Hypertension is a serious health problemoriginates from a combination of genetic, environmental, and social factors.Environmental factors are overweight/obesity, bad diet, high dietary sodium, stress, lack of physical activity, smokingand alcohol consumption. Higher degree of BP control can be achieved by providing a care source, maximum adherence, and minimizing therapeutic lethargy. The targeted technique to be followed includes many interventions to raise the awareness among people, provide the right treatment, and control for individuals. Team-base care system is the latest and ideal model needed to get an appropriate care, control, prevention and recognition of hypertension. This model is a multilevel relationship among patient, physician, pharmacist and other health care provider.
Introduction
Hypertension is a very common cardiovascular disease recognized by the elevation in blood pressure, pressure exerted by blood circulated in the vessels against its walls. This illness is diagnosed by high systolic blood pressure readings and/or high diastolic blood pressure readings which are ≥140 mmHg, ≥90 mmHg respectively. It is a leading cause of death globally reaching 9 million every year (Jamie Kitt, 2019). The incidence of hypertension shown to be lowered by a successful counteraction between Population-based and/or individual interventions. The application of such interventions requires full understanding about the impact of modifiable lifestyle factors (MLFs) and how these factors interact with each other’s(Andriolo, 2019).Many people assumed that HTN occurs only in older ages while more than 2.1 million individuals below 45 years old had this disease. This prevalence among adults is high and still rises in U.S. reaching 31.9% of total cases and expected to be 45.6% in the next decades. Moreover, a household survey done in small cities and country side of Iran where only 34% of hypertension individuals were aware of it while big cities has a higher degree of awareness reaching 50% in Tehran and 43.8% in Isfahan(Masoud M. MALEKZADEH, 2013). A detailed information on risk factors, management, control and prevention of hypertension will be discussed.
Methods
Systematic search was performed to get an accurate information about the topic from various articles published between 2013-2019 retrieved from PubMed, science direct and google scholar. The search terms were a combination of “hypertension”, “prevention”, “management”, “risk factors”, “overview”, “review” and “control”. The search was precise to get most relevant and up to date literature. No restriction applied on language,geographical location or specific population. The Referencelists for most of the articles were searched manually forany relevant studies.
Risk factors
Overweight or Obesity
Obesity- hypertension relationship can be cleared as there are many alterations occurs within high weight individuals’ bodies such as increased blood flow, and retention of renal sodium which leads to hypertension. One of obesity problems is abnormal LV [left ventricular] geometry which is more in obese than non-obese patients (49% vs 44%) as it leads to hypertension. Studies in U.S. shows that about 40% of their hypertension adults are obese (BMI >30 kg/m2), and more than one-third of the obese individuals has hypertension (SBP/DBP >140/90 mmHg or taking antihypertensive medication (Robert M. Carey, 2018).
High salt (sodium) intake
High sodium consumption in human diet >5 g sodium per day can be a leading cause of hypertension as it is known that salt results in fluid retention so more pressure will be present on the arteries as its more constricted. One study shows that reduction in salt intake of 5 g per day results in 2.8% reduction in carotid femoral PWV readings about arteries stiffness. Low salt intake should be combined with DASH eating plan to get better reduction in BP (Robert M. Carey, 2018). Dash (Dietary Approaches to Stop Hypertension) eating plan consists of fruits, vegetables, whole grains, nuts, legumes, lean protein, and low-fat dairy products.
Lack of physical activities
As it is directly related to gaining weight, it is very essential to exercise at least 3 to 4 times a week in proper and right manner. Exercising is known for its effect on increasing blood flow to the arteries so natural hormones and cytokines will be released to relax these vessels which eventually reduce the pressure on them. WHO studies show that physical exercise can reduce systolic blood pressure by 5 mmHg.Moreover, reduction in deaths from strokes by 14% and deaths from coronary heart disease by 9%(Ihab Hajjar, 2006).
High alcohol consumption
Too much alcohol drinking seems to have an effect on the activation of adrenergic nervous system which leads to blood vessels constriction so blood flow will increase with a raise in heart rate.
Stress
Many people underestimate the psychological problems effects on various body organs. Stress does have a temporary but dramatic effect on blood pressure as its increasing so relaxing and meditation is the key to lower such an elevation.
Social determents
Social determents are linked with hypertension causes along with environmental and genetic risk factors. These determents are defined as the collection of circumstances related to where people born, grow, live, work, and age, and the systems used to deal and treat a disease. In U.S., a strong linkage presents between social determinants of health and hypertension, specifically within blacks and Hispanics societies who are minority populations. Black people show more prevalence of hypertension compared to white people which leads to high rates of stroke risk and end-stage kidney disease. Moreover, unstable and uncontrolled hypertension is more in blacks because of weak control on BP while taking antihypertensive medication (Robert M. Carey, 2018).
Another determent is Neighborhood characteristics which has a great influence on prevalence of this disease. A higher chance to have high BP seems to be in people who live in most economically deprived neighborhoods. Geographic areas may also have a link to hypertension as it is prevalent in southeastern United States (Robert M. Carey, 2018). However, it is necessary to put these factors in consideration as they are critically important in the control and prevention of this disease.
Management
Hypertension is controlled by using non-pharmacological methods to lower blood pressure. These methods are associated with higher control BP. Non-pharmacological and pharmacological management decrease the risk of CVD and all cause of deaths are reduced by 20% to 40%. Hyper tension has been classified from self-monitoring tele-monitoring to virtual clinics and artificial intelligence. (Robert M. Carey, 2018)
Self-monitoring of BP will lead to enhance the management of BP and it is the most remarkable part of hypertension control. It is acceptable by patients. Self-monitoring trials represent the enhancement for the management of BP. As result patients may use remote monitoring for BP at home. To improve the self-monitoring outcome by using BP monitoring apps. (Jamie Kitt, 2019)
Tele-monitoring is an application of tele-medicine -transfer data remotely- which is transferring of BP readings automatically. Moreover heart rate, oxygen saturation and pacemaker data can be sending with the BP form patients to professionals. Tele-monitoring programs are present but it varies in their modality of data collection, transmission, and reporting. Digital involvement now afford the users with further support over the simple tele-monitoring which can lead to lower BP than the normal care. (Jamie Kitt, 2019)
Virtual clinics supply system-level choice for the technology use and include structured asynchronous online communication between patients and professionals to increase the medical care instead of office visit.(Jamie Kitt, 2019)
Artificial intelligence support mediator such as Alexa and Siri which can set up a reminder and renew the medication lists wirelessly. There is a clear evidence of the important of these and their usage raised by time. Consolidation of tele-monitored data on BP into advance social health care program can now additionally permit combination with other physiological factors including blood glucose, heart rate and exercise permitting adjustment of management recommendations based on pre-determined variables such us user demographics, indicated morbidities and co morbidities.(Jamie Kitt, 2019)
Prevention and control
Application and population-based strategies is a way to help in prevention and control hypertension among the society. A traditional strategy is used to reach the targeted approach in healthcare and to achieve a noticeable reduction in BP for individuals with high BP whom are in the upper end of the BP distribution. Management of patients with hypertension and prevention of hypertension share a similar approach, which is the targeted approach strategy. In approaching a smaller reduction they go for the population-based strategy which is derived from public health mass environmental control experiences, therefore this approach results in a small downward shift in the entire BP distribution. Modeling studies consistently provide greater potential to prevent CVD versus the targeted strategy. The large number of people whom are exposed to small increased CVD risk may generate many more cases than a small number of people exposed to a large increased risk based on the findings of the principal.(Robert M. Carey, 2018)
Conclusion
In conclusion, hypertension has been a major risk of morbidity and mortality by WHO. Many Patients are unaware of the disease and the control rate of disease is low.Despite the management, treatment, many studies had showed that many patients will remain sub-optimally controlled. New strategies and technologies are needed to improve detection and control of raised blood pressure in the community. Possible ways to decrease the prevalence of hypertension is to provide a care source, maximum adherence, minimizing therapeutic lethargy, and increasehypertension awareness and accessibility to health services