The impact of hypertension on the developing countries

Hypertension

Introduction

An outbreak of diseases in a country has adverse effects. There is a massive loss of lives before, and an influx of patients in hospitals before proper research about a disease becomes conclusive. Research on non-communicable and mental disorders is a priority as it is the leading cause of fatalities globally. Epidemics in the non-communicable include cancer, diabetes, mental illness, respiratory infections, joint and bone diseases, and cardiovascular diseases. Mental illness and non-communicable conditions (NCDs), contribute to 60% deaths and increases the burden of death by 46% globally. Smoking, high cholesterol intake in diets, sedentary lifestyle, low vegetable, fruit intake, and high salt intake increases the vulnerability of (NCDs). The condition in which the blood pumping through the arteries is higher than the circulatory system can handle over a continued period is results in hypertension. For instance, hypertension has been a significant killer disease in both developed and developing countries where there are inadequate medical research facilities. Although hypertension prevalence may be high in developed countries developing countries, its impacts fall more on the developing countries due to resource constraints.

The time taken to identify the disease outbreak, its causes, prevalence, and diagnostic testing costs lives and increases the burden of death both at national and global levels. For their high prevalence in developed countries, NCDs are mythically referred to as the diseases of the wealthy. The association of NCDs to the affluent is misleading because it excludes the effects of these diseases in developing countries, yet they are significant killers in developing countries. However, some studies associate NCDs with urbanization due to its high prevalence in people living in urban areas. Therefore there is a need for high-quality research, which will enable quality data collection, thus facilitating prior preparedness and surveillance in matters about hypertension.

Morbidity and Mortality

Several pieces of research closely relate hypertension to a specific cause. The prevalence of the disease also closely relates to its death rates. For instance, findings from a 40-year follow-up study of 9260 hypertensive adult subjects show high salts(phosphate and calcium) in their serum. Thus attributing their cardiovascular disease to high salt intake. In another study examining 1161 hospitalized stroke patients, the findings show that their blood pressure variations during the first 72 hours. The study linearly and independently correlates this to the early development ofneurological deterioration. In support of this, the Scandinavian Candesartan Acute Stroke Trial finding shows that patients with a small SBP drop in the first two days of onset have less neurological deterioration compared to those with large SBP falls.

In an Olmesartan analysis, two types of olmesartancombinations for analytical comparison. Olmesartan-diuretic and olmesartan-calcium antagonistic.Olmesartan-calcium antagonist registered a gradually falling SBP than the olmesartan-diuretic. Patients between 75 and 84 years in the combinationolmesartan-calcium antagonist group showed less cardiovascular incidences as compared to their counterparts in the olmesartan-diuretic group.

Study of the relationship between steady blood pressure components, the pulsatile and levels of MRI in cerebral small vessel disease, study cohort of Northern Manhattan, formed the study population. The population of stroke-free middle-aged and old age was randomly sampled. this examination establishes that pulsatile haemodynamics and aortic stiffness contributes to the damage of small brain blood vessels. The study urges the need for further research in search of more ways to prevent age-related brain damage diseases. However, commentary studies show that there are slim chances of finding prevention for cognitive dysfunction and celebralvascular illness soon. Despite the high prevalence of the cerebral vascular condition, it is poorly managed in first timeischemic stroke patients contrary to expectations of better control in first-time patients. The frequency cerebrovascular patients who end up in conditions of severe disability are pieces of evidence of poor control of the disease. Scanty trial pieces of evidence and targets in different parts of the world concerning the set thresholds of low blood pressure may be contributing factors to delayed efforts in formulating better control for celebralvascular and cognitive dysfunction. Thus clinical trials for better control are an urgent necessity.

A Newcastlestudy consisting of a sample population of people aged 85 years Peters et al. findings show that the use of calcium antagonists contributes to declining of cognitive dysfunction in subjects over three years. However, the study cannot be conclusive as it used a small study group; therefore, more conclusive research is necessary using a larger random sample group. Report findings from early biomarkers show that albuminuria stage transition may be predictable through the use of plasma proteomics in hypertensive patients.Walraven et al.’s study aims at examining the effect of control of blood pressure on small blood vessel disorders and death rates. In a 5711 patient population follow up study that took 5.7 years, showed that occasional occurrence of suboptimal blood pressure control heightened the incidence of microvascular disorders. Further, the research shows that the subjects with poor pressure control are at a lower risk of total death rates than those with better control, a finding that Nilsson disputes.

Association of the geometrical location of the left ventricle with all-cause mortality in the PAMELA study shows that identification of new system classifying left ventricular geometry will play a significant role in reducing the risk of death. A supporting survey by purports two-thirds of patients who have rheumatoid arthritis, have defectives left ventricular mass. Inappropriate ventricular mass contributes to concentric geometry and systolic malfunction.

Some articles relate hypertension morbidity to arterial stiffness. Independent of factors such as carotid intima-media thickness and Framingham risk score, arterial a lower ratio of carotid systolic flow velocity tosystolic arterial diameter relates to cardiovascular diseases. The research further adds that the arterial stiffness index may find its use in the future in predicting cardiovascular events. Arterial stiffness index offers strong indications of arterial atrial fibrillation while holding other factors constant.

Genetics, treatment, and epidemiology are aspects of some studies associates with thehypertension morbidity and cause of mortality. A report from Michigan university cardiac rehabilitation program shows that patients exposed to air currents containing fine particles are vulnerable to the risk of high blood pressure. Consequently,Okello et al. confirm that HIV infected persons have a high incidence of hypertension in his study in Uganda. Induction of sunitinib (antiangiogenesis) into a human contributes to a reduction in endothelium-dependent vasodilation after hypertension.

Etiology

Hypertension etiology research literature available is vague. However, etiological factors of essential hypertension can be discussed based on observable clinical pieces of evidence. Abnormal genetic expressions form a contributing element to hypertension, otherwise known as inherited blood pressure. However, genes that cause alterations in blood pressure are unknown. Family studies show that over or under expression of genes can lead to three BP variations, including low. Normal and severe hypertension.

Apart from genetic causes, there exist other factors that increase BP incidence or accelerates the transition of inherited BP from one stage to another(hypertensinogenic factors). These factors include; stress, obesity, high salt intake, high cholesterol intake, insulin resistance, alcoholism, inactive lifestyle, aging, low calcium, and potassium intake. This study considers the inherited BP as elemental, whilehypertensinogenic factors raise the levels of inherited BP beyond normal levels, thus creating four scenarios. First, the addition of one or more hypertensinogenic elements to a patient’s inherited BP range (<120/<80 mm Hg) will trigger an increase in BP to (<135/<85 mm Hg). In the first case scenario, the factor makes observable incremental changes in pressure, but the normal range remains. For patients with normal inherited BP ranges in the category of (≤130/≤85 mm Hg), addition of hypertensinogenic factors will lead to an increase of BP to a high but normal range of (≤139/≤ 89 mm Hg) or consequently a shift to (140 /90 mm Hg) in the last case.

The complication of identifying which genes cause hypertension unfolds because intermediary phenotypes control total peripheral resistance and cardiac output. The phenotypes are many, and complex mechanisms BP included controls them. Family studies show a close relation of BP between parent, siblings, and their children because of genetic inheritance. Better associations are visible in identical than fraternal twins, biological than adopted children. There is a 25% BP variance in pedigree and 65% in twins. Since genetics has some influence on some hypertensinogenic factors, determining genetic variations in BP may be difficult. It is worth noting that some gene mutations contribute to decreases in BP.

Aldosterone hormone in adolescents secretesGlucocorticoid-Remediable Aldosteronism monogenic hypertension. This autosomal mutation causes a fall in BP. The chimeric gene formed as a result of a meiotic mismatch is attributable to creating a genetic variation that leads to GRA. First, GRA patients had severe hypertension and succumbed to a premature stroke. Liddle’s Syndrome is anther gene mutation which reports refer to as genetically heterogeneous.Suppression of plasma and renin aldosterone hormones activity,early signs of hypertension with hypokalemia are significant characteristics of the Syndrome. Since the Syndrome increases sodium channel activity, patients with Liddle’s condition are salt-sensitive.

A recessive mutation of autosomes which causes mutations in the renal-specific gene. This leads to deactivation of metabolite cortisol, thus activation of mineralocorticoid following a condition of enzyme deficiency. The resultant is the retention of water and salts in the nephron, low levels of low reninaldosterone, and finally, salt-sensitive hypertension.Jeunemaitre et al. first reported a polymorphism in the angiotensinogen gene linked with essential hypertension in hypertensive siblings from Utah and France.

Hypertensinogenic factors

A major hypertensinogenic factor is an abdominal obesity. As Framingham study confirms, each 10% weight increase leads to systolic BP increase by 6.5 mm Hg. A direct association between hypertension to BMI direct association studies shows that irrespective of age, a healthy BMI is below 25. BMI ranging from 26 to 28 creates a 180% probability of hypertension and >1000%. Insulin resistance. Thus many obese patients have insulin resistance.HighBMI closelyrelates to increasing cardiac output and plasma volume. These two variations can promote weight loss in subjects who are either hypertensive or normotensive. Obese adolescent patients are victims of sodium-sensitive BP. Fasting in obese patients contributes to a10 mm Hg BP fall. Change diet for two weeks from an intake of high- sodium (>250 mmol sodium/d) to a diet of low-sodium (<30 mmol/d) in obese adolescents led to weight loss in some, a 10 mm Hg and salt sensitivity was eliminated.

Pathophysiology

The examination of essential hypertension pathogenesis involves consideration of several factors alongside other complexities. For instance, the kidney acts as a target and contributing organ to the hypertensive processes.HBP affects several organ systems and several mechanisms pathways that are either independent or interdependent. Significant factors hypertensionpathogenesis include neurohormonal systems activationgenetics, obesity, and high salt intake in diets. A constant increase in the pressure of systemic blood results in Arterial hypertension, which eventually results in variations in cardiac output as well as the resistance of peripheral vessels.

Studies show that hypertension causes provided may not be conclusive as only a small percentage of patients suffering from kidney diseases have been diagnosed with hypertension. However, essential hypertension has been associated with several causes that are classifiable into either genetic mutations or hypertensinogenic factors. Over-expression or under-expression of allelic genes either in dominant or recessive forms in individuals lead to inherited blood pressure. Hypertensinogenic factors increase the incidence of inherited blood pressure from regular to high and, consequently, from grade 1 to grade 2 hypertension.

Essential physiology affects systemic mechanisms in several ways. For instance, peripheral resistance and cardiac output must balance for BP to remain at normal levels. A high peripheral resistance, coupled with average cardiac output, results in essential hypertension. Prolonged use of calcium channel blocker drugs contributed to the eventual thickening of the blood vessel, thus increasing their resistance. Sympathetic nerve grew activity increases cardiac output, and therefore it is thought to be a significant contributor to the initial rise in blood pressure in the absence of peripheral resistance.

Diagnostic TestingClinical Presentation

Initial Evaluation

Carrying out initial evaluation plays a significant role in determining the baseline BP. The review also helps in the establishment of levels of damage on a target organ, learning the presence of CVD. Identification of reversible causes and occurrence of hypertensinogenic factors, thus enabling in making therapy and medical decisions.

BP Measurement

Proper cuff technique BP measurementsare important considerations diagnostic evaluation and making treatment follow-up of the patient. The acceptable world guidelines provide that a standardized fashion should be used when carrying out BP measurement. Well calibrated and certified equipment such as mercury sphygmomanometer can be used. Alternatively, a validated electronic arm cuff device or calibrated aneroid manometer is preferable. At least two BP measurements on each visit, and an interval least 2 minutes between readings because blood pressure keeps on varying. The moment when sounds disappear is best for taking a diastolic reading. Occasional BP monitoring helps in clarifying hypertension severity and the recommendation of diagnostic measures. Self BP measurement is preferable to the analysis from medical personnel because it is more advantageous. BP reading from self-measurement is useful because they lead to improvements in treatment. After all, the patient plays a part in taking care of their health. Additionally, self BP measurement forms the best basis in the differentiation of hypertension, which occurs only as a result of being in a healthcare facility from sustained hypertension. However, for reliable BP measurements, instructions on the user equipment and frequency of analysis must be carefully given and followed.

Medical History and Physical Examination

Before treatment, a clinician should carefully examine the patient’s medical history. The history helps to identify reversible causes of hypertension and establish whether there is any damage of a target organ. History will also help cardiovascular diseases, which could affect the treatment process. Several repeated tests, including; blood chemistry, urinalysis, complete blood count, are essential in the diagnosis of hypertension.

Relevant Objective

The relevance of this research is to provide hypertension based awareness to medical practitioners, scholars, governments, and the broader population. Proper treatment of hypertension will help in the prevention of incidence and occurrence of effects of high blood pressure, such as target organ damage, cardiovascular disorders, and blood vessel diseases. The containment of these effects will prevent organ dysfunctions as well as eventual mortality. Treatment of already existing cardiovascular disease helps prevent its progression and also to prevent its recurrence to reduce hypertension-related death rate and to ensure that hypertensive patients regain their health.

Recent past research findings conclude that hypertension treatment effects are more magnificent, with an increase in cardiovascular disease risk. The best evaluation of hypertension treatment is provided by random comparative studies. Comparative studies put two factors of hypertension treatment to test. Treatment through lifestyle modification is compared with therapeutic drug treatment. However, results from random comparative studies are limited because the survey is carried over a short duration. At the same time, hypertension is subject to lifetime treatment; thus, the research has been found to underestimate drug treatment effects on hypertensive patients. International comparative studies show clearly that antihypertensive drug therapy help reduces hypertension incidence in patients and thus reduces CVD related mortality rates.

Based on abroad research findings, antihypertensive drugs relatively reduce stroke risk by 30–40%, heart disease by 15–20%, The drug also lowers blood pressure to the range of 10–20 mm Hg for systolic and 5–10 mm Hg diastolic. However, due to differences in ischemic stroke incidence in japan and other western countries,the above results fail to apply in Japan. The effectiveness of the antihypertensive drug is high on HBP patients and elderly patients irrespective of race. Hypertensive treatment relative risk is higher in hypertensive middle-aged and young than normotensive patients similar in age. On the other hand, the absolute risk becomes high in elderly patients as compared to young and middle-aged. Therefore young and middle-aged patients should be considered for longterm antihypertensive treatment. Because their absolute hypertensive risk is lower than relative risk. Results from mete-analysis show that there is no difference between men and women regarding the effect of antihypertensive drug therapy in cardiovascular disease prevention.

Subjective Findings

The diagnosis of hypertension cannot be concluded without the initial examination of a patient’s blood pressure and at least two readings at each visit.from the historical investigation, information on the presence or absence of damage on a target organ and the extent of damage caused to the organ. Hypertensive target organs that should be examined include eyes, heart, kidney, and brain. This research has established that hypertension may affect the normal functioning of kidneys through impairing ultra-filtration processes contributing to sodium and water retention, thus heightening the risk of patient’s .conditions such as diabetes mellitus cardiovascular diseases increases the hypertensive risk. Elevated blood pressure in the brain leads to small blood vessel disease, which is a significant contributor to ischemic stroke. Pulsatile and arterial hypertension come about as a result of compression of blood vessels and stiffness of arteries.

Planning of Hypertension Management at Initial Examination

For a clinician to diagnose a patient with hypertension, a patient’s blood pressure initiates the process of diagnosis. If the initial examination shows elevated blood pressure, it will be advisable to instruct the patient to take the BP measurement at home. As earlier mentioned, home BP measurements eliminate the chance of “white coat hypertension. Thus the true nature of a patient’s hypertensive status can be established before a declaration of hypertension is made.

After a hypertension diagnosis on a patient, modifications in the patient’s lifestyle(less salt and cholesterol dietary intake,regular physical exercise, alcohol avoidance, and maintenance of healthy body weight) becomes a necessity, especially on patients considered as high-risk. Patients already diagnosed with other conditions such as chronic kidney diseases, Mets diabetes mellitus, and cardiovascular diseases are factored as high-risk patients. These patients are expected to modify their lifestyles rigorously. The Japanese health guidance 2008 gives priority to the support, prevention, and management of patients with the Mets. Additionally, home blood pressure measurements found to differ from measures taken from a clinical setting, home measurement should preferential weight should be attached to the latter. After proper analysis of home and clinic blood pressure on overall risks of CVD, the clinician should clearly explain to the patient about the levels of target control, therapeutic strategy, and blood pressure evaluation results until they understand.

Low –risk patients with stage 1 blood pressure having no cardiovascular disease, organ damage, the stratification of risk involves three-month interval blood pressure measurement, modification of lifestyle, and well-determined therapy is initiated. Studies show that if lifestyle alone does effectively reduce blood pressure below stage 1 hypertensive levels, antihypertensive treatment is supposed to begin in three months. When planning treatment and management of hypertension, even in high-risk patients, lifestyle modification should precede the initiation of antihypertensive drug therapy. Stage two blood pressure 160–179/100–109 mm Hg patients, on initial examination of home measurement independent of white coat influence, drug therapy should begin after one month of lifestyle modification if there signs of high risk. Drug therapy for patients with grade three blood pressure should start after a few days of lifestyle modification if the assessments prove high risk.Patients diagnosis showing the presence of diabetes mellitus, cardiovascular disease, chronic kidney diseases are top–risk and thus should begin drug therapy immediately if lifestyle modification does not prove useful.

Massive clinical results have not shown how effective drug therapy is on a patient with metabolic syndrome (Mets) with no other risk factors, normal high BP, fasting levels of glucose, no diabetes mellitus, or organ damage. Therefore according to 2007 ESH/ESC health guidelines, placed these patients second in the rank. However, the study recommends nothing more, but lifestyle modification as drug therapy cannot be initiated at such a stage. Consequently, the present guidelines agree that lifestyle modification is best for Mets patients.

Apart from lifestyle modification and antihypertensive therapy, other medications applied to the high blood pressure includeThiazide diuretics, which help in blood volume reduction through stimulation of kidneys to enable the body to eliminate water and sodium. Research purports that diuretics may be useful to Africans as compared to the angiotensin-converting enzyme. However, diuretics may cause frequent urination to a patient. Hypertensive patients may also be treated using calcium channel blockers, which cause relaxation of blood vessels. They are also useful for the elderly and Africans that ACE. Calcium blockers can slow the rate of heartbeat. Grapefruit juice has been found to increase calcium channel blockers’ side effects on a patient under medication through elevating blood levels.

Angiotensin-converting enzyme (ACE) inhibitors help in the relaxation of blood vessels through inhibiting the production of chemicals associated with blood vessel narrowing. It is more effective in chronic kidney disease patients. Consequently, alpha-blockers are essential in reducing the effects of nerves on blood vessels as well as blood vessel narrowing chemicals. Additionally, alpha-beta blockers slow the heartbeat thus decreasing blood pressure in vessels.

Aldosterone antagonists. Reduces the effect of a natural chemical that promote retention salt and fluid in the body, which cause elevated blood pressure. Inducing Renin inhibitors in a hypertensive patients will slow down the production of enzyme renin by the kidneys which while at high levels creates favorable conditions of high blood pressure. Renin inhibitors are used in conjunction with ACE to reduce risk of complications such as stroke. Administration of vasodilators reduces arterial stiffness. Central-acting agents work on to reduce brain from triggering impulses on nervous system which heightens heartbeat rate while causing vasoconstriction of blood vessels.

Hypertension doctors may prefer to prescribe two or more hypertension drugs on a patient in order to reduce daily medication doses. Research shows that small doses of many hypertensive treatment drugs are more effective as compared to one large dose of a single drug. To medically manage hypertension, always take hypertensive strictly as prescribed without failing. Never make dosage changes without informing your doctor.

References

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