Leon is an African American 55-year-old male. He is a non-smoker, is a nondrinker, and has a healthy weight for his height. On weekends, he coaches a youth baseball team in his community and loves to eat hot dogs and nachos with the children after they play. Leon attends a community health clinic to have routine urinalysis and blood pressure monitoring. At his last visit, his blood pressure was 168/92 mm Hg. Although Leon was pleased that the lower number had dropped from 96 to 92, his physician was still concerned. He warned Leon about the dietary choices he was making and reminded him to limit his salt intake. He also renewed Leon’s prescription for diuretics and added an ACE inhibitor to Leon’s treatment regime.
Speculate how Leon’s ethnicity contributes to his hypertension. What other determinants of health contribute to the prevalence of the hypertensive disease in this population?
What is the significance of an elevated systolic pressure, even in the absence of diastolic hypertension?
Sample Answer
How Leon’s Ethnicity Contributes to His Hypertension and How Other Determinants of Health Contribute to the Prevalence of the Hypertensive Disease in this Population
African Americans have a higher prevalence of hypertension compared to other ethnic groups. This can be attributed to genetic factors that contribute to the development and progression of hypertension. The ethnic groups have genetic underpinnings that increase the tendency of the body to retain sodium. Such underpinnings include polymorphism of epithelial sodium channels that lead to defects in cellular transport of sodium (Ortega, Sedki, & Nayer, 2015). Other genetic factors include low levels of kinins, renin, and natriuretic vasodilator prostaglandins. Environmental factors also contribute to the increased prevalence of hypertension. Other factors include cultural dietary habits of the ethnic groups that increase the risk of hypertension. In Leon’s case, he does not have other risk factors such as obesity; he does not smoke, abuse alcohol and engages in exercise. His diet, however, is a concern. The physician-directed Leon to limit salt intake due to the genetic factors that may increase his risk factors. For effective results, exercise should be combined with diet.
There are determinates of health that affects the prevalence of hypertension among African American. Socio-economic factors affect the development of hypertension. They include high poverty rates, low levels of education, limited access to health care due to lack of insurance, poor housing and low levels of education. The determinants of health impact the ability of the individual to maintain a healthy lifestyle, such as consumption of fruits and vegetables and exercise. African Americans have limited access to health care hence may not be aware of the increased risk of developing hypertension. Early interventions, especially lifestyle changes, reduce the risk of hypertension. Studies indicate that hypertension is associated with low levels of satisfaction with life, lack of social support systems, depression and low social cohesion (Basharic, Janati, Pezeshki, Khodayari-Zarnaq, Sadeghi-Ghyassi, & Gholizadeh, 2020). The factors can be directly or indirectly linked to the social determinants of health. Social determinants such as housing and incomes increase the risks of obesity, a risk factor for hypertension. African Americans are, therefore, at greater risk of hypertension due to the listed social determinants of health that affects a healthy lifestyle and access to care.
Social factors such as the level of education play a significant role in reducing the prevalence of diseases. Leon is happy that the DBP has reduced, although SBP is still elevated. He does not realize the implications of the elevated SBP. Despite the concerns raised by the physician, Leon may not adhere to the precautions fully as he may feel that he is no longer at risk of any adverse health condition. With increased health knowledge Leon would realize that the elevated SBP is a concern and should work towards maintaining normal blood pressure.
Significance of an Elevated Systolic Pressure, Even in the Absence of Diastolic Hypertension
Elevated systolic pressure predicts the risk of cardiovascular disease better even without diastolic hypertension. Isolated systolic hypertension the major form of hypertension in older adults. Previous definition of SBP was systolic blood pressure that is above 140 mmHg and a DBP that is less than 90mm Hg. Current Blood Pressure Guidelines provided by considers a SBP of 130mm Hg hypertension for individuals at all ages the American Heart Association and the American College of Cardiology considers a systolic blood pressure of 130mm Hg hypertension for individuals of all ages (Tan & Thakur, 2020). The new definition is expected to facilitate the early diagnosis of hypertension in older adults. Systolic hypertension is a health concern since it carries significant mortality and morbidity. For patient above the age of 50 years, systolic and diastolic blood pressure are both independently associated with the risk of cardiovascular diseases. At the age of 50 years and above, systolic blood pressure is important than diastolic blood pressure since it facilitates the prediction of the patient’s risk of congestive heart failure, renal failure, left ventricular hypertrophy and coronary heart disease (Tan & Thakur, 2020).
In the case of Leon, his systolic blood pressure during the clinical visit was 168mm Hg indicating isolated systolic hypertension. Despite the reduction in diastolic blood pressure, he is still at risk of cardiovascular diseases such as heart attack or stroke. His age also increases the risk of heart disease associated with hypertension. Isolated systolic blood pressure is associated with reduced elasticity of the arteries, a common occurrence among older adults due to increased deposition of collagen and calcium to the arterial walls. The deposition results in reduced compliance of the arteries, a reduction in the lumen to wall ratio, and vascular intima and media thicken and undergoes fibrotic remodelling. The stiffened arteries cause an increase in pulse pressure and wave velocity resulting in an increase in SBP while DBP decreases (Tan & Thakur, 2020). Stiffening of the arteries leads to atherosclerosis. Rupturing of the plaque causes coronary thrombosis. This could result in myocardial infarction or ischemic heart disease (Bergheanu, Bodde, & Jukema, 2017). The physician is still concerned about Leon as the systolic pressure indicate a risk of suffering from cardiovascular diseases.
