Historical Perspectives of the Diagnosis of Hypertension

Question: Discuss about theHistorical Perspectives of the Diagnosis of Hypertension. Answer: Introduction: According to Cause (1994), hypertension is most commonly regarded as high blood pressure. It is a long term clinical condition which involves the pressure of the blood in the arteries gets elevated Burt et al. (1995). Although hypertension does not generally show any remarkable symptoms, long term hypertension can evolve the risk factors such as coronary artery disease, heart failure, loss of vision and chronic kidney failure. There are several factors that increases the risk of hypertension such as smoking, high salt intake, excess body weight and alcohol. It may also occur because of consumption of birth pills, kidney or endocrine diseases (Jeunemaitre et al., 1992). As discussed by Calhoun et al. (2008), hypertensions are of two types based on the cause and these primary hypertension and secondary hypertension. The two journals selected for the comparison states that the primary hypertension is due to the complex interaction between the genetic and environmental factors Burt et al. (1995). Both the journals focus mainly on the secondary hypertensions which are hyperthyroidism, hypothyroidism, acromegaly, obesity, pregnancy and excessive liquor consumption. As stated by Ong et al. (2007), the pathophsiology of hypertension can be described as the increased peripheral resistance to blood flow results in high pressure (Jeunemaitre et al., 1992). Evidences revealed the fact that in some young individuals associated with pre-hypertension has elevated cardiac output and heart rate and the term coined for this condition is known as hyperkinetic borderline hypertension Burt et al. (1995). Addition to this, in older people it has been observed that pulse rate gets elevated. The mechanism behind the increase in the peripheral resistance may be either due to disturbance in the salt and water handling renal process or deformities in the sympathetic nervous system (Calhoun et al. 2008). According to Burt et al. (1995), the basis of diagnosis of hypertension is the persistent high blood pressure. The past diagnosis and treatment could reduce the risks associated with hypertension but could not eliminate certain complications linked to this condition. There has been a huge advancement in the diagnosis and treatment process of hypertension. As discussed by Burt et al. (1995), the most common instrument of measuring blood pressure is sphygmomanometer that includes stethoscope, arm cuff, pump, dial and valve. The treatment process of hypertension or high blood pressure includes medications such as diuretics, beta blockers, angiotensin and also diet and lifestyle. This report will highlight the pathophysiology, causes, diagnosis and treatment of hypertension. In addition to the report will also analyze and discuss the difference in diagnosis mode of the past and the present based on two articles. Analysis and Discussion: According to Wilkening (1999), hypertension is one of the major reasons for the visits to the physicians in United States. Despite of the fact that in the 1972, National High Pressure Education Program was established in order to elevate the awareness, diagnosis, treatment and prevention of this condition, this medical condition persists as one of the major community health problem(Johnson et al. 2003). As stated in the Hackam et al. (2013), hypertension impacts on almost 19.7% Canadian adults every year. The CHEP recommendations aims at public care based on the most advanced diagnosis and treatment (Jeunemaitre et al., 1992). The recommendations are based on the various studies related to detection, prevention and improved management of hypertension in Canada (Jeunemaitre et al., 1992). As discussed by Wilkening (1999), the management of hypertension should be based on several factors such as patient with or without diabetes, or the patient have a target organ damage or any other clinical cardiac diseases (Sowers et al. 2001). Based on such factors the management should aim to reduce the morbidity and mortality associated with this clinical condition. However, in the contemporary world views have changed based on the diagnosis and treatment of hypertension. As discussed by Hackam et al. (2013), antihypertensive agents should be considered while proceeding with the diagnosis process. The diagnosis process in the current treatment of hypertension also involves patient and community education which has been developed by the healthcare professionals (Weisstuch et al. 1992). In the past the usual tools used was manometers. As discussed by Weisstuch et al. (1992), out of all the different types of manometers used mercury and aneroid manometer was used in workplaces. Since the electronic devices were not accurate expect for the twenty four hour ambulatory monitoring automated devices which must have been calibrated Hackam et al. (2013). The aneroid manometers used previously for the diagnosis of blood pressure for detection of hypertension were not accurate as compared to the mercury manometers. Such devices required recalibration whenever the readings used to differ by more than 3mm Hg (Wilkening 1999). According to Hackam et al. (2013), in the recent diagnosis process Automated office BP measurement machine is used. This automated tool is usually handled by the trained healthcare professionals in order to measure the blood pressure as well as monitor the antihypertensive treatment. With the use of the automated tool the systolic blood pressure (SBP) and the diastolic blood pressure (DBP), can be measured. For example, as per CHEP, if the SBP is more than equal to 140mm Hg or DBP is more than equal to 90mm Hg then a specific physician should be visited for the assessment of hypertension. Whereas, if SBP is between 130-139 mm Hg or DBP is between 85-89 mm Hg and annual follow-up is recommended. Moreover, using home BP monitoring (HBPM), an individual can diagnose the hypersensitivity by checking the blood pressure at home (Hackam et al., 2013). As discussed by Wilkening (1999) The diagnosis process of hypertension was based on the average of any two or more than two readings detected by the tool that was made on at least two more visits after first screening process (Hackam et al., 2013). In order to take the most accurate reading with those tools it was important to control any sort of external influences or biological determinants which might have caused unpredictability in BP (Jeunemaitre et al., 1992). These determinants involved were room stress, pain, temperature, caffeine, a full bladder (which can raise BP by 10 mm Hg [7]), and prescription and OTC drugs. Once the blood pressure was measured and a medical history is obtained, physical examination along with other necessary diagnostic procedures used to be followed to detect hypertension (Wilkening 1999). The hypertension diagnosis was focused on few observations as observed. Hypertension without any compelling symptoms or indications, diabetes related hypertension, cardiovascular disease, hypertension linked with chronic kidney disorder and other conditions such as dyslipidemia (Wilkening 1999). The main focus of the current diagnosis procedure home based diagnosis and detection of other organ failure that can be responsible for the development of hypertension (Hackam et al., 2013). Moreover, in the current clinical practice public and patient education related to the cause, prevention, diagnosis and treatment of hypertension is also a trend in the cure practice. With time the cost has also been reduced (Hackam et al., 2013). By following risk management, change in lifestyle which is recommended for each and every patient with hypertension (Wilkening 1999). A huge number of resources are obtainable to assist physicians hold up patient lifestyle modifications and self-management which can help in managing blood pressure. Previously the tools used for measuring blood pressure were not accurate and was full of errors. But with the advancement such errors were removed. New techniques have eliminated certain risks linked with this condition (Hackam et al., 2013). Conclusion: Hypertension is one of the medical conditions that do not reflect many symptoms to be diagnosed. Thus, it is important to diagnose the disease well and properly in order to plan for a clinical treatment. The diagnosis and the treatment plan differ in terms of past and current healthcare system. It has been observed that with the development in the technological aspect there has been progress in terms of tools and the various procedures. In this report two journals have been selected to compare the advancement in the diagnosis process. Both the journals focus mainly on the secondary hypertensions which are hyperthyroidism, hypothyroidism, acromegaly, obesity, pregnancy and excessive liquor consumption. The pathophsiology of hypertension can be described as the increased peripheral resistance to blood flow results in high pressure (Jeunemaitre et al., 1992). Once suitable blood pressure measurement has corroborated a diagnosis of hypertension, medical assessment and schedule laboratory examination can stratify the risk of patient by recognizing any linked situations or hypertension-induced target organ damage. Thus, it can be concluded with the advancement in the diagnosis and treatment procedure the risk factor which are associated with hypertension or that can cause hypertension can be reduced. References: Burt, V.L., Cutler, J.A., Higgins, M., Horan, M.J., Labarthe, D., Whelton, P., Brown, C. and Roccella, E.J., 1995. Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population data from the health examination surveys, 1960 to 1991.Hypertension,26(1), pp.60-69. Burt, V.L., Whelton, P., Roccella, E.J., Brown, C., Cutler, J.A., Higgins, M., Horan, M.J. and Labarthe, D., 1995. Prevalence of hypertension in the US adult population results from the Third National Health and Nutrition Examination Survey, 1988-1991.Hypertension,25(3), pp.305-313. Calhoun, D.A., Jones, D., Textor, S., Goff, D.C., Murphy, T.P., Toto, R.D., White, A., Cushman, W.C., White, W., Sica, D. and Ferdinand, K., 2008. Resistant hypertension: diagnosis, evaluation, and treatment a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research.Hypertension,51(6), pp.1403-1419. Cause, H.D.H., 1994. Pathophysiology and management of hypertension in acute ischemic stroke. Hackam, D.G., Quinn, R.R., Ravani, P., Rabi, D.M., Dasgupta, K., Daskalopoulou, S.S., Khan, N.A., Herman, R.J., Bacon, S.L., Cloutier, L. and Dawes, M., 2013. The 2013 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension.Canadian Journal of Cardiology,29(5), pp.528-542. Jeunemaitre, X., Soubrier, F., Kotelevtsev, Y.V., Lifton, R.P., Williams, C.S., Charru, A., Hunt, S.C., Hopkins, P.N., Williams, R.R., Lalouel, J.M. and Corvol, P., 1992. Molecular basis of human hypertension: role of angiotensinogen.Cell,71(1), pp.169-180. Johnson, R.J., Kang, D.H., Feig, D., Kivlighn, S., Kanellis, J., Watanabe, S., Tuttle, K.R., Rodriguez-Iturbe, B., Herrera-Acosta, J. and Mazzali, M., 2003. Is there a pathogenetic role for uric acid in hypertension and cardiovascular and renal disease?.Hypertension,41(6), pp.1183-1190. Ong, K.L., Cheung, B.M., Man, Y.B., Lau, C.P. and Lam, K.S., 2007. Prevalence, awareness, treatment, and control of hypertension among United States adults 19992004.Hypertension,49(1), pp.69-75. Sowers, J.R., Epstein, M. and Frohlich, E.D., 2001. Diabetes, hypertension, and cardiovascular disease an update.Hypertension,37(4), pp.1053-1059. Weisstuch, J.M. and Dworkin, L.D., 1992. Does essential hypertension cause end-stage renal disease?.Kidney International Supplement, (36). Wilkening, B., 1999. Making an accurate diagnosis of hypertension.JAAPA-Journal of the American Academy of Physicians Assistants,12(10), pp.78-78.