The Impact of Using JNC Guideline in Treating Hypertension - Essay Example

The Impact of using JNC Guideline in Treating Hypertension and Reducing Future Risk of Cardiovascular Disease Impact of using JNC Guideline in reducing future Risk of Cardiovascular Disease Introduction According to Cooper and Cene (2008), cardiovascular disease is the leading cause of death in the world. Their study notes that in 2005, there were 17.5 million people worldwide lost their lives to cardiovascular disease and this accounted for 30% of all deaths in the world that year. The study also observed that a sizeable portion of the heart disease cases is caused by hypertension. It is documented that racial and ethnic disparities exist in the toll of cardiovascular disease that results from hypertension. African Americans are affected more heavily by hypertensive cardiovascular disease compared to other races (Cene & Cooper, 2008). In 2011, the World Health Organization (WHO) argued that the risk of cardiovascular disease is increased by the lack of control or detection of hypertension. In that publication, W.H.O claimed that an increase in blood pressure by 20/10 mmHg from such a level as 115/75 mmHg doubles the risk of cardiovascular disease (WHO, 2011). The eighth Joint National Commission panel (JNC 8) developed an evidence-based guideline for managing high blood pressure in adults. The guideline was captured in nine recommendations. Each recommendation shows its target age bracket, strength and the treatment intervention appropriate for the said age bracket or section of the population. The aim of the current paper is to understand whether the JNC guideline can help reduce the future risk of cardiovascular disease. Background Rosendorff et al (2007) reckon that hypertension is a major independent risk factor for coronary artery disease. Based on JNC’s definition of hypertension as having a blood pressure of greater or equal to 140/90 mm Hg, Rosendorff et al (2007) concluded that sixty five million American adults have hypertension. This was equivalent to one fourth of the population of the United States as at 2007. The study also concluded that one fourth of the population of the United States was in prehypertension stage that the JNC stipulated as systolic blood pressure of between 120 and 139 mm Hg or a diastolic blood pressure ranging between 80 and 89 mm Hg (Rosendorff et. al., 2007). Rosendorff et al (2007) noted that blood pressure is strongly related to age but that the relationship is complicated. As one progresses through life up to age fifty, the systolic blood pressure rises in line with diastolic blood pressure. Systolic blood pressure continues rising after fifty years of age but diastolic blood pressure starts decelerating. According to their study, more than half of the American population above sixty-five years of age either have systolic or a combination of systolic and diastolic hypertension. Diastolic blood pressure is associated with the risk of a cardiovascular disease for persons under the age of fifty years. On the other hand, though, systolic blood pressure accounts for higher chances of a cardiovascular disease in persons above the age of sixty years (Rosendorff et. al., 2007). Available data shows that persons of all ages are at risk of hypertension and by association, cardiovascular disease. Given the high prevalence of hypertension and cardiovascular disease, it follows that there is a high likelihood that any hospital will receive a hypertension patient almost every day. The Centers for Disease Control and Prevention (CDC) claim that one in three American adults is at prehypertension stage. According to CDC, African Americans are leading in the prevalence of hypertension and Mexican Americans are last (CDC, 2014). Significance One of the reasons why it is important to study whether using JNC guideline in treating hypertension can help in reducing the risk for cardiovascular disease. Gaziano (2007) refers to a World Bank study that revealed that cardiovascular disease is the cause of death in many developing regions. The deaths that accrue from cardiovascular disease rob the countries off their working-age population. Additionally, it is important to study the possibility of reducing cardiovascular disease using JNC guideline because cardiovascular disease can lead to a loss of job or school drop-out for the caregiver. Gaziano (2007) showed that developing countries spend twice as much as developed countries spend on healthcare. Cardiovascular diseases take many funds that would go to fighting communicable diseases (Gaziano, 2007). According to Rosendorff et al (2007) treating hypertension would help avoid the risk of dying from stroke by between 50 and 60%. The treatment would strengthen patients to resume functionalities that might have been interrupted by the cardiovascular diseases (Rosenorff et. al., 2007). Evidence-based practice Evidence-based practice entails application of available research knowledge in identifying a treatment option that is most appropriate for a certain case. This practice needs skills of making meaningful use of scientific evidence, intensive clinical knowhow and factoring in the values of the patient (Melnyk & Fineout-Overholt, 2011). According to Bostrom et al (2013), academic qualification, individual perception of the value of evidence-based practice and organizational culture are pertinent determinants of whether a clinician will uphold this practice. Evidence-based practice helps to raise the quality of care that patients receive as well as their safety (Bostrom et. al., 2013). PICO PICO is an acronym for Population, Intervention, Comparison, and Outcome. Population highlights the patient under study and their attributes. It captures the problem being studied. The intervention entails the concept to which the population will be exposed. Comparison denotes the intervention that will not be exposed to the concept being tested. Outcome refers to the results of the intended study activity (Akobeng, 2005). The PICO question for this study is; For all individuals over the age of 18 with hypertension does the use of JNC guideline reduce the future risk of cardiovascular disease as a result of untreated hypertension compared to not using JNC guidelines? A group of hypertension patients with cardiovascular diseases will be isolated and their conditions recorded. They will receive hypertension treatment as stipulated in the JNC guideline and any changes in their conditions will be noted. In the end of the study, the differences between the initial and later conditions will be analyzed. It is expected that after receiving treatment using JNC guideline, the group will have a lesser risk of future cardiovascular disease than before the treatment. Components of PICO Population The population of this study will be persons of 18 years of age and above. Males and females will be included in the study sampled randomly. The population will bring together persons of different educational levels from those with high school education through to those with higher education. The participants will be sampled from different wage brackets and residential places. Their diverse medical conditions will be important to the study. Risk factors for cardiovascular diseases such as diabetes that will accompany hypertension will be regarded pertinent (Olafiranye et. al., 2011). Intervention The intervention of choice for this study will include antihypertensive drugs that will help reduce both the diastolic and systolic blood pressures of participant patients. These drugs will be administered according to JNC blood pressure goals. For the purposes of incorporating evidence-based practice to this intervention, participants will be involved in the decision of which pharmacologic and non-pharmacologic elements will work best for them. One broad category of intervention in this study will be the observation of healthy nutrition. Food low in salt and cholesterol will be suggested (Reusser & McCarron, 2006). Follow up visits will help ensure that patients comply with the requirements of the intervention. Metal grills will be installed on beds to help reduce patient falls among hospitalized participants. Comparison It is expected that majority of participants will be in poor conditions before the study. Some might be at a risk of stroke or heart attack (Olafiranye et. al., 2011). Many others might be having financial issues due to the money that they will be spending on seeking treatment. Additionally, some participants may exhibit symptoms of cardiovascular disease such as dizziness, shortness of breath and chest pain. Outcome After administering the intervention, the blood pressures of patients will be lowered to optimum levels. Symptoms of cardiovascular diseases will be cured and any impairment that might be accruing from the disease will be corrected (Olafiranye et. al., 2011). Finally, the socioeconomic quality of life of the participants will improve. References Akobeng, A. (2005). Principles of evidence based medicine. Archives of Disease in Childhood, 90: 873 – 840. Bostrom, A., Rudman, A., Ehrenberg, A., Gustavsson, J. & Wallin, L. (2013). Factors associated with evidence-based practice among registered nurses in Sweden: a national cross-sectional study. BMC Health Services Research, 13: 165. CDC. (2014). High Blood Pressure Facts. Centers for Disease Control and Prevention. Retrieved September 16, 2014 from http://www.cdc.gov/bloodpressure/facts.htm Cene, C. & Cooper, L. (2008). Death Toll From Uncontrolled Blood Pressure in Ethnic Populations: Universal Access and Quality Improvement May Not Be Enough. Annals Family Medicine, 6(6): 486 – 489. Gaziano, T. (2007). Reducing The Growing Burden of Cardiovascular Disease in the Developing World. Health Affairs, 26(1): 13 – 24. Melnyk, B., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. (2nd ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Olafiranye, O., Zizi, F., Brimah, P., Jean-louis, G., Makaryus, A., McFarlane, S. & Ogedegbe, G. (2011). Management of Hypertension among Patients with Coronary Heart Disease. International Journal of Hypertension, 2011: 1 – 6. Reusser, M. & McCarron, D. (2006). Reducing Hypertensive Cardiovascular Disease Risk of African Americans with Diet: Focus on the Facts. Journal of Nutrition, 136: 1099 – 1102. Rosendorff, C., Black, H., Cannon, C., Gersh, B., Gore, J., Izzo, J., Kaplan, N., O’Connor, C., O’Gara, P. & Oparil, S. (2007). Treatment in the Prevention and Management of Ischemic Heart Disease: A Scientific Statement From the American Heart Association Council for High Blood Pressure Research and the Councils on Clinical Cardiology and Epidemiology and Prevention. Journal of the American Heart Association, 115: 2761 – 2788. WHO. (2013). A global brief on Hypertension: Silent killer, global public health crisis. World Health Organization. Read More