice and lastly, medication advice. A study carried out by Caban-Martinez et al. (2010, p. 12) revealed that compared to non-smokers, current smokers have a lower likelihood of receiving healthcare provider advice to cut down salt intake, take hypertensive medication and exercise. However, they are more likely to receive advice regarding the reduction of alcohol intake. Moreover, there are other factors that contribute to lower odds of receiving advice to control BP, and they include being a female, widowed, separated or divorced, and being a heavy drinker of alcohol. Conversely, greater odds for receiving the advice is found among Hispanics, Blacks, obese/overweight, those that graduated high school and those whose health was generally fair or poor. These findings reveal that doctors are more likely to give high BP control advice to some sub-groups who have a higher prevalence of hypertension and poor health outcomes, but might be neglecting heavy drinkers as well as smokers. In order to effectively manage hypertension among all risk groups, there is need for interventions to improve the rates of BP control advice especially amongst hypertensive smokers as well as those that have lower odds of receiving advice to control BP, for instance women, the widowed, separated or divorced, and those who are heavy alcohol drinkers.
There is also the technique of assessing BP as pointed out by Pickering et al. (2005, p. 7). Determining BP continues to be an essential measurement in clinical medicine yet is still performed inaccurately. The clinical BP measurement gold standard has constantly been readings taken by a care provider using the korotkoff sound and a mercury sphygmomanometer technique. However, increasing evidence reveals that this procedure could lead to misclassifying a vast majority of people as hypertensive, and fail to diagnose other persons whose BP might be normal within the clinic context but raised at other times. The reasons for this include the following: (i) inexactness in the methods and some of which could be avoided; (ii) intrinsic variability of BP; (iii) the propensity for BP to increase in the presence of a doctor – the white coat effect (Pickering et al., 2005, p. 10). The different types of measurement methods and devices include the Auscultatory method, Mercury Sphygmomanometers, Aneroid Sphygmomanometers, Hybrid Sphygmomanometers, and the Os...
Student:
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Course title:
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Introduction
In the past decade, medical officers and researchers have realized and recognized that hypertension is one of the ill health conditions which record the highest rates of mortality and is also a major cause of disability in the world. This is in spite of the fact that medical researchers have been able to bring in new and modernized methods of assessing and controlling blood pressure (BP). In actual fact, some of these methods are ineffective in the sense that they lead to diverse results which hamper effective decision-making regarding the treatment to be administered on the patients. Dissimilar medical practitioners in various countries apply different techniques with regard to assessing and controlling BP, proving that notwithstanding being used, most of these techniques are not accurate and may not be effective in providing their results to the physicians. For instance, techniques that do not effectively take into account factors such as arm position, body position, cuff size, inter-arm differences and cuff placement could lead to significantly different readings. Inaccurate measurement of blood pressure could result in misclassification of patients as hypertensive or normotensive as well as lead to inapt medical management.
Nonetheless, the methods of assessing and controlling BP should not be blamed for ineffectual control of hypertension particularly in Western nations. Other risk factors including body fitness and lifestyle influence the response to the treatment administered, and different people typically respond differently to treatment, for instance, exercising works well for some people while to some it does not. Therefore, physicians should not seek to make decisions on treatment solely on the evaluation results of the BP. They need to study a patient first prior to recommending the best mode of treatment. Some of the key varied techniques employed in controlling and assessing blood pressure include exercise training, preventive advise, using the right procedure and devices in measuring BP, as well as self-monitoring and adherence to treatment on the part of the patient. These techniques are important because they could lead to improved adherence to medication and BP control. In addition, they would most likely result to better management of hypertension and improved health outcome for the patient. The purpose of this paper is to discuss how the varied techniques of controlling and assessing blood pressure affect the treatment of hypertension.
Techniques for controlling and assessing Blood Pressure (BP) and their effects on hypertension treatment
Calhoun et al (2008, p. 4) stated that presently, hypertension affects 1 out of 6 people in the United States, and costs roughly $45.7 billion every year. Effective control of BP among patients who are hypertensive plays a vital role in decreasing the lifetime risk of stroke, myocardial infarction, and all-cause mortality. Regardless of the fact that nearly 90% of patients BPs could be controlled if adequate pharmacotherapy is prescribed, only half of patients have their BP treated to target levels. In spite of several available effectual therapies for managing hypertension, a vast majority of patients in the United States who have high BP are not controlled sufficiently, and this incapability to effectively manage hypertension can be credited to patient, provider, as well as system failures (Roark et al., 2012, p. 2). For the patients, hypertension is typically a silent illness with very few or no symptoms at all, until the beginning of lasting complications. Consequently, patients are less likely to monitor their BP closely or seek continuing follow-up with their medical teams. Moreover, patients also sometimes fall short with regard to the management of their illness – defined as the every day decisions concerning lifestyle as well as medicine observance to support better risk factor control (Roark et al., 2012, p. 6). This failure of patients to engage in monitoring and adherence to treatments detracts from the potential improvements of health linked with evidence-based medicine.
Some providers of healthcare services contribute to the inability to properly manage hypertension. For them, failure to control BP to the guideline-based goals might be connected to clinical inertia – recognizing a problem but failing to act (Roark et al., 2012, p. 3). A number of related factors play a role regarding the commonness of clinical inertia in the management of hypertension amongst providers. The first factor is that readings of BP from diverse patient encounters are usually not aggregated and communicated to the healthcare provider in a format which facilitates speedy assessment of a patient’s BP trajectory or effectual medical intervention. Presently, ambulatory BP care is embedded in having patients visit a heath facility to see a provider, complete a BP check, then obtain treatment. When the patient leaves the health facility, he/she hardly ever interacts with the provider until the following appointment, which often creates lags with regard to the management of BP.
Ray, Nawarskas and Anderson (2011, p. 6) observed that most BP values, even when measured from the office are concealed in a sequence of charts, electronic records with text or data fields that are unstructured, or in systems that do not allow inter-practice data exchange. Similarly, static and inefficient documentation of the present medical problems, allergies and medications of the patient limits the ability of the provider to react swiftly and effectively to an abnormal BP value within the ambulatory care setting. Thus, regular office visits for measurements of BP are practically unappealing and compel patients as well as providers into a model which relies on sporadic BP data for clinical decision-making. The lack of feedback as well as outcomes data to care providers for patients who are in their care limits progress on improving the level of BP.
According to Pickering et al. (2005, p. 5) payers, providers and the society at large expect patients to be active healthcare participants and partners through self-monitoring of the state of their disease and sharing this crucial information with providers in a timely manner. Remote or home self-monitoring helps to improve patient recognition levels of BP control, and this could lead to improved adherence to medication and BP control. In creating an impeccable continuum of care, a joint team of health care needs to support the management of BP. Particularly, there is need to move from systems requiring doctors to simultaneously monitor and manage patients. Rather, providers who are not physicians – pharmacists, nurses, physician assistants and practitioners – can augment care of BP by reviewing BPs frequently and regularly, and making timely therapeutic decisions with standardized algorithms. This integration of care helps to decrease frequencies of uncontrolled hypertension owing to failures of the care providers including clinical inertia and inadequate follow-up of data. Likewise, community health workers can help by engaging patients to make sure there is self-monitoring and observance to medicine.
Apart from the above method, another technique in the control of BP is exercise training as Hagberg, Park and Brown (2000, p. 2) observed. Hypertension is a highly widespread cardiovascular (CV) disease risk factor in industrialized nations, and treatment guidelines always stress on the significance of non-pharmacological interventions such as physical activity. Training has effects on both systolic and diastolic BP. Hagberg, Park and Brown carried out a research comprising 1284 hypertensive persons who initially had systolic BP> 140mm Hg, and these individuals went through endurance exercise training. Among these people, 76% drastically decreased systolic BP with exercise training. Prior to the exercise training, weighted systolic BP among them averaged 153mm Hg, while after the training, the reduction averaged 10.6mm Hg. This result implies that endurance exercise training or physical activity leads to a significant reduction in systolic BP in people who have systolic hypertension, and thus, it should be encouraged and promoted as a technique of controlling/decreasing systolic BP.
With regard to effects of physical activity on diastolic hypertension, Hargberg, Park and Brown (2000, p. 4) also conducted a research that involved 1261 people who had diastolic hypertension with diastolic BP> 90mm Hg, and who went through endurance exercise training. After the exercise training, 81% had substantially reduced diastolic BP. Prior to the training, they had on average a weighted diastolic BP of 97 mm Hg, and after the exercise training, the average weighted reduction was 8.2mm Hg. Moreover, there is also an effect of gender with regard to exercise training. Generally, the prevalence of hypertension is equally in women and men. Nonetheless, since estrogen modulates BP, effects of exercise training on BP differs between men and women. In overall though, hypertensive women reduce their BP fairly more and fairly more consistently with exercise training compared to men (Hargberg, Park & Brown, 2000, p. 4). This study is important since it lucidly indicates that exercise training plays an important role in controlling diastolic BP, and it should therefore, be encouraged and promoted as a technique of controlling/decreasing diastolic BP and hypertension in general.
Apart from effects of gender, further results encompassing studies from other areas such as effects of age, effects of the intensity and length of exercise training, effects of weight loss and effects of ethnicity all support the fact that exercise training indeed decreases BP in most hypertensive patients, with diastolic and systolic BP reductions averaging roughly 8mm Hg and 11mm Hg, respectively (Miranda et al., 2013, p. 9). Dependable evidence shows women and middle-aged individuals may derive higher benefits with exercise training compared to men and younger and older hypertensive patients respectively. As such, it is lucid that exercise training has significant benefits for hypertensive patients, not just in terms of decreasing BP, but also by improving several other risk factors that drastically enhance their risk of developing CV ailment. These results emphasize and support the recommendation that exercise training is vital in the treatment of people who have mild to moderate elevations in BP (Wolf-Maier et al., 2003, p. 9).
Another technique used in controlling BP is preventive advice. Commonly, smokers and hypertensive people have the highest risk for adverse cardiovascular outcomes including heart attacks and even untimely death. As such, hypertensive smokers is one of the groups that doctors need to target with the goal of lowering their BP (Caban-Martinez et al., 2010). Conversely, smokers might be an especially difficult group to get to and treat due to a number of reasons, chief among them being that they are more unwilling to stick to a doctor’s preventive advice than those who do not smoke, and are generally inclined to underestimating the health risks which are linked to smoking. Therefore, doctors might have lower expectations for smoking patients regarding the likelihood of adhering to recommendations for lowering BP for instance dietary modifications.
However, BP control advice given to hypertensive adults is indispensable towards the control of hypertension. Caban-Martinez et al. (2010, p. 8) stated that sticking to advice from healthcare provider plays a significant role with regard to lowering levels of BP in hypertensive individuals. The advice is classified into five broad categories: advice to change eating habits, salt reduction advice, alcohol reduction advice, exercise advice and lastly, medication advice. A study carried out by Caban-Martinez et al. (2010, p. 12) revealed that compared to non-smokers, current smokers have a lower likelihood of receiving healthcare provider advice to cut down salt intake, take hypertensive medication and exercise. However, they are more likely to receive advice regarding the reduction of alcohol intake. Moreover, there are other factors that contribute to lower odds of receiving advice to control BP, and they include being a female, widowed, separated or divorced, and being a heavy drinker of alcohol. Conversely, greater odds for receiving the advice is found among Hispanics, Blacks, obese/overweight, those that graduated high school and those whose health was generally fair or poor. These findings reveal that doctors are more likely to give high BP control advice to some sub-groups who have a higher prevalence of hypertension and poor health outcomes, but might be neglecting heavy drinkers as well as smokers. In order to effectively manage hypertension among all risk groups, there is need for interventions to improve the rates of BP control advice especially amongst hypertensive smokers as well as those that have lower odds of receiving advice to control BP, for instance women, the widowed, separated or divorced, and those who are heavy alcohol drinkers.
There is also the technique of assessing BP as pointed out by Pickering et al. (2005, p. 7). Determining BP continues to be an essential measurement in clinical medicine yet is still performed inaccurately. The clinical BP measurement gold standard has constantly been readings taken by a care provider using the korotkoff sound and a mercury sphygmomanometer technique. However, increasing evidence reveals that this procedure could lead to misclassifying a vast majority of people as hypertensive, and fail to diagnose other persons whose BP might be normal within the clinic context but raised at other times. The reasons for this include the following: (i) inexactness in the methods and some of which could be avoided; (ii) intrinsic variability of BP; (iii) the propensity for BP to increase in the presence of a doctor – the white coat effect (Pickering et al., 2005, p. 10). The different types of measurement methods and devices include the Auscultatory method, Mercury Sphygmomanometers, Aneroid Sphygmomanometers, Hybrid Sphygmomanometers, and the Os...
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