Hypertension/High Blood Pressure
Epidemiology Paper PHC 6000
Jennifer Lea & Malerie Murphy
Executive Summary: Hypertension or high blood pressure is a chronic disease that affects a large portion of individuals all around the world. This paper seeks to understand the prevalence and distribution among the world, U.S., Florida and OrangeCounty. It also examines the risk factors associated with hypertension, both modifiable and non-modifiable risk factors. After identifying risk factors it is important to understand the preventative strategies. This paper does examine the preventative strategies of hypertension and how they affect the risk of developing hypertension. Lastly, this paper attempts to identify the public health interventions for hypertension. Due to the prevalence of hypertension among adults in the world and especially in the U.S. it has increasingly become a more important to make lowering high blood pressure a priority. Hypertension is strongly correlated with an increased risk of developing coronary heart disease and stroke and is a modifiable risk factor for both. By synthesizing the information available about hypertension it is concluded that hypertension is a pertinent health issue that should be addressed consistently with prevention programs, intervention programs, and treatment programs. The high prevalence should cause concern for health care professionals and society.
Trends and Distributions of Hypertension Hypertension is defined as elevated blood pressure greater than or equal to a systolic pressure of 140mmHg and a diastolic reading of 90mmHg.It affects about 1 billion people worldwide and contributes to half of all cardiovascular diseases (WHO, 2010). Because there are no symptoms for hypertension it is known as a silent killer and nearly one-third of people don’t know they have it. Hypertension is a very important modifiable risk factor for heart disease, one of the most preventable causes of premature deaths worldwide, stroke, and kidney disease. The amount of people who live with hypertension is startling. About 30% of adults in most countries worldwide suffer from hypertension (WHO, 2010). The prevalence of hypertension increases with age, salt intake, low physical activity, and obesity. It is known as a morbidity and risk factor for other types of disease development. In fact, due to the positive relationship between age and hypertension, when age increases the percentage of adults with this condition also increases (CDC, 2009). After the age of 55 there is a 90% lifetime risk for developing hypertension (DDHS, 2003). World There are about 1 billion people worldwide who are affected by hypertension (WHO, 2010). The prevalence rate for adults ranges from 8-18% throughout the world (Shwe, 2004). Hypertension is the most common cardiovascular disorder affecting about 20% of the population worldwide. It is prevalent both in developed on developing countries, therefore making hypertension a global health concern. Hypertension rate differ worldwide between rural and urban areas. For rural areas the prevalence of hypertension is 12.4% as compared to the 14.5% of urban areas (Shwe, 2004). People living in low and middle-income countries have a high risk of developing hypertension because they are less likely to be exposed to preventive strategies and also more likely to be exposed to major contributing risk factors (WHO, 2009). U.S. From 2005-2006 the data showed that 29% of all U.S. adults 18 years and older were hypertensive (Ostchega, 2008). In 2010, those numbers have not changed very much because hypertension affects approximately 74.5 million people in the U.S. (OCHD, 2010). The prevalence of hypertension in men and women ages 45-54 from 2003-2006 was 36% (DHHS, 2009). For those whose age is greater than 75 years the prevalence rose to 65% of men and 80% of women have hypertension (DHHS, 2009). In addition, 28% of the U.S. population over the age of 18 has pre-hypertension, systolic blood pressure 120-139mmHG or diastolic blood pressure 80-89mmHg and not pharmacologically treated (Ostchega, 2008). Gender does not play a role in prevalence of hypertension in fact; the prevalence of heart disease in men and women is very similar. When results are compared between single ethnicity groups the African American population is more likely than the white or Asian population to have been told they had hypertension (CDC, 2009). Thirty-two percent of non-Hispanic black adults had been told that they had hypertension compared to 21% of Hispanic adults and 24% of non-Hispanic white adults (CDC, 2010). Poverty and education levels are inversely associated with hypertension. The poor are more likely to be diagnosed with hypertension. Also, lower education levels are associated with higher hypertension rates (CDC, 2010) Florida One in four deaths in Florida are a direct result of heart disease (DHDSP, 2010). Hypertension is a risk factor for heart disease making it a very important health outcome for provider’s to address with their patients. Heart disease and stroke are the number 1 and 3 leading causes of death in the state of Florida and hypertension contributes to that ranking. In 2006, 28.2% of Floridians had hypertension making Florida’s prevalence rate slightly higher than the U.S. (DHDSP, 2010). Also, there was a high rate of other risk factors such as obesity, physical inactivity, poor dietary habits, and smoking. All of these risk factors contribute to hypertension and heart disease. It is not surprising heart disease is the number one killer in the state of Florida. OrangeCounty Once again the prevalence rate of heart disease is an important consideration when identifying the rate of high blood pressure. OrangeCounty has a death rate from heart disease that is slightly higher than the state of Florida. In 2007, 170,900 people died from heart disease and 61% of those people had hypertension. When looking at the death rate it is startling to see that 61% had hypertension, 62% had high cholesterol, and 59% were inactive. Clearly, there are many different risk factors that contribute to heart disease but hypertension is a significant risk factor and chronic disease that can have severe long-term consequences. In 2007 the prevalence of hypertension in Orange Country was 25.6%, slightly lower than the state (FDOH, 2010). Risk Factors Although the direct cause of high blood pressure in many individuals is unknown there are several risk factors for this life-threatening disease that affects one in every three Americans in the United States today (DHDSP, 2010). Risk implies the relation between the exposure and the likelihood of an individual to develop the specific disease or illness. The risks of developing hypertension range from those we cannot control to those that can be lowered by the lifestyle choices we make each and every day. These risks include family history, age, gender-related, race, physical inactivity, unhealthy diet, overweight/obesity, and alcohol abuse (AHA, 2009). These factors not only increase an individual’s risk for developing hypertension, but also for some of the leading causes of death in the world today, cardiovascular disease (CVD) and stroke. Each of these risk factors can be grouped into four different risk categories: genetic risks, biological risks, behavioral risks, and environmental risks. Genetic Risks Genetic risks are those predisposed risks factors due to inheritance of specific genes. Hypertension, like other chronic diseases, is known to be hereditary. Family history of high blood pressure such as parental guardians, grandparents and past generations can increase the risk of an individual developing hypertension (AHA, 2009). Although genetics does play a role in the risk of developing high blood pressure, behavioral, biological, and environmental risks are the determinants in the prevalence of the disease. Biological Risks Biological risks are the physical characteristics that make an individual more or less prone to developing a disease such as hypertension. For high blood pressure, these risks include gender, age, race, and weight. Although men have a high risk of developing high blood pressure, before the age of 45, woman encompass 50% of the adult population living with high blood pressure (AHA, 2009). As every individual ages, there risk for developing hypertension increases as the blood vessels in our body lose flexibility and result in an increase in pressure throughout our cardiovascular system (AHA, 2009). Race also plays a role in one’s risk in developing high blood pressure. Findings between Caucasians, African Americans, Hispanics and Asians in regard to the prevalence of hypertension vary greatly. Approximately 40% of African Americans are living with high blood pressure (AHA, 2009). Finally, weight is an underlying issue that millions of Americans are facing. In Florida alone, nearly two-thirds of adults have reported overweight (Body Mass Index between 25 and 30) or obese (Body Mass Index over 30) (DHDSP, 2010). A healthy weight differs for each individual depending on body shape and lifestyle but should not be a factor in hypertension risk. Individuals with excess weight put more stress on their heart and other cardiovascular components. Behavioral Risks Behavioral risks account for nearly 50% of total health care costs in the United States. Behavior risks associated with high blood pressure include lack of physical activity, poor diet, tobaccos usage, and excessive alcohol intake. (AHA, 2009). An individual and the lifestyle choices they make throughout their lifetime control all these risks. Leading a sedentary lifestyle increase the risk of developing not only high blood pressure but also several other leading cardiovascular diseases affecting millions of individuals. Physical inactivity and overweight/obesity go hand in hand as without daily exercise, weight gain will occur. Unhealthy eating habits also play a huge role in the risk of developing high blood pressure. Diets high in fat, calories, sodium, and sugars greatly increase the chance of hypertension development (AHA, 2009). Alcohol abuse and tobacco usage also dramatically increase one’s chance of developing high blood pressure. Environmental Risks Environmental risks, although not proven, play a role in developing one’s risk to high blood pressure. Home and work environments greatly impact an individual’s lifestyle. A body of individuals can either encompass a positive or negative environment. Positive environments where other practice and engage in healthy behaviors is beneficial. Negative environments promote poor lifestyle behaviors and usually develop stressful and hostile situations. Stress can unknowingly raise an individual’s blood pressure and cause future development of hypertension if not regulated. Stress is becoming one of the leading causes of health issues in the United States today.
Preventative Strategies There are many different ways to prevent hypertension or high blood pressure. Due to the large number of modifiable risk factors hypertension is almost 100% preventable. The preventative strategies reach much further than regular screening and include behaviors such as proper nutritional habits, regular physical activity and exercise, smoking cessation, decreased total body weight, diabetes management, and stress management. When discussing these different behaviors it is also important to acknowledge that genetics still plays a role in the risk of developing hypertension so, those with family history or genetic risk factors much ensure proper preventative behaviors to lower their risk for developing hypertension. Also, as one implement preventative strategies they will mostly likely observe a lower risk of developing heart disease because hypertension is one of the contributing factors for heart disease and heart failure. Dietary Habits Proper nutrition plays a significant role in one’s ability to prevent the onset of hypertension. Consuming a diet high in fat, sodium, calories, sugars and alcohol can significantly increase one’s risk for developing hypertension. From a preventative perspective, it is important that one decreases sodium intake and alcohol consumption. Sodium is an element found in most food and when consumed in excess can pose risk to the human system specifically, the heart and its ability to properly function (DHDSP, 2010). The recommendation is to consume less (DHHS, 2003). It is also recommended that one with hypertension decrease salt intake to 1,500mg or lower. Along with reducing salt intake the “DASH” diet is a healthy way to eat to prevent and stop hypertension. DASH or diet approaches to stop hypertension encourage the consumption of many fruits vegetables, low fat dairy as well as decreased consumption of saturated fats, total fat, and cholesterol (DHHS, 2003).
Regular Physical Activity & Exercise Regular physical activity and exercise has been shown to help prevent blood pressure and also manage hypertension. It is one of the most important preventative strategies that one should implement. Regular physical activity keeps the cardiovascular system working at optimal levels. Decreasing plaque in the arteries and also improving the heart’s ability to pump blood more efficiently through the body. When the heart becomes more efficient at pumping typically blood pressure will either decrease or remain in normal ranges. Regular Screening Regular screening is a very important preventative strategy because hypertension does not present many symptoms and often times presents no symptoms at all. The only way to be sure that one does not have chronically increasing blood pressure readings is to make sure to schedule regular screenings. There are many ways to do this. One can schedule annual check-ups with their general physician, use a home monitoring device, participate in a free high blood pressure screening at a local health fair, or use high blood pressure monitors in some drug stores. Smoking Cessation Quitting smoking or making the choice not to smoke at all is also a preventative strategy for hypertension. Smoking damages the vessels walls and therefore decreases one’s cardiovascular strength and efficiency. It can also harden arteries making the heart have to work harder to pump blood through the system (DHHS, 2003). One’s risk for heart attack associated with hypertension can decrease significantly within one year of quitting smoking. Decreased Total Body Weight The lower one’s total body weight the less risk they have for developing hypertension. Therefore, another preventative strategy is to either decrease one’s weight or maintain a healthy weight for life. Blood pressure rises and weight increases in an individual and in fact, with each 10 pound decrease one can lower blood pressure significantly (DHHS, 2003). Weight loss can significantly affect those who are already hypertensive and overweight. Individuals with the greatest room for improvement have the ability to change their health status at a faster rate. Diabetes Management Diabetes management helps to prevent hypertension because if one can manage their diabetes they are less likely to create increased pressure on the vessel walls. Sixty percent of people who have diabetes also have hypertension so when one’s diabetes is not managed correctly their chance of developing hypertension increases (CDC, 2010). Stress Management
Stress management is also another important preventative strategy. The lower one’s stress the lower their blood pressure. Ways to reduce stress are to exercise, engage in deep breathing activities, cut out personal or professional stress from one’s life. Alternative methods used for reducing stress are massage, acupuncture, recreational activities, and more vacation. Public Health Interventions As the prevalence of those living with high blood pressure continues to rise, other cardiovascular diseases contributing to the amount of individuals affected, lives lost, and financial burden to individuals and governments increase as well. Worldwide, one-third of deaths are due to cardiovascular diseases, resulting in the leading cause of death globally (WHO, 2010). In the United States alone, nearly 74.5 million Americans age 20 and older live with high blood pressure (ASH, 2010). Cardiovascular diseases cost the United States $475.3 billion in 2009, $76.6 billion contributing to the health care services, medications, and other related medical needs of high blood pressure specifically (CDC, 2010). Public health interventions around the world, across the United States, and throughout almost every state are focusing on preventative strategies to reduce the prevalence of high blood pressure through preventative, management, and monitoring strategies. Heart healthy intervention programs are being developed to decrease the incidence, morbidity, and mortality of high blood pressure and associated cardiovascular diseases (WHO, 2010). Behavioral risks by them self reflect 80% of the development of cardiovascular diseases (WHO, 2010). Epidemiology reflects the need for public health interventions. Hypertension prevention programs range from reaching out to trillions globally to small communities such as the Central Florida area. Around the world, collaboration in taking action to effectively reduce the risk factors, prevalence, and cost of high blood pressure are being developed. Global action includes the WHO Programme on Cardiovascular Disease, as well as research and awareness efforts by the International Society of Hypertension. World Hypertension Day is May 17 of each year. Hypertension has caused a dramatic negative impact on the United States. In the United States, approximately one in every four American adults has pre-hypertension, inevitably raising one’s risk for high blood pressure (CDC, 2010). The American Society of Hypertension (ASH) exists to educate both health care professionals and patients on the ways to effectively treat hypertension and other cardiovascular diseases. ASH most recent hypertension intervention, the 2010 Hypertension Community Outreach Initiative, strives to promote healthy lifestyle rituals by providing free blood pressure screenings and counseling (ASH, 2010). The American Heart Association has defined “Ideal Cardiovascular Health” as 7 health factors & lifestyle behaviors that support heart health. Goals are set to improve Americans cardiovascular health by 20 percent, while reducing cardiovascular deaths by 20% (AHA, 2010). Healthy People 2010, developed back in 2000, was launched by the United States to focus on improving the health of Americans. By setting objectives in several aspects of health care including access, physical activity, overweight and obesity, and tobacco use, the mortality and morbidity rate of American lives can be positively changed (CDC, 2009). Coincidentally, these focus areas that strive to increase quality of life and eliminate health disparity, are the same factors to prevent hypertension and several other chronic disease that affect millions of Americans today. Of the twenty-six focus areas, seven directly relate to the risk factors associated with hypertension. Healthy People 2020 is currently being developed as the US hopes to continue reaching out to current and future generations in improving overall health in all Americans. Some states, like Florida, are taking their own hypertension prevention initiatives as the Behavioral Risk Factors Surveillance System survey showed an astonishing 28.2 % of Floridians live with high blood pressure and 62% are overweight or obese (DHDSP, 2010). The burden of hypertension is prominent as over one-fourth of total Floridian deaths are from cardiovascular disease. Intervention programs such as the Florida Heart Disease and Stroke Prevention promote heart-healthy living by providing funding for increased health access in high blood pressure high-risk areas. As it is estimated that 90% of Americans will have high blood pressure in their lifetime, Central Florida residents have taking strides in not allowing this to affect them. Central Florida initiated a program called Project Pressure, part of Get Healthy Florida, which brings awareness and education through community involvement with local health care providers and promotional events. The 5th largest college in the nation, University of Central Florida, has taken part in Project Pressure where students have monitored over 1300 blood pressures. Uniting health care providers and local residents in the fight to control and prevent hypertension sets an example for the entire world to follow. References World Health Organization (WHO).(2010) The Atlas of Heart Disease and Stroke: Part I Cardiovascular disease, Part II Risk Factors, Part III the burden, Part IV action. Retrieved from http://www.who.int/cardiovascular_diseases/resources/atlas/en/ on June 23, 2010. U.S. Department of Health and Human Services (DHHS): Center for Disease Control and Prevention, NationalCenter for Health Statistics.(2009)Health, United States, 2009.Retrieved from http://www.cdc.gov/nchs/data/hus/hus09.pdf on June 23, 2010. Center for Disease Control (CDC): NationalCenter for Health Statistics.(2009) Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008.Retrieved from http://www.cdc.gov/nchs/data/series/sr_10/sr10_242.pdfon June 25, 2010. Ostchega, Y., Yoon, S., Hughes, J., Louise, T., (2008) Hypertension Awareness, Treatment, and Control—Continued Disparities in Adults: United States, 2005-2006.National Center for Health Statistics (NCHS).Retrieved from http://www.cdc.gov/nchs/data/databriefs/db03.pdfon June 23, 2010. Robert Wood Johnson Foundation (RWJF).(2010). F as in Fat: 2010, How Obesity ThreatensAmerica’s Future. Trust for America’s Health. Retrieved June 20, 2010 from www.healthyamericans.org U.S. Department of Health and Human Services (DHHS): National Institutes of Health, National Heart, Lung, and Blood Institute. (2003).The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Retrieved on June 30, 2010 from http://www.ncbi.nlm.nih.gov/bookshelf/picrender.fcgi?book=hbp7&blobtype=pdf Orange County Health Department (OCHD) (2010). Press release: May is American Stroke and High Blood Pressure Month. Retrieved on June 30, 2010 from http://www.orchd.com/absolutenm/templates/archives.aspx?articleid=79&zoneid=17 Shwe, S., Than, K., Sein, T., Thu, Aung., Maung, K., Lwin, M., Tun., H. (2004) Prevalence of Hypertension in Two Selected Villages of Kayin State, Myanmar.Regional Health Forum: Regional Health Forum WHO South-East Asia Region Regional Health Forum v8(1).Retrieved on July 6, 2010 from http://www.searo.who.int/EN/Section1243/Section1310/Section1343/Section1344/Section1836/Section1839.htm Florida Department of Health (FDOH) (2010) Orange County Disease Profile.Retrieved from http://www.floridacharts.com/charts/DisplayHTML.aspx?ReportType=7244&County=48&year=2008 on July 7, 2010. Division for Heart Disease and Stroke Prevention (DHDSP). (2010). High Blood Pressure Fact Sheet. Retrieved on July 8, 2010 at http://www.cdc.gov/dhdsp/library/fs_bloodpressure.htm World Health Organization (WHO). (2009). Cardiovascular diseases (CVDs). Retrieved on July 7, 2010 at http://www.who.int/mediacentre/factsheets/fs317/en/index.html American Society of Hypertension (ASH). (2010). American Society of Hypertension Practices What It Preaches to Combat ‘Neglected Disease’ of Hypertension. Retrieved on July 3, at www.ash-us.org. Division for Heart Disease and Stroke Prevention (DHDSP). (2010). About Heart Disease and Stroke Prevention at CDC. Retrieved on July 13, 2010 at http://www.cdc.gov/dhdsp/about_program.htm Centers for Disease Control and Prevention (CDC). (2009). About Healthy People 2010. Retrieved on June 22, 2010 at http://www.cdc.gov/nchs/healthy_people/hp2010.htm Division for Heart Disease and Stroke Prevention (DHDSP). (2010). State Program: Florida basic Implementation. Retrieved on July 8, 2010 at http://www.cdc.gov/dhdsp/state_program/fl.htm American Heart Association (AHA). (2009). Understanding Your Risk for Developing HBP. Retrieved on June 22, 2010 at http://www.americanheart.org/presenter.jhtml?identifier=2142 Appendix
We worked very well together in organizing, researching, and developing this epidemiology paper on hypertension. By dividing the four main topics; Trends and Distributions, Risk Factors, Preventative Strategies, and Public Health Interventions, we were able to focus on specific areas of the paper and then combine, review, and finalize each section. Jenn chose to research Trends and Distributions as well as Preventative Strategies and Malerie, on the other hand, focused on the Risk Factors and Public Health Interventions for high blood pressure. We thought that this would be a fair split in the paper to allow the two of us to really research and understand the epidemiology of our topic. The two of us worked very well together in drafting our paper as well as researching a topic that we are so passionate about. We both collaborated on the paper via email, phone conversation as well as Wiki development.
We were once coworkers at a healthcare facility called the Human Performance Institute, where we taught others the important key fundamentals of living a healthy, well balanced lifestyle that enhanced performance in the home, work, and social environment. Working with clients from all around the world, the prevalence of those living with high blood pressure not only in the United States but globally as well was observed. The two of us have worked with many clients that are managing and treating their hypertension. Also, we both have a passion for healthy lifestyle choices. Many times engaging in healthy behaviors such as exercise and good eating habits can help someone prevent, manage, or treat their hypertension.
Jenn’s research on the Trends and Distribution of high blood pressure came from many difference government websites and sources. Most of the research conducted came from the Department of Health and Human Services, Center for Disease Control. Other sources were the World Health Organization, peer-reviewed articles that examined the influence of hypertension on populations, and the National Heart, Lung, and Blood Institute. This section describes the distribution of hypertension among adults in the world, the United States, Florida, and OrangeCounty. It examines the affect that hypertension has on the health of specific populations. The statistics are amazing. Over 1 billion adults have hypertension in the world and close to 65 million adult Americans live with hypertension everyday. Also, the research helped Jenn understand the impact that hypertension has on heart disease and preventable health care costs.
Malerie’s findings of the Risk Factors associated with high blood pressure were mainly researched from the Center for Disease Control and Prevention website. This section describes age, gender, race, family history, weight, and lifestyle as the main contributors to developing high blood pressure. These risk factors can be broken down into four main risk groups, which include genetic, biological, behavioral, and environmental risks.
Jenn’s research development for the Preventative Strategies section primarily came from the National Heart, Lung, and Blood Institute. There was extremely valuable information on their website that mentioned many of the top preventative strategies one can implement to prevent hypertension. Also, Jenn used other sources such as the CDC, NIH, and Healthy People to help her understand the real causes of hypertension. By understanding the causes of hypertension one can better determine the preventative strategies because most risk factors for hypertension are preventable and modifiable. This is a good thing because though not all will prevent there are ways to treat and management hypertension until it is completely reversed, exercise, weight loss and smoking cessation being the two most important for decreasing blood pressure.
Malerie’s research on the Public Health Interventions section came from a number of relevant sources including the World Health Organization, Center for Disease Control and Prevention, and American Heart Association to name a few. Specific details under this section relate to the underlying need for hypertension public health interventions to exist. High blood pressure awareness and education is highly important in reducing mortality, morbidity, and health care costs associated with hypertension and cardiovascular diseases. In summary, the two of us worked in unison to research and synthesize the best information about hypertension. The synergy between us is evident. Both of us are working full time as well as going to school part-time and we believe that we managed our lives very well in the midst of the development of our paper and research for our paper. There were many times when the two of us had to depend on one another to write a weekly discussion and we did a great job at making sure that there was and even workload for the two of us. During our research we learned a significant amount statistics about hypertension and gained more knowledge on a subject that we are both so passionate about. Hypertension is a disease that has many risks including increased risk for coronary artery disease and stroke. It is a chronic disease that does not present many symptoms and because of its lack of symptoms it can be assumed that there may be more that 65 million Americans that have hypertension but have yet to be diagnosed. It was a great pleasure for the two of us to have the opportunity to work with one another this semester, especially to be able to create a research paper that we are so closely connected to.
Epidemiology Paper PHC 6000
Jennifer Lea & Malerie Murphy
Executive Summary:
Hypertension or high blood pressure is a chronic disease that affects a large portion of individuals all around the world. This paper seeks to understand the prevalence and distribution among the world, U.S., Florida and Orange County. It also examines the risk factors associated with hypertension, both modifiable and non-modifiable risk factors. After identifying risk factors it is important to understand the preventative strategies. This paper does examine the preventative strategies of hypertension and how they affect the risk of developing hypertension. Lastly, this paper attempts to identify the public health interventions for hypertension. Due to the prevalence of hypertension among adults in the world and especially in the U.S. it has increasingly become a more important to make lowering high blood pressure a priority. Hypertension is strongly correlated with an increased risk of developing coronary heart disease and stroke and is a modifiable risk factor for both. By synthesizing the information available about hypertension it is concluded that hypertension is a pertinent health issue that should be addressed consistently with prevention programs, intervention programs, and treatment programs. The high prevalence should cause concern for health care professionals and society.
Trends and Distributions of Hypertension
Hypertension is defined as elevated blood pressure greater than or equal to a systolic pressure of 140mmHg and a diastolic reading of 90mmHg.It affects about 1 billion people worldwide and contributes to half of all cardiovascular diseases (WHO, 2010). Because there are no symptoms for hypertension it is known as a silent killer and nearly one-third of people don’t know they have it. Hypertension is a very important modifiable risk factor for heart disease, one of the most preventable causes of premature deaths worldwide, stroke, and kidney disease. The amount of people who live with hypertension is startling. About 30% of adults in most countries worldwide suffer from hypertension (WHO, 2010).
The prevalence of hypertension increases with age, salt intake, low physical activity, and obesity. It is known as a morbidity and risk factor for other types of disease development. In fact, due to the positive relationship between age and hypertension, when age increases the percentage of adults with this condition also increases (CDC, 2009). After the age of 55 there is a 90% lifetime risk for developing hypertension (DDHS, 2003).
World
There are about 1 billion people worldwide who are affected by hypertension (WHO, 2010). The prevalence rate for adults ranges from 8-18% throughout the world (Shwe, 2004). Hypertension is the most common cardiovascular disorder affecting about 20% of the population worldwide. It is prevalent both in developed on developing countries, therefore making hypertension a global health concern. Hypertension rate differ worldwide between rural and urban areas. For rural areas the prevalence of hypertension is 12.4% as compared to the 14.5% of urban areas (Shwe, 2004). People living in low and middle-income countries have a high risk of developing hypertension because they are less likely to be exposed to preventive strategies and also more likely to be exposed to major contributing risk factors (WHO, 2009).
U.S.
From 2005-2006 the data showed that 29% of all U.S. adults 18 years and older were hypertensive (Ostchega, 2008). In 2010, those numbers have not changed very much because hypertension affects approximately 74.5 million people in the U.S. (OCHD, 2010). The prevalence of hypertension in men and women ages 45-54 from 2003-2006 was 36% (DHHS, 2009). For those whose age is greater than 75 years the prevalence rose to 65% of men and 80% of women have hypertension (DHHS, 2009). In addition, 28% of the U.S. population over the age of 18 has pre-hypertension, systolic blood pressure 120-139mmHG or diastolic blood pressure 80-89mmHg and not pharmacologically treated (Ostchega, 2008). Gender does not play a role in prevalence of hypertension in fact; the prevalence of heart disease in men and women is very similar.
When results are compared between single ethnicity groups the African American population is more likely than the white or Asian population to have been told they had hypertension (CDC, 2009). Thirty-two percent of non-Hispanic black adults had been told that they had hypertension compared to 21% of Hispanic adults and 24% of non-Hispanic white adults (CDC, 2010).
Poverty and education levels are inversely associated with hypertension. The poor are more likely to be diagnosed with hypertension. Also, lower education levels are associated with higher hypertension rates (CDC, 2010)
Florida
One in four deaths in Florida are a direct result of heart disease (DHDSP, 2010). Hypertension is a risk factor for heart disease making it a very important health outcome for provider’s to address with their patients. Heart disease and stroke are the number 1 and 3 leading causes of death in the state of Florida and hypertension contributes to that ranking.
In 2006, 28.2% of Floridians had hypertension making Florida’s prevalence rate slightly higher than the U.S. (DHDSP, 2010). Also, there was a high rate of other risk factors such as obesity, physical inactivity, poor dietary habits, and smoking. All of these risk factors contribute to hypertension and heart disease. It is not surprising heart disease is the number one killer in the state of Florida.
Orange County
Once again the prevalence rate of heart disease is an important consideration when identifying the rate of high blood pressure. Orange County has a death rate from heart disease that is slightly higher than the state of Florida. In 2007, 170,900 people died from heart disease and 61% of those people had hypertension. When looking at the death rate it is startling to see that 61% had hypertension, 62% had high cholesterol, and 59% were inactive. Clearly, there are many different risk factors that contribute to heart disease but hypertension is a significant risk factor and chronic disease that can have severe long-term consequences. In 2007 the prevalence of hypertension in Orange Country was 25.6%, slightly lower than the state (FDOH, 2010).
Risk Factors
Although the direct cause of high blood pressure in many individuals is unknown there are several risk factors for this life-threatening disease that affects one in every three Americans in the United States today (DHDSP, 2010). Risk implies the relation between the exposure and the likelihood of an individual to develop the specific disease or illness. The risks of developing hypertension range from those we cannot control to those that can be lowered by the lifestyle choices we make each and every day. These risks include family history, age, gender-related, race, physical inactivity, unhealthy diet, overweight/obesity, and alcohol abuse (AHA, 2009). These factors not only increase an individual’s risk for developing hypertension, but also for some of the leading causes of death in the world today, cardiovascular disease (CVD) and stroke. Each of these risk factors can be grouped into four different risk categories: genetic risks, biological risks, behavioral risks, and environmental risks.
Genetic Risks
Genetic risks are those predisposed risks factors due to inheritance of specific genes. Hypertension, like other chronic diseases, is known to be hereditary. Family history of high blood pressure such as parental guardians, grandparents and past generations can increase the risk of an individual developing hypertension (AHA, 2009). Although genetics does play a role in the risk of developing high blood pressure, behavioral, biological, and environmental risks are the determinants in the prevalence of the disease.
Biological Risks
Biological risks are the physical characteristics that make an individual more or less prone to developing a disease such as hypertension. For high blood pressure, these risks include gender, age, race, and weight. Although men have a high risk of developing high blood pressure, before the age of 45, woman encompass 50% of the adult population living with high blood pressure (AHA, 2009). As every individual ages, there risk for developing hypertension increases as the blood vessels in our body lose flexibility and result in an increase in pressure throughout our cardiovascular system (AHA, 2009). Race also plays a role in one’s risk in developing high blood pressure. Findings between Caucasians, African Americans, Hispanics and Asians in regard to the prevalence of hypertension vary greatly. Approximately 40% of African Americans are living with high blood pressure (AHA, 2009). Finally, weight is an underlying issue that millions of Americans are facing. In Florida alone, nearly two-thirds of adults have reported overweight (Body Mass Index between 25 and 30) or obese (Body Mass Index over 30) (DHDSP, 2010). A healthy weight differs for each individual depending on body shape and lifestyle but should not be a factor in hypertension risk. Individuals with excess weight put more stress on their heart and other cardiovascular components.
Behavioral Risks
Behavioral risks account for nearly 50% of total health care costs in the United States. Behavior risks associated with high blood pressure include lack of physical activity, poor diet, tobaccos usage, and excessive alcohol intake. (AHA, 2009). An individual and the lifestyle choices they make throughout their lifetime control all these risks. Leading a sedentary lifestyle increase the risk of developing not only high blood pressure but also several other leading cardiovascular diseases affecting millions of individuals. Physical inactivity and overweight/obesity go hand in hand as without daily exercise, weight gain will occur. Unhealthy eating habits also play a huge role in the risk of developing high blood pressure. Diets high in fat, calories, sodium, and sugars greatly increase the chance of hypertension development (AHA, 2009). Alcohol abuse and tobacco usage also dramatically increase one’s chance of developing high blood pressure.
Environmental Risks
Environmental risks, although not proven, play a role in developing one’s risk to high blood pressure. Home and work environments greatly impact an individual’s lifestyle. A body of individuals can either encompass a positive or negative environment. Positive environments where other practice and engage in healthy behaviors is beneficial. Negative environments promote poor lifestyle behaviors and usually develop stressful and hostile situations. Stress can unknowingly raise an individual’s blood pressure and cause future development of hypertension if not regulated. Stress is becoming one of the leading causes of health issues in the United States today.
Preventative Strategies
There are many different ways to prevent hypertension or high blood pressure. Due to the large number of modifiable risk factors hypertension is almost 100% preventable. The preventative strategies reach much further than regular screening and include behaviors such as proper nutritional habits, regular physical activity and exercise, smoking cessation, decreased total body weight, diabetes management, and stress management. When discussing these different behaviors it is also important to acknowledge that genetics still plays a role in the risk of developing hypertension so, those with family history or genetic risk factors much ensure proper preventative behaviors to lower their risk for developing hypertension. Also, as one implement preventative strategies they will mostly likely observe a lower risk of developing heart disease because hypertension is one of the contributing factors for heart disease and heart failure.
Dietary Habits
Proper nutrition plays a significant role in one’s ability to prevent the onset of hypertension. Consuming a diet high in fat, sodium, calories, sugars and alcohol can significantly increase one’s risk for developing hypertension. From a preventative perspective, it is important that one decreases sodium intake and alcohol consumption. Sodium is an element found in most food and when consumed in excess can pose risk to the human system specifically, the heart and its ability to properly function (DHDSP, 2010). The recommendation is to consume less (DHHS, 2003). It is also recommended that one with hypertension decrease salt intake to 1,500mg or lower. Along with reducing salt intake the “DASH” diet is a healthy way to eat to prevent and stop hypertension. DASH or diet approaches to stop hypertension encourage the consumption of many fruits vegetables, low fat dairy as well as decreased consumption of saturated fats, total fat, and cholesterol (DHHS, 2003).
Regular Physical Activity & Exercise
Regular physical activity and exercise has been shown to help prevent blood pressure and also manage hypertension. It is one of the most important preventative strategies that one should implement. Regular physical activity keeps the cardiovascular system working at optimal levels. Decreasing plaque in the arteries and also improving the heart’s ability to pump blood more efficiently through the body. When the heart becomes more efficient at pumping typically blood pressure will either decrease or remain in normal ranges.
Regular Screening
Regular screening is a very important preventative strategy because hypertension does not present many symptoms and often times presents no symptoms at all. The only way to be sure that one does not have chronically increasing blood pressure readings is to make sure to schedule regular screenings. There are many ways to do this. One can schedule annual check-ups with their general physician, use a home monitoring device, participate in a free high blood pressure screening at a local health fair, or use high blood pressure monitors in some drug stores.
Smoking Cessation
Quitting smoking or making the choice not to smoke at all is also a preventative strategy for hypertension. Smoking damages the vessels walls and therefore decreases one’s cardiovascular strength and efficiency. It can also harden arteries making the heart have to work harder to pump blood through the system (DHHS, 2003). One’s risk for heart attack associated with hypertension can decrease significantly within one year of quitting smoking.
Decreased Total Body Weight
The lower one’s total body weight the less risk they have for developing hypertension. Therefore, another preventative strategy is to either decrease one’s weight or maintain a healthy weight for life. Blood pressure rises and weight increases in an individual and in fact, with each 10 pound decrease one can lower blood pressure significantly (DHHS, 2003). Weight loss can significantly affect those who are already hypertensive and overweight. Individuals with the greatest room for improvement have the ability to change their health status at a faster rate.
Diabetes Management
Diabetes management helps to prevent hypertension because if one can manage their diabetes they are less likely to create increased pressure on the vessel walls. Sixty percent of people who have diabetes also have hypertension so when one’s diabetes is not managed correctly their chance of developing hypertension increases (CDC, 2010).
Stress Management
Stress management is also another important preventative strategy. The lower one’s stress the lower their blood pressure. Ways to reduce stress are to exercise, engage in deep breathing activities, cut out personal or professional stress from one’s life. Alternative methods used for reducing stress are massage, acupuncture, recreational activities, and more vacation.
Public Health Interventions
As the prevalence of those living with high blood pressure continues to rise, other cardiovascular diseases contributing to the amount of individuals affected, lives lost, and financial burden to individuals and governments increase as well. Worldwide, one-third of deaths are due to cardiovascular diseases, resulting in the leading cause of death globally (WHO, 2010). In the United States alone, nearly 74.5 million Americans age 20 and older live with high blood pressure (ASH, 2010). Cardiovascular diseases cost the United States $475.3 billion in 2009, $76.6 billion contributing to the health care services, medications, and other related medical needs of high blood pressure specifically (CDC, 2010).
Public health interventions around the world, across the United States, and throughout almost every state are focusing on preventative strategies to reduce the prevalence of high blood pressure through preventative, management, and monitoring strategies. Heart healthy intervention programs are being developed to decrease the incidence, morbidity, and mortality of high blood pressure and associated cardiovascular diseases (WHO, 2010). Behavioral risks by them self reflect 80% of the development of cardiovascular diseases (WHO, 2010). Epidemiology reflects the need for public health interventions. Hypertension prevention programs range from reaching out to trillions globally to small communities such as the Central Florida area.
Around the world, collaboration in taking action to effectively reduce the risk factors, prevalence, and cost of high blood pressure are being developed. Global action includes the WHO Programme on Cardiovascular Disease, as well as research and awareness efforts by the International Society of Hypertension. World Hypertension Day is May 17 of each year. Hypertension has caused a dramatic negative impact on the United States.
In the United States, approximately one in every four American adults has pre-hypertension, inevitably raising one’s risk for high blood pressure (CDC, 2010). The American Society of Hypertension (ASH) exists to educate both health care professionals and patients on the ways to effectively treat hypertension and other cardiovascular diseases. ASH most recent hypertension intervention, the 2010 Hypertension Community Outreach Initiative, strives to promote healthy lifestyle rituals by providing free blood pressure screenings and counseling (ASH, 2010). The American Heart Association has defined “Ideal Cardiovascular Health” as 7 health factors & lifestyle behaviors that support heart health. Goals are set to improve Americans cardiovascular health by 20 percent, while reducing cardiovascular deaths by 20% (AHA, 2010).
Healthy People 2010, developed back in 2000, was launched by the United States to focus on improving the health of Americans. By setting objectives in several aspects of health care including access, physical activity, overweight and obesity, and tobacco use, the mortality and morbidity rate of American lives can be positively changed (CDC, 2009). Coincidentally, these focus areas that strive to increase quality of life and eliminate health disparity, are the same factors to prevent hypertension and several other chronic disease that affect millions of Americans today. Of the twenty-six focus areas, seven directly relate to the risk factors associated with hypertension. Healthy People 2020 is currently being developed as the US hopes to continue reaching out to current and future generations in improving overall health in all Americans.
Some states, like Florida, are taking their own hypertension prevention initiatives as the Behavioral Risk Factors Surveillance System survey showed an astonishing 28.2 % of Floridians live with high blood pressure and 62% are overweight or obese (DHDSP, 2010). The burden of hypertension is prominent as over one-fourth of total Floridian deaths are from cardiovascular disease. Intervention programs such as the Florida Heart Disease and Stroke Prevention promote heart-healthy living by providing funding for increased health access in high blood pressure high-risk areas.
As it is estimated that 90% of Americans will have high blood pressure in their lifetime, Central Florida residents have taking strides in not allowing this to affect them. Central Florida initiated a program called Project Pressure, part of Get Healthy Florida, which brings awareness and education through community involvement with local health care providers and promotional events. The 5th largest college in the nation, University of Central Florida, has taken part in Project Pressure where students have monitored over 1300 blood pressures. Uniting health care providers and local residents in the fight to control and prevent hypertension sets an example for the entire world to follow.
References
World Health Organization (WHO).(2010) The Atlas of Heart Disease and Stroke: Part I Cardiovascular disease, Part II Risk Factors, Part III the burden, Part IV action. Retrieved from http://www.who.int/cardiovascular_diseases/resources/atlas/en/ on June 23, 2010.
U.S. Department of Health and Human Services (DHHS): Center for Disease Control and Prevention, National Center for Health Statistics.(2009)Health, United States, 2009.Retrieved from http://www.cdc.gov/nchs/data/hus/hus09.pdf on June 23, 2010.
Center for Disease Control (CDC): National Center for Health Statistics.(2009) Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008.Retrieved from http://www.cdc.gov/nchs/data/series/sr_10/sr10_242.pdfon June 25, 2010.
Ostchega, Y., Yoon, S., Hughes, J., Louise, T., (2008) Hypertension Awareness, Treatment, and Control—Continued Disparities in Adults: United States, 2005-2006.National Center for Health Statistics (NCHS).Retrieved from http://www.cdc.gov/nchs/data/databriefs/db03.pdfon June 23, 2010.
Robert Wood Johnson Foundation (RWJF).(2010). F as in Fat: 2010, How Obesity Threatens America’s Future. Trust for America’s Health. Retrieved June 20, 2010 from www.healthyamericans.org
U.S. Department of Health and Human Services (DHHS): National Institutes of Health, National Heart, Lung, and Blood Institute. (2003).The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Retrieved on June 30, 2010 from http://www.ncbi.nlm.nih.gov/bookshelf/picrender.fcgi?book=hbp7&blobtype=pdf
Orange County Health Department (OCHD) (2010). Press release: May is American Stroke and High Blood Pressure Month. Retrieved on June 30, 2010 from http://www.orchd.com/absolutenm/templates/archives.aspx?articleid=79&zoneid=17
Shwe, S., Than, K., Sein, T., Thu, Aung., Maung, K., Lwin, M., Tun., H. (2004) Prevalence of Hypertension in Two Selected Villages of Kayin State, Myanmar.Regional Health Forum: Regional Health Forum WHO South-East Asia Region Regional Health Forum v8(1).Retrieved on July 6, 2010 from http://www.searo.who.int/EN/Section1243/Section1310/Section1343/Section1344/Section1836/Section1839.htm
Florida Department of Health (FDOH) (2010) Orange County Disease Profile.Retrieved from http://www.floridacharts.com/charts/DisplayHTML.aspx?ReportType=7244&County=48&year=2008 on July 7, 2010.
Division for Heart Disease and Stroke Prevention (DHDSP). (2010). High Blood Pressure Fact Sheet. Retrieved on July 8, 2010 at http://www.cdc.gov/dhdsp/library/fs_bloodpressure.htm
World Health Organization (WHO). (2009). Cardiovascular diseases (CVDs). Retrieved on July 7, 2010 at http://www.who.int/mediacentre/factsheets/fs317/en/index.html
American Society of Hypertension (ASH). (2010). American Society of Hypertension Practices What It Preaches to Combat ‘Neglected Disease’ of Hypertension. Retrieved on July 3, at www.ash-us.org.
Division for Heart Disease and Stroke Prevention (DHDSP). (2010). About Heart Disease and Stroke Prevention at CDC. Retrieved on July 13, 2010 at http://www.cdc.gov/dhdsp/about_program.htm
Centers for Disease Control and Prevention (CDC). (2009). About Healthy People 2010. Retrieved on June 22, 2010 at http://www.cdc.gov/nchs/healthy_people/hp2010.htm
Division for Heart Disease and Stroke Prevention (DHDSP). (2010). State Program: Florida basic Implementation. Retrieved on July 8, 2010 at http://www.cdc.gov/dhdsp/state_program/fl.htm
American Heart Association (AHA). (2009). Understanding Your Risk for Developing HBP. Retrieved on June 22, 2010 at http://www.americanheart.org/presenter.jhtml?identifier=2142
Appendix
We worked very well together in organizing, researching, and developing this epidemiology paper on hypertension. By dividing the four main topics; Trends and Distributions, Risk Factors, Preventative Strategies, and Public Health Interventions, we were able to focus on specific areas of the paper and then combine, review, and finalize each section. Jenn chose to research Trends and Distributions as well as Preventative Strategies and Malerie, on the other hand, focused on the Risk Factors and Public Health Interventions for high blood pressure. We thought that this would be a fair split in the paper to allow the two of us to really research and understand the epidemiology of our topic. The two of us worked very well together in drafting our paper as well as researching a topic that we are so passionate about. We both collaborated on the paper via email, phone conversation as well as Wiki development.
We were once coworkers at a healthcare facility called the Human Performance Institute, where we taught others the important key fundamentals of living a healthy, well balanced lifestyle that enhanced performance in the home, work, and social environment. Working with clients from all around the world, the prevalence of those living with high blood pressure not only in the United States but globally as well was observed. The two of us have worked with many clients that are managing and treating their hypertension. Also, we both have a passion for healthy lifestyle choices. Many times engaging in healthy behaviors such as exercise and good eating habits can help someone prevent, manage, or treat their hypertension.
Jenn’s research on the Trends and Distribution of high blood pressure came from many difference government websites and sources. Most of the research conducted came from the Department of Health and Human Services, Center for Disease Control. Other sources were the World Health Organization, peer-reviewed articles that examined the influence of hypertension on populations, and the National Heart, Lung, and Blood Institute. This section describes the distribution of hypertension among adults in the world, the United States, Florida, and Orange County. It examines the affect that hypertension has on the health of specific populations. The statistics are amazing. Over 1 billion adults have hypertension in the world and close to 65 million adult Americans live with hypertension everyday. Also, the research helped Jenn understand the impact that hypertension has on heart disease and preventable health care costs.
Malerie’s findings of the Risk Factors associated with high blood pressure were mainly researched from the Center for Disease Control and Prevention website. This section describes age, gender, race, family history, weight, and lifestyle as the main contributors to developing high blood pressure. These risk factors can be broken down into four main risk groups, which include genetic, biological, behavioral, and environmental risks.
Jenn’s research development for the Preventative Strategies section primarily came from the National Heart, Lung, and Blood Institute. There was extremely valuable information on their website that mentioned many of the top preventative strategies one can implement to prevent hypertension. Also, Jenn used other sources such as the CDC, NIH, and Healthy People to help her understand the real causes of hypertension. By understanding the causes of hypertension one can better determine the preventative strategies because most risk factors for hypertension are preventable and modifiable. This is a good thing because though not all will prevent there are ways to treat and management hypertension until it is completely reversed, exercise, weight loss and smoking cessation being the two most important for decreasing blood pressure.
Malerie’s research on the Public Health Interventions section came from a number of relevant sources including the World Health Organization, Center for Disease Control and Prevention, and American Heart Association to name a few. Specific details under this section relate to the underlying need for hypertension public health interventions to exist. High blood pressure awareness and education is highly important in reducing mortality, morbidity, and health care costs associated with hypertension and cardiovascular diseases.
In summary, the two of us worked in unison to research and synthesize the best information about hypertension. The synergy between us is evident. Both of us are working full time as well as going to school part-time and we believe that we managed our lives very well in the midst of the development of our paper and research for our paper. There were many times when the two of us had to depend on one another to write a weekly discussion and we did a great job at making sure that there was and even workload for the two of us. During our research we learned a significant amount statistics about hypertension and gained more knowledge on a subject that we are both so passionate about. Hypertension is a disease that has many risks including increased risk for coronary artery disease and stroke. It is a chronic disease that does not present many symptoms and because of its lack of symptoms it can be assumed that there may be more that 65 million Americans that have hypertension but have yet to be diagnosed. It was a great pleasure for the two of us to have the opportunity to work with one another this semester, especially to be able to create a research paper that we are so closely connected to.