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Bhima D
Bhima D
Writing Assignment-2
part A (Essay)
pressure (HBP) where the pressure exerted by the arteries is considerably high (systolic blood
pressure (SBP) ≥ 140 mm of Hg and diastolic blood Pressure (DBP) ≥ 90 mm of Hg). The symptoms
of HBP may not be identified or noticed until the disease gets worse so, it is also named as the
silent killer. HBP is one of the most common cardiovascular disease (CVD) in Australia.
HBP has become one of the largest health issues in Australia. In 2003, 42 out of every 100 cases
of CVD’s were hypertension and was became leading burden in Australia (Heart Foundation,
2017). In 2011-2012, almost 1 in 3 (31.6%) Australian adults were affected by HBP (SBP and DBP
≥ 140/90 mmHg) or were taking medications (Australian Bureau of Statistics (ABS), 2013).
Similarly, in 2014/2015, 34% Australian adults age ≥ 18 were suffered from HBP where 2/3rd of
them (68%) were unmanaged high BP (Heart Foundation, 2017), among which more male were
affected than female (24.4% and 21.7 % respectively) while the percentage of measured HBP in
Australia increased with age. In 2012-13, ABS (2014) added that 20% (1 in 5) of Aboriginal and
Torres Strait Islander age ≥ 18 were found with HBP. It also reported that indigenous people were
Kaplan (2010) stated that the exact cause of high BP is not known, however heredity, obesity,
age, smoking, psychological stress, poor diet, salt intake, certain medications, underlying diseases
and physical inactivity may be the risk factors of HBP. In contrast, Falkner (2006) stated that there
is no immune against HBP and it may be measured in young thin people without having any family
history. Janus, Bunker, Kilkkinen, Namara, Philpot, Tideman and Dunbar (2008) revealed that
unmanaged diet and childhood obesity are the main causes of HBP especially in Australia.
American Heart Association (AHA) (2017) divided the causative factors into modifiable and non-
modifiable.
Modifiable causative factors can be controlled which includes obesity, lack of exercise, unhealthy
diet (high in sodium), smoking, alcohol consumption, sleep apnea, stress, high cholesterol level
and Diabetes mellitus (Kaplan, 2010). Non-modifiable factors are out of control such as age, sex,
family history or ethnic backgrounds (AHA, 2017). The risk of HBP is increased with increasing age
and more male are likely to have HBP than female (Heart Foundation, 2017). Similarly, adults
with family history of HBP have higher chance to develop HBP than without family history
(Kaplan, 2010). Ethnic background also plays a key role to develop HBP for example Australian
Aboriginals, Inuit population of Canada and black Americans have been shown more prevalent
to HBP (ABS, 2014; Hackam, Khan, Hemmelgarn, Rabkin, Touyz, Campbell and Quinn, 2010;
Depending on the range of pressure exerted by the blood on the arteries, High BP is divided into
three grades (Krause, et al., 2011; Mancia, 2005). Mancia (2005) stated that in grade 1
hypertension (mild) SBP is 140-159 mmHg and DBP is 90-99 mmHg, grade 2 HBP (Moderate)
where systolic BP is 160-179 mmHg and diastolic BP is 100-109 mmHg, grade 3 HBP (severe) is
represented by ≥180 SBP and ≥110 DBP (Krause et al., 2011). In addition, a condition with
increased systolic BP >140 with normal diastolic BP (<90) is named as isolated systolic HBP, and
in isolated systolic BP with widened pulse pressure, SBP is >160 where DBP is <70 mmHg (Krause
et al., 2011). A critical situation which requires immediate medical response is Hypertensive crisis
where both systolic and diastolic BP is >180 and > 120 mmHg respectively (AHA, 2017).
Management:
Management of each stages of HBP is vital and depends on the complete clinical assessment of
CV system and diagnosis of condition which may help to identify the stages of HBP {National
Institute for Health and Care Excellence (NICE), 2016}. Mild and moderate HBP can be maintained
through the control of modifiable causative factors followed by lifestyle modification includes,
modification of diet, involving in physical activities, reducing salt intake, smoking cessation and
fruits, vegetables, low fat dairy products, nuts and seeds along with reduced saturated and trans-
fat. Hackam et al. (2010) concluded that salt intake of 1500 mg/day for children and adults <50
years and 1300mg/day for adults >50 years is adequate to prevent development of mild and
moderate HBP. Physical activity such as running, jogging or aerobic exercises can reduce 5-
10mmHg of systolic BP (Barrios & Calderón, 2010). Nicotine from tobacco and cigarette can cause
vasoconstriction and increase BP and is same in alcohol consumption. So, limitation of smoking
and alcohol consumption help to decrease BP (NICE, 2016). In case of unsuccessful with life style
changes in grade 1 HBP with low risk of CVD, Antihypertensive drugs should be provided (NICE,
2016).
Severe (grade 3) hypertension is difficult to control only by life style changes as blood pressure
is very high. Antihypertensive drug therapy is vital to control BP and prevent complications (Heart
Foundation of Australia, 2017). High risks of developing various CVDs and multiple organs failure
are the results of prolonged untreated BP (Hackam et al., 2010). Therefore, management of HBP
followed by life style modification to manage isolated systolic BP as it may also develop various
CVDs such as stroke, heart attack and other complications. Moreover, isolated systolic HBP with
widened pulse pressure can be treated with antihypertensive drugs and life style modification
Team
exercise.
to 60 minutes is
products.
healthy foods.
sweet beverages.
fruits.
alcohol consumption of 14
Reduce stress Clinical psychologist Advise the patient regarding Varvogli & Darviri
psychological support to
their family.
Reduce body Physiotherapist Advice patients to limit daily Barrios & Calderón
circumferences.
nurse
Provide awareness regarding
complications in both
indigenous society.
aching pain.
diseases.
Furthermore, encourage
up.
Prevent family Registered nurse Explain the family members Hackam et al. (2010)
group.
From the given case study, Trevor is having atorvastatin which act as HMG CoA reductase
inhibitor mainly prescribed for patient with high risk of CVD with DM and atherosclerosis
(Lennernäs, 2003). One month later, GTN was prescribed to Trevor as he had mild hypertension
(Barrios & Calderón, 2010). Dietary management and physical activities should be suggested to
him as he is under the high risks of further developing HBP. According to diabetic Australia (2015),
Secondly, Katrina is from Indigenous group of Australia which has high prevalence of HBP than
other Australians (ABS, 2014). In addition, Amanda (Katrina’s mother) is on Avapro for her
or sometimes swellings should be provided to Amanda and their family members. Dietary
management and reducing salt intake and alcohol consumption are main areas of education plan
American Heart Association (2017). Managing Blood Pressure with a Heart-Healthy Diet.
Retrieved from https://www.heart.org/en/health-topics/high-blood-pressure/changes-
you-can-make-to-manage-high-blood-pressure/managing-blood-pressure-with-a-heart-
healthy-diet
Australian Bureau of Statistics (2013). Australian Health Survey: Health service Usage and
health related actions, 2011-12. Retrieved from
http://www.abs.gov.au/ausstats/abs@.nsf/lookup/322DB1B539ACCC6CCA257B39000F
316C?
open document
Australian Bureau of Statistics (2014). Australian Aboriginal and Torres Strait Islander Health
Survey: First Results, Australia, 2012-13. Retrieved from
https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4727.0.55.006~2012
%E2%80%9313~Main%20Features~Measured%20high%20blood%20pressure~15
Barrios, V., Escobar, C., & Calderón, A. (2010). Clinical profile and management of patients with
hypertension and chronic ischemic heart disease according to BMI. Obesity, 18(10),
2017-2022.
Dorner, T. E., Genser, D., Krejs, G., Slany, J., Watschinger, B., Ekmekcioglu, C., & Rieder, A.
(2013). Hypertension and nutrition. Position paper of the Austrian Nutrition Society.
Herz, 38(2), 153-162.
Falkner, B. (2006). Hypertension in children. Pediatric Annals, 35(11), 795-801. Retrieved from
http://search.proquest.com.ezproxy.une.edu.au/docview/217546408?accountid=17227
Hackam, D. G., Khan, N. A., Hemmelgarn, B. R., Rabkin, S. W., Touyz, R. M., Campbell, N. R., ... &
Quinn, R. R. (2010). The 2010 Canadian Hypertension Education Program
recommendations for the management of hypertension: part 2–therapy. Canadian
Journal of Cardiology, 26(5), 249-258.
Heart Foundation (2017). Heart Disease in Australia: High Blood Pressure. Retrieved from
https://www.heartfoundation.org.au/about-us/what-we-do/heart-disease-in-
australia/high-blood-pressure-statistics
Janus, E. D., Bunker, S. J., Kilkkinen, A., Namara, K. M., Philpot, B., Tideman, P., ... & Dunbar, J.
A. (2008). Prevalence, detection and drug treatment of hypertension in a rural
Australian population: The Greater Green Triangle Risk Factor Study 2004–2006. Internal
medicine journal, 38(12), 879-886.
Krause, T., Lovibond, K., Caulfield, M., McCormack, T., & Williams, B. (2011). Management of
hypertension: Summary of NICE guidance. BMJ: British Medical Journal (Online), 343 doi:
https://doi.org/10.1136/bmj.d4891
Mancia, G. (2005). Proceedings of the symposium: 'A straightforward strategy for all grades of
hypertension'. Journal of Human Hypertension, 19, S1. doi:
http://dx.doi.org.ezproxy.une.edu.au/10.1038/sj.jhh.1001885
National Institute for Health and Care Excellence (NICE) (2016). Hypertension in adults:
diagnosis and management. Retrieved from https://www.nice.org.uk/guidance/cg127
Varvogli, L., & Darviri, C. (2011). Stress management techniques: evidence-based procedures
that reduce stress and promote health. Health science journal, 5(2), 74.