Page 279 - Encyclopedia of Nursing Research

246 n HyperTeNSION

on prevention, Detection, evaluation, and the United States, improvements since 1988
Treatment of High Blood pressure (JNc 7) in awareness (81% vs. 69%), treatment (73%
H define HTN as two or more Bp readings of vs. 54%), and control (50% vs. 27%) of HTN
systolic Bp ≥140 mmHg or diastolic Bp ≥90 have helped to recently attain the Healthy
mmHg (chobanian et al., 2003). pre-HTN, People 2010 goal of 50% control of HTN (egan,
defined as systolic Bp ≥120 mmHg or diastolic Zhao, & Axon, 2010). Despite the improve-
Bp ≥80 mmHg, increases the risk (up to twice ments in HTN control over the last decade,
the risk) of developing HTN (chobanian dramatic disparities in the prevalence and
et al., 2003). HTN is classified as either pri- control of HTN exist in certain subpopula-
mary HTN (formerly called essential HTN) or tions (Institute of Medicine, 2003). For exam-
secondary HTN. The cause of primary HTN, ple, Blacks have higher rates of HTN, (40% vs.
which accounts for 95% of cases, remains 27 and 25% in Whites and Hispanics, respec-
in question, but it is known to be correlated tively; Glover, Greenlund, Ayala, & croft,
with obesity, increasing age, diabetes, alco- 2005), higher average Bp, and more frequent
hol consumption, and salt intake (carretero target organ damage than other racial groups
& Oparil, 2000). Secondary HTN accounts for (lloyd-Jones et al., 2010). Mexican Americans
the rest of the cases and results from identifi- have disproportionately poor rates of HTN
able disorders, such as chronic renal disease, control when compared with other groups
renovascular disease, primary aldosteron- (17% vs. 30% in both Blacks and Whites)
ism, or sleep apnea, and may resolve with despite comparable prevalence (Glover et al.,
appropriate treatment of the underlying con- 2005). Socioeconomic status is consistently
dition (chobanian et al., 2003). inversely related to HTN prevalence, regard-
HTN is a major risk factor for cardiovas- less of race or ethnicity (Kaplan & Keil, 1993;
cular disease, independent of other risk fac- Mensah, Mokdad, Ford, Greenlund, & croft,
tors, although it is related to other metabolic 2005). Finally, geographic disparities in
risk factors. Metabolic syndrome, which is HTN control may contribute to higher rates
increasing in prevalence, comprises a con- of stroke in the Southeastern United States
stellation of risk factors, including HTN, than in other regions (Howard et al., 2006).
abdominal obesity, dyslipidemia and insulin These disparities are most likely the prod-
resistance (chobanian et al., 2003). Although uct of complex social, financial, and political
causal origins are not well understood, met- processes that result in barriers to effective
abolic syndrome itself is a risk factor for the health care and barriers to adoption of low-
development of HTN, and the presence of risk lifestyles (cooper et al., 2000; Institute
HTN alongside metabolic syndrome poses of Medicine, 2003). Unfortunately, despite
increased cardiovascular risk. Similar under- recent attention to health disparities, dispar-
lying modifiable lifestyle risk factors have ities in HTN in the United States have either
been identified for both the metabolic syn- persisted or worsened in the past three
drome and HTN. physical inactivity, diets decades, continuing to place an undue bur-
high in fats and refined carbohydrates, and den of cardiovascular risk on certain sub-
obesity are each associated with both HTN groups of the population (cooper et al., 2000;
and the metabolic syndrome. lifestyle modi- Mensah et al., 2005).
fications of these risk factors and smoking The current approach to HTN treat-
cessation is a central to management of both ment relies on adherence to treatment
disorders (Grundy et al., 2005). algorithms, such as the recommendations
Because HTN cannot be cured in the of JNc 7, within an organized health care
vast majority of cases, actions to increase system that provides regular assessments
awareness, treatment and control of HTN and reviews of care (Glynn, Murphy,
are critical to avert target organ damage. In Smith, Schroeder, & Fahey, 2010). The JNc