Genetic and Other Factors of Predisposition to Hypertension - Research Paper Example

? Hypertension Table of Contents Table of Contents 2 I. Introduction This article is projected to emphasize, give additional perspective, and augment the overall importance of topical studies available in hypertension that assist individuals to understand hypertension and associated areas. It is a hypertension research paper that analyzes details of the disease through the use of empirical literatures finding. The research that has been done shows that hypertension is a chronic medical state that leads to augmented vulnerability to life-threatening illness.  Stroke and coronary heart disease, are the two leading causes of fatality in the United States, these disorders are associated or directly linked to hypertension.  As the occurrence of heart disease and stroke commences to augment, finding feasible techniques for treating and remedying the hypertension becomes crucial. To gather relevant data in regard to the research question, literature review of the studies done form the pillar of this paper. The study dwells on the effect of hypertension in the United State of America. The research will seek to find the prevalence of the disease among female and males, age group of children, teenagers, youths and the elderly. The research seeks to find out whether culture or race as consequences on preference to the disease. Before settling on the methodology it is essential to comprehend different kinds of clinical research/epidemiology technology. Analyze the merits and demerits of diverse clinical research or epidemiology approaches. Application of the suitable research method to investigate research questions is empirical for the outcome of the research. This research would involve qualitative and quantitative methodologies in order to gather the necessary information. The search method combined recognized methodological studies for qualitative research, with precise references to hypertension. The process would be done by including information of face to face qualitative consultation and focus groups available in peer analyzed journals investigating patient perspectives on hypertension; phone interviews and quantitative questionnaire finding are debatable, could be included or not. The outcome of this research would entails preference rate in regards to age, culture within US (Hypertension Working Group, 2000). Apart from that, what are the interventions the government is doing to manage the disease and reduce fatality rate? Medication strategy to prevent and treat the disease also factors that influence hypertension. II. Literature Review This is a section of research that analyzes the previous literature articles finding and form a basis of comparison through the analysis. Research has revealed that hypernatremia or elevated serum sodium augments the quantity of blood that raises blood pressure. It is documented that primary hypertension may also build up from changes in some bosy chemicals. For a number of clients who react to stress at an advanced degree, the desease may be connected to a higher level, hypertension may be associated to a higher discharge of catecholamines, like norepinephrine and epinephrine, which raises blood pressure (Burt et al, 1995). Some experts feel that hypertension could be caused by a lack of natriuretic factor that is a hormone generated by the heart making arteries to stay in a condition of sustained vasoconstriction. In spite of of whether an individual has primary or secondary high blood pressure, the same kinds of organ injury and complications happen. Hypertension makes the heart to propel against much resistance, increasing its pressure. The volume of the heart muscle augments from the external layer of the epicardium to the internal film of the endocardium. A part from the direct damages on the heart, hypertension accelerates atherosclerosis and can do other severe complications. Damage to a lot of organs of the body could also happen, such as to the brain, heart, eyes, and kidneys. Blood vessels may burst under the overload of high pressure. Small arteries in the retina could hemorrhage, probably consequential in blindness. A blood vein may bleed in the brain resulting cerebrovascular problems. Renal malfunction may also consequence from declined flow to the kidneys. The most apparent discovery during a physical evaluation is a continued elevation of one or both blood pressure calibrations. The pulsation may feel leaping from the strength of ventricular contraction. Hypertensive victims may be obese and may perhaps have tangential edema (Psaty el at, 2004). An opthalmic assessment may expose vascular alterations in the retinal hemorrhages, eyes, or a bulging optic disk. Presently there is no known treatment for hypertension that is not lesser to another illness or state. However, there are fruitful treatments that do manage the consequences of high blood pressure. Preliminary control of hypertension relies on the level of pressure elevation. Mild level may be curable with nonpharmacologic psychotherapy, which may comprise weight loss, rest, counseling, reduction of stress, limiting the drinking of alcohol reduction of sodium in the diet and the stoppage of smoking tobacco products. If triglyceride and cholesterol levels are augmented, a meal low in saturated fats could be suggested. Depending on the patients’ reaction to nonpharmacologic treatment, one of many antihypertensive medicines may be approved. There are numerous different kinds of medicines with proven track findings in the management of hypertension, such as Brodipine and Apresoline. Option of treatment relies upon the client's race, age, and medical record. If not treated, hypertension puts a client at high risk for the enhancement of a disabling or deadly disease (SHEP, 2007). Thorough assessment by a medical physician will initiate a patient on a fruitful treatment program that will incorporate patient training for a healthier standard of living. Adherence to the recommended treatment process will allow the patient to benefit from a more active life. These are findings that research papers have given in regard to Hypertension management. Outcomes of the researches show that hypertension affects 29% of the grown-up U.S. population and is a foremost cause of stroke, heart disease, and kidney failure. Regardless of numerous successful treatments, only 53% of individuals with hypertension are at target blood pressure. Fortunately, the management of hypertension lessens associated risks: lowering blood pressure reduces the danger of stroke by estimated 35%, coronary heart disease by 28% and congestive heart failure by 42%. The results of researches show that augmented age is connected with a noteworthy rise in the prevalence of hypertension and in particular of systolic hypertension over age 60 years. Augmented obesity amid ages 30-50 years is connected with considerable increases in diastolic hypertension and this tendency is also among African-Americans who are bigger than whites. population The program tends to analyze the prevalence of hypertension among the adult population of U.S. Estimated over 50 million mature Americans are affected hypertension, which is the leading prevalent risk issue for kidney disease and cardiovascular complications. High blood pressure, have effects on African-Americans in exceptional ways: African-Americans develop hypertension at younger ages compared to other groups in America. They are more prone to develop complication related to hypertension (Sacks et al, 1999). These problems include kidney disease, stroke, dementia, blindness, and heart disease. The questions that the research answers regarding Africa-America hypertension prevalence comprise; why is hypertension in African-Americans so rampant? What can one do to shun developing the disease? Currently, researchers do not possess a definite resolution to these questions, but suppose that hypertension in African-Americans may be generated by the following issues: Genetic factors. The increase in number of hypertension in African-Americans may be because of the genetic composition of individuals of African origin. Experts have revealed some details such as in Africa, blacks who preserve customary lifestyles have hardly any problems with hypertension. In the America, Africa-Americans respond in a different way to the disease drugs than the rest of the people. Blacks in America also appear to be more susceptible to salt, which augments the threat of getting high blood pressure. Environmental factors. A number of scientists suppose that hypertension in African-Americans is because of factors exclusive to the practice of blacks in the U.S. Blacks internationally have levels of high blood pressure, which are comparable to whites. In the America, however, the dissimilarity is theatrical: over 41% of them have hypertension, as contrasted to over 27% of whites. Additionally, black individuals in the U.S are more liable to be obese than blacks in the rest of the world. These factors are attributed to social and economic issues including economic inequality and discrimination. A Combination of Factors. A majority of experts suppose that high level of hypertension in African-Americans is the consequence of a mixture of various factors, both environmental and genetic. It is documented that by chance, researchers will discover the roots of high occurrence of high blood pressure in black-Americans in the near future. For now, individuals can do a lot to prevent the pressure from damaging their health. Being a Black-American is one threat issue for getting high blood pressure. Others may involve: Excessive and increased weight, a family record of hypertension, diabetes, idleness, high nutritional salt and fat, low ingestion of potassium and smoking (Kannel, 2001). The more threat issues one has, the more probable it is that you have hypertension or will get it in the future. It is recommended that each one take steps now to discover out more. Even if one does no have high blood pressure, it will or can lessen risk by abiding by the treatment strategy for high blood pressure in black-Americans. Methodology Many research methodologies have been used by researchers to handle the hypertension research studies. A cross-sectional multicentre corroboration study of diabetes mellitus and high blood pressure diagnoses in automated clinical records of essential health care was performed. Diagnostic procedures from the most outstandingly clinical practice strategy were considered for typical reference. Sensitivity, positive, specificity and negative prognostic values, and international agreement were computed. Results were revealed generally and stratified by age and sex groups. Hypertension analysis showed considerable agreement with the suggestion standard as resolute by the instruction (? = 0.778), the receptiveness was over 85%, the specificity was over 96%, the constructive predictive value was approximately 85.24%, and the unconstructive predictive worth was over 96 %. Sensitivity outcomes were worse in clients who also suffer from diabetes and in individuals are aged 70 years and above (Gueyffier, Froment & Gouton, 1996). Electronic Health Records give great prospective for research, due to their capability to give data for large number of people. Although the CCR can be applied for research, it is imperative to note that the information collected mainly for routine clinical rather than for studying purposes. Data value and dependability must be evaluated by researchers who use the facilities created in the CCR in order to avoid compromising the outcomes. There are many methods that are applied in research of hypertension cases in United States of America. The other categories of research methods include qualitative and quantitative approach which will be discussed in details later. A better comprehension of research perspective, through qualitative study, is therefore important to offer a clarification of the low rates of adherence, treatment, and management and why instructive interventions have so far been unsuccessful, and to notify the advance of evidence based interventions to enhance management. The outcome results of various research methods used to gather data about hypertension studies have given similar outcomes though differs in figures. Certainly, authors of researches of lay epidemiology propose that clinicians’ failure to identify how individuals understand illness causation and threat is one of the major barriers to the achievement of public health programs. This has lead to new innovative means to undertake research for better outcomes. Combining qualitative study approaches is the most excellent way to achieve a more credible quality guarantee or treatment methodology-based study program.  Traditional studies emphasizes on a solitary or few approaches of researching results, and frequently opt to focus on just a parametric method or a non-parametric method, with the contradictory of whatever strategy was preferred as the primary technique of research, applied to put in details and otherwise essential fillers to the study project and its last reports.  This is for the mainly element how conventional qias and pips are performed for employee physical condition, Medicare Medicaid, and other hedis/qa-assessed, yearly assessed medical programs and research outcomes. These methodologies assist to analyze hypertension cases in a number of ways in various circumstances. The difficulty with this methodology is primary; the qualitative job that is used in most research project is never completely performed, but rather supplementary as adornment to the research as a whole.  This manner, the methodology set to apply is often just overlooked, not at all explained, or detailed in such a manner that its recognition as a qualitative examination method is never acknowledged to in the concluding reports.  This way the qualitative study methods put to employ hardly ever if ever experience the same inspection as the overall quantitative part of the account. Recent research studies in the plan and development of medical agenda review methods have also incorporated the requirements that more comprehensive, much longer reviews be performed with each knowledge-based research activity and each clinical expertise training agenda that is researched.   The most excellent and only means to do the combining quantitative and qualitative research methodologies is noting from the start the needs for involving this kind of research method. The differences in the outcomes of various researches are not significant since their objectives of the methods are the same as per regions. III. Methodology The methodology used to collect the data would be based on the quantitative methods. Qualitative study in any research method is applied to assist in analyzing of the information and is aim in incidences and theory analysis. The questionnaire approach involves meeting and questioning selected informants who are established correspondents in particular research study. In addition, qualitative study methods aid the researcher to achieve inclusive and rich data in the mode of printed information through the observation and give a chance for survey, which is significant during interpretation. In the case, of our study this method may not apply so the most applicable one is quantitative. Quantitative research system on the other hand scrutinizes data collected through set questions with exact number of fixed answer option and generally engages a moderately large figure of respondents. This method assists to adequately give facts of the data collected through quantitative method. Equally, the method helps the researcher to effectively contrast the connection between reliant and autonomous variables in order to make purpose conclusion. Finally, the investigate techniques help to test hypotheses set in this study work. In this case, the method tests the literature findings already discussed. The method used to study the hypertension is clinical trial. The randomized clinical trial is applied in hypertension research project as a primary method for assessing new, potential cases. Below is the design aspect of clinical trials, especially those applicable for creating a hypertension therapeutic scientific trial that assist in collecting data. A clinical trial is “a designed research method to assess the efficiency of a handling in man by contrasting results in a group of patients analyzes with a test approach with those surveyed in a comparable group of clients or patients receiving a organize treatment, where both affected groups are enrolled, given medical attention, and this is within the same period of time (Walsh and McPhee, 2001). Phase 1 trials involve a key focus of describing adverse practice outlines, phase 2 trials continue to obtain further security information and approximates of effectiveness, and phase 3 trials are programmed to evaluate efficacy or efficiency of the new therapy evaluate with historical medical therapy. In this research, we analyze choice clinical trial plan issues, with a concentration on phase 3 experimental trials. It involve introduction of several issues including the target vs. the deliberate population and the option of control cluster, as well as talk about explanations for experimental treatment effectiveness and, for a moment, randomization and blinding. Sample size, chosen statistical matters, and some aspect of multicenter trials are also analyzed.. Method design A fundamental feature of a clinical trial is an accurate hypothesis that spearheads the essential research question. This will oversee both the design and analysis and design of the trial. The theory is based on previous studies and has a reasonable biomedical rationale. One characteristic of the theory is the specification of the target research population to be surveyed. Frequently, this population will be broad and may comprise all people with a complication, such as primary high blood pressure. However, a trial may confine its study size through its insertion and barring criteria. These criteria are frequently developed to reduce adverse experiences and objected at those targeted groups who are most probable to gain. These two matters of conclusive and real trial patient assortment are often in clash with one another when creating a clinical trial. For instance, a trial does not offer an aggressive anticoagulant treatment to all ischemic stroke victims when the harshest cases are predictable to have instantaneous hemorrhage complications. Therefore, victims’ enrollment may be confined and generalizability of the trial outcomes suffers, since some stroke acuteness is involved in the trial (ALLHAT, 2001). Consequently, a critical stage of a clinical trial is the accurate description of exclusion/inclusion criteria and their association to the primarily targeted population of the theory. Trials that employ a highly controlled subpopulation of subjects may yield outcomes validly appropriate to this slight subset, but not conclusive to the larger number. Such trial outcomes are termed as having internal soundness or narrowly generalizable but not exterior validity that is not broadly generalizable. Another significant feature of the clinical trial is the apparent definition of the cure regimen. This is essential for the entire trials, but can be demanding for multicenter trials. Educational consideration including instruction sessions may be included to ensure that the handling protocol is consistently applied across places. A connected treatment protocol deliberation is conditions care. In most cases, individuals are in receipt of concomitant rehabilitation that continues in the trial. If the conclusion is to be widespread, it is essential to article these background therapies. A further dispute in developing a clinical test is the classification of an appropriate contrast or control group. It is frequently easy to condition that the treatment will be evaluated with a control, but defining this management may be not easy (Hart and Bakris, 2004). Frequently, a placebo is the suitable control. This is the state of affairs when there is no conventional therapy for a exacting malady. It then may be morally reasonable to assign clients to a placebo. Alternatively, a non-active control is not suitable if a developed standard of handling exists. This method of research is applicable to our research in that by visiting research centers or clinics the data is achievable. It assists to analyze the prevalence and effect plus the methods that have been applied to manage the disease. In a formal sense, a lot of clinical trials are regarded as blinded. Blinding is a gadget to assist increase impartiality of assessment. In a single-blind clinical examination, only the victims do not be acquainted with which exacting treatment they are getting. A more attractive form of blinding is double-blinding. In this circumstance, not merely is the patient masked to the treatment got, but the doctor is also masked to the treatment that the patient is getting. More normally, it is not the treating doctor who would be masked but the person who makes the primary evaluation of the clinical trial results. Hence, in a situation where it is factually impossible to mask the treating doctor, another assessor who is blind to the patient's action would, for example, evaluate the patient's blood pressure. Such methods are frequent in trials to give the trial a higher stage of objectivity. These processes assess the accuracy of the data collected that upholding the accuracy of research. Population description The targeted group or population would be the mature population of U.S. The clinic trials approach would assist in gathering data to compare with the literature review outcomes and give statistics. The population concentration would be the African-American grown up so as to confirm the literature review findings. The research would not involve questioning the patients; however, gather information from various clinics within America areas where blacks mostly reside and get feedback of their physicians. It is never easy getting factual information from the patients because of various reasons including myths and beliefs. Evaluation method During the collection of data from the clinic would use sample questionnaire to assist in collecting physicians. At this stage of questionnaire, for accurate answers we can not use the open-ended questions that qualitative method. This is because the qualitative is opinion based and would derail the objective of the survey. The questionnaire is closed-ended thus restricting the informant or respondent from giving broad answer but direct question. These questions would be in a form: Q1. What is the age group mostly vulnerable to hypertension? 0-17, 17-35, 36-55, Over 55. Q2. Which gender is mostly affected? Female Male The survey also would evaluate behaviors mostly affecting or influencing development of hypertension. Behavior or human habits are hypothetical regarded as the causes of most illness we suffer. This would be obtained from assessing smokers against non-smoker prevalence restore. The outcomes show that the lifestyle is a factor that influences hypertension. This is because those who smoke have been found to be vulnerable to hypertension. According to the responses from respondent would find that greater percentages of smokers are affected by hypertension compared to non-smokers. Behavioral change such as quitting smoking, taking the stairs not using the elevator, increasing physical activity, eating more fruits and vegetables and avoiding saturated fats are found to be essential for reducing chances of high blood pressure. Health improvements strategies like managing once blood pressure, augmented physical actions, lower BMI, reduced threat of cancer, lesser cholesterol and reduced cardiovascular disease are essential cautions that individuals should adopt to reduce chance of hypertension (Chobanian et al, 2005). The conclusion is arrived at following the response from the physicians that unanimously agreed that these changes reduce chances considerately. IV. Discussion  Program Design and Description To establish the efficiency of systematic, continued, antihypertensive rehabilitation in reducing mortality and morbidity from hypertension in a wide range of people with raised blood pressure in among the African-American communities. The clinic trial program obtains a direct establishment of the prevalence, severity, and management status of respondents’ white and black populations with hypertension in these clinics survey, and obtained an approximation of the degree of achievable reduction of complication of high blood pressure by a prearranged screening and blood pressure handling program. Published statistics from the Veterans management Cooperative research of Hypertension established that decrease in morbidity and death rate could be achieved by curing men with permanent diastolic blood pressure above 105 mm Hg. Comparable tendency happened for those with set diastolic blood pressure of 90 to 104 mm Hg. Outcomes and current tendency from other researches supported these statistics (Meinert, 2007). However, earlier to beginning of HDFP- the Hypertension Detection and Follow-up Program, it was not recognized whether gains from antihypertensive treatment applied to all hypertensive in the broad population and whether utilizing existing medical information could considerably reduce mortality and morbidity from hypertension in the nation. The trial is a non-blind, randomized, fixed sample examination with single involvement and control groups. The involvement group established stepped concerns from the clinical trial clinics, while ones in control group were concerned as their own physicians. Every population contributed both referred-care and stepped-care participants, but for study purposes, the populations were collective into 2 groups. The primary conclusion was mortality. The consequence of stepped- vs. referred-care is evaluated on middle and secondary factors, involving nosologic specification causing adverse effects.   Eligibility Ages:   30 -69 Years Genders:   Male and female Allow Healthy Volunteers:   No Criteria Men and women, ages 30-69 Hypertension Diastolic blood pressure Home monitoring and clinic monitoring equivalent to or over 95 mm Hg and 90 mm Hg, correspondingly. Limitation Affordability is a drawback effect of the program due to its nature of involvement thus increasing cost. There is another problem of implementation which requires skills. Thirdly cooperation from the respondent is a challenge since most are either unwilling or doubtful on the intention. V. Conclusion Hypertension is more rampant to African-American to whites due to genetic factors; environmental factors and a combination of the factors. We have analyzed several aspects of clinical trials, comprising some key matters such as randomization, blinding, and statistical analyses. There are apparently a number of matters to be measured in designing, or reviewing, a clinical trial. References Burt VL, Whelton P, Roccella EJ, Brown C, Cutler JA, Higgins M, Horan MJ, Labarthe D: Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988–1991. Hypertension 1995, 25:305-313. Hypertension Working Group of the National Institutes of Health: Working Group Report on Primary Prevention of Hypertension. National High Blood Pressure Education Program. Bethesda, MD. 2000. Kannel W: Blood pressure as a cardiovascular risk factor: prevention and treatment. JAMA 2001, 275:1571-1576. Psaty B, Smith N, Siscovick D, Koepsell TD, Weiss NS, Heckbert SR, Lemaitre RN, Wagner EH, Furberg CD: (2004) Health outcomes associated with antihypertensive therapies used as first-line agents: a systematic review and meta-analysis. JAMA 1997, 277:739-745. Systolic Hypertension in the Elderly Program (SHEP) ( 2007)Cooperative Research Group: Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). Gueyffier F, Froment A, Gouton M: (1996)New meta-analysis of treatment trials of hypertension: improving the estimate of therapeutic benefit. J Hum Hypertens 1996, 10:1-8. PubMed Abstract ALLHAT ( 2001) Officers and Coordinators for the ALLHAT Collaborative Research Group: Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ,( 2005) National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee: The seventh report of the Joint National Committee on Prevention, Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, Obarzanek E, Conlin PR, Miller ER 3rd, Simons-Morton DG, Karanja N, Lin PH, for the DASH-(1999) Sodium Collaborative Research Group: Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. N Engl J Med 2001, 344:3-10. Cabana M, Rand C, Powe N, Wu AW, Wilson MH, Abboud PA, Rubin HR: Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA 1999, 282:1458-1465. 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