General Information On Hypertension Complications
A review of related literature is an essential aspect of scientific research. Review of literature is a key step in research process. It refers to an extensive, exhaustive and systematic examination of publications relevant to the research project. A review of literature was done in order to broaden the understanding and develop an insight into the selected problem which was under study. This chapter is discussed under the following headings.
I - General information on hypertension, complications and its prevention.
II - General information on patient education regarding preventive care and
management of self with hypertension.
III- Studies related to preventive care and management of self with
Hypertension.
GENERAL INFORMATION ON HYPERTENSION, COMPLICATIONS
AND ITS PREVENTION:
According to the American Heart Association, 50 million Americans are estimated to have hypertension -a condition that is preventable and treatable.
Hypertension is becoming an important public health problem worldwide. It is the third leading killer disease in the world and is responsible for one in every eighth death. It is silent killer and most of the patients are accidentally detected to have hypertension, when they are admitted to the hospital for unrelated disease or are subjected to pre operative check up and then their blood pressure (BP) is examined.
Though headache is popularly considered as a symptom of elevated arterial pressure, it is a main characteristic caused by severe hypertension. Most commonly such headaches are localized to the occipital region and present when the patient awakens in morning but subside spontaneously after several hours. Other complaints that may be related to elevated blood pressure include dizziness, palpitations, easy fatigability and impotence. Complaints referable to vascular disease include epistaxis, hematuria, blurring of vision owing to retinal changes. Many patients are diagnosed when they seek medical advice due to target organ damage. Hence, it is important to know the blood pressure status before target organ damage occurs and to keep the blood pressure under control, once hypertension is detected.
It is estimated that more than 60 million Indians may have hypertension. In India, the prevalence of hypertension varies considerably from one region to another. So, many surveys were conducted to find out the prevalence of hypertension, its awareness and control in many region of rural population in India.
Hypertension, like most cardiovascular conditions, is a nutritional-hygienic disease. The seeds of hypertension are rooted in physical inactivity, obesity, high caloric intake, and excessive dietary sodium intake as well as alcohol consumption. Genetic susceptibility to hypertension remains ill-defined; however, environmental exposures of gene-environment interactions can be favorably influenced by manipulation of lifestyle choices.
John M.Flack stated that Prevention of hypertension-related complications such as reduced kidney function depends on well known hypertension risk factors. Population-based hypertension prevention strategies would require widely implemented public health measures such as significant alterations to the food and effective strategies to enhance physical activities. That will helps to prevent the complications and premature mortality in hypertension.
Hypertension places stress on several organs (called target organs), including the kidneys, eyes, and heart, causing them to deteriorate over time. High blood pressure contributes to 75% of all strokes and heart attacks. It is particularly deadly in African-Americans.
Risk of complications of hypertension become more likely in the presence of other risk factors, including significant elevation of blood pressure, increasing age , smoking, abnormal cholesterol, family history of premature heart disease, obesity, diabetes, coronary artery disease, and other evidence of vascular disease.
COMPLICATIONS:
According to American heart association, Left untreated, hypertension can cause many complications. Hypertension causes the walls in the arteries to thicken and harden. It also decreases the elasticity or stretchiness in the arteries, requiring the heart to work harder. As the heart works harder the muscle walls can grow larger. An enlarged heart can cause the heart to pump improperly, leading to possible damage to lungs.
A consistently elevated blood pressure expedites the formation of plaque or fatty deposits within the blood vessels which causes atherosclerosis (or hardening of the arteries). Atherosclerosis can lead to an increased risk of heart attack or stroke.
Kidneys, which filter waste out of the body, are also vulnerable to damage. Hypertension can cause the arteries to become constricted as a result of plaque build-up within the vessel walls decreasing the body's ability to filter waste and leading to kidney damage.
Eyes can be harmed by hypertension. The retinas may be damaged due to increased pressure in the blood vessels in the eyes. Vision loss may result.
PREVENTION:
Physicians will decide the course of treatment based on the severity of the hypertension, its causes, and other coexisting medical conditions. Lifestyle modification plays a large role in prevention and treatment.
Here are some key preventive and treatment measures recommended in the Sixth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure:
1) Keep body weight within acceptable limits. Lose weight if needed. Obesity causes the heart to work harder.
2) Eat a well balanced diet including fresh fruits and vegetables and low-fat dairy products. Avoid eating high-fat, high-cholesterol foods, which can promote atherosclerosis. Reduce the amounts of sodium (salt) in the diet. Sodium increases fluid retention and can increase the heart's workload. Allow for adequate amounts of potassium, magnesium and calcium in your diet.
3) Exercise regularly. Be sure that aerobic exercise is included.
4) Stop smoking. Smoking causes the blood vessels to constrict and can cause an elevation in blood pressure.
5) Limit the daily consumption of alcohol.
GENERAL INFORMATION ON PATIENT EDUCATION REGARDING
PREVENTIVE CARE AND MANAGEMENT OF SELF WITH
HYPERTENSION:
According to the American Heart Association (AHA), approximately 75 million adults in the United States are affected by hypertension, which is defined as a systolic blood pressure (SBP) of 140 mm Hg or more or a diastolic blood pressure (DBP) of 90 mm Hg or more or taking antihypertensive medicationÂÂ Substantial improvements have been made with regard to enhancing awareness and treatment of hypertension. However, a National Health Examination Survey (NHANES) spanning 2005-2006 showed that 29% of US adults with 18 years of age and older were hypertensive; 7% of hypertensive adults had never been told that they had hypertension.
Hypertension is a lifelong disorder. For optimal control, a long-term commitment and also effective education regarding lifestyle modifications and pharmacologic therapy is required. Therefore, repeated in-depth patient education and counseling not only improve compliance with medical therapy but also reduce cardiovascular risk factors.
Various strategies to decrease cardiovascular disease risk include the following:
Prevention and treatment of obesity: an increase in body mass index (BMI) and waist circumference is associated with an increased risk of developing conditions with high cardiovascular risk, such as hypertension, diabetes mellitus, impaired fasting glucose, and left ventricular hypertrophy [LVH]
Appropriate amounts of aerobic physical activity
Diets low in salt, total fat, and cholesterol
Adequate dietary intake of potassium, calcium, and magnesium
Limited alcohol consumption
Avoidance of cigarette smoking
Avoidance of the use of illicit drugs, such as cocaine
Vander palen et al (1998) conducted a study on structured educational programme on management of self on hypertension. He assert that it is the health care providers responsibility to teach, motivate, and strengthen the patients to maximize adherence to management of self on hypertension.
Saounats M. et al (2001) stated that hypertensive individuals who are educated about the importance of their medication and about the consequences of not taking the prescribed dosage will show better compliance with their prescribed drug regimen than those who are not thus educated.
Warsi A.et al (2005), reported that the management of self education programs resulted in small to moderate effects for selected chronic diseases such as diabetes, hypertension and etc.
Gras M. Paul (2006), reported that healthy life style behavior and perception of self-efficacy regarding medication adherence showed improvement after educative sessions in many chronic diseases.
Fridriksson et al(2006) reported that the patients and their families must be taught to recognize the signs and symptoms of possible increased blood pressure such as giddiness, epistaxis and etc to promote self activities to manage the high blood pressure by their own.
Hacihasanoghu .R (2011), stated that nurses play an important role in uncontrolled hypertension and diabetic mellitus detection and can improve medication adherence and healthy life style behavior.
Furies et al, (2011) stated that participants who came across educative sessions had additional weight loss, lower cholesterol and triglyceride levels than the other two groups who were not attended.
LIFESTYLE CHANGES:
Healthy lifestyle changes are an important first step for lowering blood pressure. Current guidelines recommend that people should:
Exercise at least 30 minutes a day
Maintain normal weight
Reduce sodium (salt) intake
Increase potassium intake
Limit alcohol consumption to no more than one or two drinks a day
Consume a diet rich in fruits, vegetables, and low-fat dairy products while reducing total and saturated fat intake. (The DASH diet is one way of achieving such a dietary plan.)
Stress reduction
Have good sleep pattern
Weight loss
Quite cigarette smoking.
PATIENT TEACHING GUIDE:
According to LEWIS (2000), the education should have the following things to motivate the client to adhere and follow the guidelines in their day today activities.
Provide the numerical value of the patient’s blood pressure and explain what it means.
Inform the patient that hypertension is usually asymptomatic and symptoms do not reliably indicate blood pressure levels.
Explain that long term follow-up and therapy are necessary to treat hypertension.
Explain the therapy will not cure, but should control hypertension.
Explain the potential dangers of controlled hypertension.
Tell patient that controlled hypertension is usually compatible with an excellent prognosis and a normal lifestyle.
Be specific about the names, actions, dosages, and side effects of prescribed medications.
Advice the patient to check the blood pressure readings weekly once.
Tell the patient to plan regular and convenient times for taking medications.
Tell the patient not to discontinue drugs because withdrawal may cause a severe hypertensive reaction
Tell the patient not to double up on doses before consulting with the health care provider.
Tell the patient to consult with the physician when there is any variation in the blood pressure levels.
Tell the patient should always keep the arm at heart level while blood pressure checking.
Explain the patient should not have smoked or ingested caffeine within 30 minutes before measurement.
Measurement should not begin until the patient has had 5 minutes of quiet rest.
Tell the patient to supplement diet with foods high in potassium (eg. Green leafy vegetables), and avoid fatty, oily foods. Also tell them about the importance DASH diet.
Tell the patient to avoid hot baths, excessive amounts of alcohol and strenuous exercise within 3hours of taking medication.
Explain that to manage the giddiness, the patient should lie or sit down, sleep with head of the bed raised.
Tell the patient to do the exercises like simple walking, breathing exercises, jogging for at least 30 minutes for everyday.
Advice the patient to adopted with the life style modifications for the better outcome. Advice the patient to come for the follow up check up once in a month regularly.
II.STUDIES RELATED TO PREVENTIVE CARE AND MANAGEMENT
OF SELF WITH HYPERTENSION:
Aubert et al (1998) mentioned that physical activity & exercise are very important factor in hypertension management. He stated that the patients with more awareness on management of self on chronic diseases such as diabetes mellitus and hypertension had better attitude than patients with less awareness.
Dekat and Balzo (2000) conducted a study on 220 patients with essential hypertension for period of 4-56 week by means of structured programme consisting of hypertension control education, physical education and smoking cessation on a long time risk factor control. And the results showed that 84% of patients improve their general health.
Rickerby J.(2002) recently employed a powerful evidence-based article, regarding the role of home measurement of blood pressure in the management of hypertension. They revealed that the use of home blood pressure measurement as an equivalent, feasible & more cost-effective technique to measure blood pressure in hypertension. And it should enable groups of patients with a poorer prognosis to be identified & their treatment adjusted in order to improve their prognosis.
Whelton PK et al(2002) stated that systematic review of intervention that have proven efficacy for decreasing elevated blood pressure level for those with high blood pressure or hypertension including, engaging in physical activity, maintaining normal body weight, limiting alcohol consumption, reducing Na intake, maintaining adequate intake of potassium, and consuming a diet rich in fruits, vegetables, and low-fat dairy products and reduced in saturated &total fat.
Suhulman (2003) reported that the diet therapy is an important aspect of hypertension. Patients must be taught which foods have to be taken and which food have not be taken in their daily practice. It will help them in controlling their blood pressure level.
Ohta et al(2003) conducted an 8 week exercise intervention with 207 sedentary untreated patients with stage 1 or 2 essential hypertension, participants were divided into 5 groups based on frequency & duration of exercise. Exercise sessions consisted of a short warm up, aerobic exercise such as walking, jogging, or swimming and conditioning such as sit-ups, stretching.The results demonstrate that minimal increase in physical activity may decrease blood pressure making the adjustment to adding beneficial amounts of exercise more feasible for sedentary hypertensive patients.
Rollin McCraty et al(2004) conducted a study to examine the impact of a workplace based stress management education programme on blood pressure and emotional health in hypertensive employees. The result suggested that a brief workplace stress management intervention can produce clinically significant reduction in blood pressure & improve emotional health among hypertensive employees.
Svelte et al (2005) conducted a randomized trial on the effect of life style modifications on blood pressure by race, sex, hypertension status and age. They concluded that divorce groups of people can adopt multiple life style modifications that can lead to improved blood pressure control and reduced coronary vascular risk.
Dori F. Zaleznik(2008) stated that the daily music and breathing therapy was associated with a significant reduction in systolic blood pressure. So he assert that management of self plays an important role in controlling the blood pressure.
Zohreh Rahare et al(2010) conducted a study on effect of education on self-monitoring of blood pressure. In this 150 outpatient with hypertension were randomly selected. The results of this study showed that the level of self-monitoring behavior in the patients was low and they recommended that educational programmes are helpful & necessary to improve self- monitoring behavior in patients with hypertension.
Goldstein et al (2010) suggested that moderate alcohol consumption and quit cigarette smoking lowers the blood pressure in hypertensive patients.
Stranges et al (2010) conducted multivariate analyses on reduced sleep duration in hypertension. The results showed that less than 6 hours of sleep was associated with a significant increased risk of hypertension compared to sleeping at least 6 hours/night.
Robert H (2010) conducted a study on randomized controlled trial of stress reduction for hypertension in old age.213 men & women were screened,127 individuals were selected. Mental & physical stress-reduction approaches were compared with a life style modification education control programme & with each other. Selected mental &physical stress reduction techniques demonstrated efficacy in reducing mild hypertension among the old age. Of the two techniques, meditation was approximately twice as effective as progressive muscle relaxation.
The above literature and research studies showed that management of self on hypertension reduces recurrent hospital admission and its complications. This review helped the investigator in clarifying her own ideas, to describe and conduct the present study, in establishing the need for the study, also helps to identify the major areas which should be included while formulating the objectives and developing the tool.
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