Hypertension, also referred to as elevated blood pressure (BP), is increasingly becoming a major healthcare concern that exacerbates the risks of chronic diseases such as heart attack.
Based on the recent statistics, approximately “1.28 billion adults aged 30-79 years worldwide have hypertension” with the majority being from developing countries (Zhou et al., 2021, p. 784). In the U.S., for instance, nearly a half of adults in the U.S. have hypertension (Zhou et al., 2021, p. 785). However, the main issue of concern is that most people may not be aware they have high blood pressure. In addition to this, only 21 percent of adults with hypertension have the ability of managing it (Zhou et al., 2021, p. 785). Therefore, this medical report seeks to provide an overview of hypertension with a particular focus on relevant medical history, testing, diagnostics, treatment options and appropriate plan of action. Understanding the medical history and other related factors is critical when managing hypertension, which remains to be a major cause of premature death globally.
Relevant Medical History
Medical history is important as it ensures the care providers develop a clear understanding of patient’s state of health. The information obtained is critical as it helps healthcare providers offer individualized patient care. It can also guide them through the diagnostic process – they develop a clear understanding of the hereditary and family related diseases as well as allergies and past and current medication. A comprehensive medical history should be extracted right after several tests have been carried out showing elevated blood pressure. Therefore, healthcare providers must strive to obtain medical history about the patient’s pre-existing medical conditions and drugs. Additionally, the care providers should put into consideration the patient’s lifestyle patterns, specifically, physical exercises and dietary intake.
In line with the above, medical history plays an important role of determining whether or not the patient has secondary hypertension. Here, the care providers should focus more on the history of previous healthcare conditions such as renal disease, anemia, obstructive sleep apnea, and urochrome pigmentation. For instance, a patient with a history of depression, weight gain, and tiredness may suggest a diagnosis of hypothyroidism.
Diagnostics
To diagnose hypertension, the care providers must conduct a comprehensive examination guided by a series of questions on a patient’s medical history and any emerging symptoms. In most cases, as explicated by Pons et al. (2021), the provider listens to the heartbeat with the help of a stethoscope. Another important step in the diagnostic process is where the care provider checks the blood pressure using a cuff – it is usually placed around a patient’s arm. Pons et al. (2021) emphasized the need to ensure the cuff fits around the arm. This is necessary because using either a bigger or small cuff will yield different blood pressure readings. The process also requires the provider to measure blood pressure in both arms to determine if there are any significant differences. After this, the arm with the highest blood pressure should be used in subsequent measurements. At the basic level, the BP reading has two numbers – top number (systolic pressure) and bottom number (diastolic pressure). The former measures pressure in arteries during heartbeat while the latter measures BP between heartbeats.
In line with the above, an individual is diagnosed with hypertension based on the readings on both the systolic and diastolic. This means that hypertension is present when BP reading is equal or greater than 130/80 mm Hg (Pons et al., 2021). Furthermore, high blood pressure can be calculated as an average between two readings obtained on separate occasions.
Appropriate Hypertension Testing
Once diagnosed with high blood pressure, the care provider will recommend several tests to determine the cause. The first test for consideration is ambulatory monitoring, which is done at regular intervals over 24 hours to determine the cause and severity of the condition. This test is carried out either at the clinic or doctor’s office using sphygmomanometer (Jones et al., 2020). This test targets patients who are not able to keep their blood pressure under control and those whose BP is caused by medications. Secondly, lab tests, specifically blood and urine tests are conducted to find out the specific conditions that can cause or exacerbate high blood pressure. For instance, care providers may carryout tests to check for cholesterol and blood sugar levels in the body. Lab tests can also be done to determine the functionality of some organs such as kidney, liver and thyroid.
The third test is electrocardiogram (ECG), a noninvasive test that is carried out to identify and, at the same time, detect the electrical activity of the heart. The findings are then recorded on a plain paper for later use. According to Jones et al. (2020), ECG is mainly used in helping evaluate the damage caused by the heart muscle including heart attack. The last test is Echocardiogram, an ultrasound evaluation of the heart which is undertaken through the chest. As the heart beats and relaxes, sound waves originating from Echocardiogram take a picture and transmit the image to the video monitor. Additionally, Echocardiogram’s main role is to detect any problems associated with heart such as enlargement and blood clots as well as abnormalities in the heart valve and motion of the heart wall. Echocardiogram also helps provide accurate measurement of the ejection fraction or stability of the heart muscle. Overall, although Echocardiogram is more accurate compared to ECG is more expensive.
Treatment Options: Lifestyle Modifications
The appropriate treatment option for patients with pre-hypertension is lifestyle modifications. Some of the common modifications, as discussed by Ott &Schmieder (2022), include “weight loss, reduced sodium intake, physical activity, and limiting alcohol consumption” (p. 36). According to British Hypertension Society (BHS) guidelines, lifestyle modification is necessary for patients with a strong family history – it helps lower blood pressure. However, lifestyle changes alone may not be enough to treat high blood pressure – the care providers may also recommend pharmacotherapy.
Pharmacotherapy
Healthcare provider will recommend medications in the event lifestyle modifications fail to adequately help an individual manage their blood pressure. The first-line treatment options for hypertension include “diuretics, angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), beta-blockers, and calcium channel blockers (CCBs)” (Ott &Schmieder, 2022, p. 37). In some instances, the healthcare provider may recommend taking 2 or antihypertensive in order to achieve the BP goal. Patients who are newly diagnosed with hypertension should receive 2 antihypertensives to help them achieve a target (Ott & Schmieder, 2022). It is also important to administer second line drugs with complementary mechanism of action (MOA) in an effort to minimize the side effects.
Appropriate Plan of Action
Having a plan of action is critical when it comes to keeping the blood pressure within the normal range. Therefore, the appropriate plan of action with regard to this medical report is the Dietary to Stop Hypertension (DASH). DASH emphasizes more on the need to eat plenty of “vegetables and fruits, low-fat milk products, whole grains, lean meats, fish, dried beans and nuts” (Osté et al., 2018, p. 523). Individuals diagnosed with high blood pressure should also monitor their sodium intake to below 2000mg every day in order to keep their BP under control. According to research, DASH diet can help lower BP within two weeks (Osté et al., 2018). Moreover, the diet if followed through can lower cholesterol levels in the blood. It therefore follows that patients should strive to consume a diet with law saturated fat and sodium, but rich in protein, fiber, calcium and magnesium.
Conclusion
Hypertension is emerging as a major issue of public concern that requires urgent solution. The problem today is that most people may not be aware that they have high blood pressure. Therefore, care providers should strive to medical history in effort to understand the severity of the condition. In addition to this, the care providers must conduct a comprehensive examination guided by a series of questions on a patient’s medical history and any emerging symptoms in order to diagnose hypertension. The care providers may recommend several tests such as ambulatory monitoring, lab tests, electrocardiogram (ECG), and Echocardiogram to determine the cause of hypertension. Overall, there are several treatment options for patients diagnosed with hypertension. For instance, the appropriate treatment option for patients with pre-hypertension is lifestyle modifications with a focus on physical activity. Medications may be recommended in the event lifestyle modifications fail to adequately help an individual manage their blood pressure.
References
Jones, N. R., McCormack, T., Constanti, M., & McManus, R. J. (2020). Diagnosis and management of hypertension in adults: NICE guideline updates 2019. British Journal of General Practice, 70(691), 90-91. Web.
Osté, M. C., Gomes-Neto, A. W., Corpeleijn, E., Gans, R. O., de Borst, M. H., van den Berg, E., & Bakker, S. J. (2018). Dietary Approach to Stop Hypertension (DASH) diet and risk of renal function decline and all-cause mortality in renal transplant recipients. American Journal of Transplantation, 18(10), 523-533. Web.
Ott, C., &Schmieder, R. E. (2022). Diagnosis and treatment of arterial hypertension 2021. Kidney International, 101(1), 36-46. Web.
Pons, M., Augustin, S., Scheiner, B., Guillaume, M., Rosselli, M., Rodrigues, S. G., &Genescà, J. (2021). Noninvasive diagnosis of portal hypertension in patients with compensated advanced chronic liver disease. Official Journal of the American College of Gastroenterology, 116(4), 723-732. Web.
Zhou, B., Perel, P., Mensah, G. A., &Ezzati, M. (2021). Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nature Reviews Cardiology, 18(11), 785-802. Web.