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Practical Application on Managing Hypertension
Clinical Question
In older adults diagnosed with hypertension, do therapy intervention on dietary habits, physical exercise, and stress management effective in lowering their blood pressure levels than lisinopril medication. Practical application on managing hypertension is well discussed in details.
The Focus of the Clinical Question
The above clinical question seeks to determine whether non-pharmacologic interventions for managing hypertension are more effective than pharmacologic interventions. Hypertension is a lifestyle disease that causes a person’s blood pressure to rise beyond the average pressure level, which is 120/80 mm Hg. There is no approved cure for this disease, but it can be managed using nonpharmacologic methods, such as eating a proper diet, exercising regularly, avoiding stress, and avoiding alcohol and cigarette smoking. The disease can also be managed using medicines, such as Lisinopril. Practical application on managing hypertensionThe medication works by widening a person’s blood veins, thereby allowing blood to flow with ease (Ashoorkani et al., 2018). Nonpharmacologic interventions aim at reducing the concentration of cholesterol plaque on a person’s blood vessels, thereby allowing blood to flow easily. Both of these methods effectively lower a person’s blood pressure levels. The clinical question seeks to understand which strategy is recommendable to persons diagnosed with hypertension.
Databases Used to Investigate the Clinical Question
Four databases were used to research and compile literature information about the clinical questions. These databases are peer-reviewed medical journals that focus on reporting data related to the epidemiology of various diseases, signs and symptoms of these diseases, diagnostic procedures, and ways of curing or managing these diseases. The journals selected for this assignment are discussed below:
- Journal of the American College of Cardiology
Practical application on managing hypertension. This journal focuses on publishing evidence-based research papers on cardiovascular diseases, such as hypertension, heart attack, and coronary heart disease. The journal publishes various kinds of papers, including clinical studies, editorials, review articles, meta-analysis papers, among many others. This database was selected for this assignment as it contains a lot of research papers on hypertension, the epidemiology of this disease, its risk factors, and management methods.
- BMC Public Health
The BioMed journal is a peer-reviewed database that publishes research papers on all kinds of diseases affecting public health. This database contains many research papers on hypertension because this condition is the primary diagnosis in the U.S. Practical application on managing hypertension.
- Hypertension
This journal focuses on publishing research papers on hypertension only. Thus, it is easy for a researcher or a student to locate research papers on this database since all papers are related. Research papers on this database focuses on the epidemiology of this disease, risk factors, diagnostic procedures, and ways of lowering blood pressure levels in a person. The journal was selected for this assignment because all the information found in this database is related to hypertension.
- PLOS One
Practical application on managing hypertension.The Public Library of Science (PLOS) One journal is a peer-reviewed journal that publishes scientific papers covering science, medicine, and diseases. This database was selected for this assignment because it contains a lot of information on hypertension and methods of managing this condition.
Research Findings from Quantitative Articles that Used Randomized Control Trial Methods
Research papers on hypertension employ various study methods to fulfill the goals of the study. The majority of these papers use clinical trial methods, whereby the researchers place study participants in two or more groups to determine the impact of employing a specific management method on the study participants. Other studies focus on the epidemiology of this disease and its risk factors among different populations. For example, Andriani and Chamidah’s (2019) study sought to investigate the risk factors of hypertension. The researchers employed questionnaires and interviews to collect primary data from 54 study participants in India. This research indicated that an increase in a person’s age is directly associated with an increase in the risk of being diagnosed with hypertension (β = 0.25115, p = 0.008). The study found that adding one year increases the risk of high blood pressure by 1.29 times. Another finding from this study is the relationship between a person’s pulse rate and hypertension. Andriani and Chamidah (2019) found that an increase in a person’s heartbeats increases the risk of being diagnosed with hypertension by 0.85 times (β = 0.15779, p = 0.021). Overly, findings from Andriani and Chamidah’s (2019) study revealed that age and pulse rate are directly related to hypertension among all population groups.
The epidemiology of hypertension among different population groups is another area of study that has attracted several researchers. As Andriani and Chamidah (2019) mentioned, many researchers seek to understand the incidence of this disease because the older population has a high risk of being diagnosed with the condition. Yu et al.’s (2021) study focused on this area, and it was carried out for 12 years. The researchers recruited 21,172 study participants with normal blood pressure levels between 2003 and 2004. The pressure levels of these participants were recorded every year until 2015. The researchers aimed to determine the rate at which the blood pressure levels of the study participants would progress from a normal blood pressure rate (< 120/80 mmHg) to elevated pressure levels (between 120/80 and 129/80 mmHg), and then to stage 1 hypertension (< 130-139/80-89 mmHg) and stage 2 hypertension (≥140/≥ 90 mmHg). Findings from this study revealed that during the 12 years, the blood pressure levels of 11,168 study participants (52.8%) had risen from a normal blood pressure to stage 1 hypertension. The pressure levels of another 5,004 participants (23.6%) had risen from normal blood pressure to stage 2 hypertension. Participants who were aged 60 years and above had a higher risk of being diagnosed with hypertension (2.8 times) than those aged 49 years and below. The researchers concluded their study by pointing out that age is directly related to the risk of being diagnosed with hypertension.
Clinical studies on the methods of managing hypertension focus on the effectiveness of early testing and the application of pharmacologic and nonpharmacologic methods of managing hypertension. For example, Egan et al.’s (2018) study focused on the effectiveness of the “measure accurately, act rapidly, and partner with patients” (MAP) strategy in managing hypertension among all population groups. The researchers began their study by conducting a small pilot study, which revealed that the MAP strategy effectively lowers the blood pressure levels of patients diagnosed with stage 2 hypertension from 61.2% to 89.8% within the first six months. This study prompted the researchers to carry out another study that sought to investigate whether the MAP strategy is effective in helping hypertension patients manage this condition within one year. According to these researchers, some patients may ignore the strategy after getting used to it. Thus, it is important to investigate the strategy’s effectiveness in the long run. Findings from Egan et al.’s (2018) study revealed that within the first six months, the MAP strategy helped 16,787 hypertension patients improve their blood pressure levels from 64.4% to 74.3% (p<0.001). However, this rate reduced to 73.6% (p<0.001) at the end of the year. These findings confirmed the researchers’ contention that some patients may ignore the MAP strategy with time. The researchers concluded the paper by pointing out the importance of teaching high blood pressure patients about the MAP strategy and why one should consistently follow it to manage pressure levels.
Studies on nonpharmacologic intervention methods of managing high blood pressure focus on researching the effectiveness of strategies, such as diet and physical exercise, in helping hypertension patients manage this disease. Lee et al.’s (2018) study aimed to investigate the importance of supervising patients using nonpharmacologic intervention methods to lower their blood pressure levels. The researchers found that 27 study participants placed under a home-based exercise group and supervised by a trainer had lower blood pressure levels than 28 participants who received instructions on managing hypertension. The blood pressure of the home-based group was reduced by 5.2 mmHg (95% C.I, p=0.011), while that of study participants who received instructions only reduced by 0.4 mmHg (95% C.I, p=0.001). These findings suggest that hypertension patients may ignore nonpharmacologic instructions given to them by healthcare providers to manage their condition. Thus, it is important for healthcare providers to put these individuals in a supervised intervention group, whereby they will receive direct instructions from a trainer.
The Selected Evidence-Based Quantitative Article
Yu et al.’s (2021) paper on the incidence and the period of hypertension progress from a normal blood pressure level is an example of a research paper that used randomized control trials to fulfill the study objectives.
A Summary of the Case Study in Yu et al.’s (2021) Paper
A total of 21,172 study participants with normal blood pressure levels were recruited for this study in 2003 and 2004. The researchers obtained information about these participants from the National Health Insurance Service-Health Screening in South Korea. These participants agreed to participate in the study for free. The researchers followed them and measured their annual blood pressure levels until 2015.
Study Approach
The researchers employed a descriptive study approach to fulfill the paper’s objectives. This study approach seeks to describe the study variables with regard to the hypotheses generated by the researchers. In this study, the main hypothesis was that an increase in a person’s age would increase the risk of being diagnosed with stage 1 or 2 hypertension.
Sample Size
Sample size refers to a small group of study participants selected by researchers to represent the characteristics of the general population. As mentioned before, the sample size for this study was 21,172 participants with normal blood pressure levels.
Study Population
Study population refers to the population of all people where the sample was selected. The sample size was selected from the total adult population of Soth Korea in 2003 and 2004.
Application of Yu et al.’s (2021) Evidence in My Practice
Findings from Yu et al. (2021) revealed that age is directly related to hypertension. In other words, as a person ages, the risk of being diagnosed with hypertension increases. These findings are critical among Family Nurse Practitioners (FNPs) because they offer the basis for public education. FNPs are responsible for caring for out-patients and other patients living in assisted living homes or their homes. One of their responsibilities is teaching their patients about public health and managing diseases. Findings from Yu et al.’s (2021) study are crucial in my role as an FNP because they will provide the basis for public education when interacting with my patients. I will inform them about high blood pressure and why they are more likely to be diagnosed with this condition in the future. I will also educate them about the ways of avoiding hypertension by eating a healthy diet, exercising regularly, avoiding life stressors, and abstaining from alcoholism and cigarette smoking. These risk factors increase a person’s risk of being diagnosed with hypertension, meaning that one can avoid this disease by avoiding these behaviors.
One of the main findings from Yu et al.’s (2021) study is that the pressure levels of 5,004 participants (23.6%) had risen from normal blood pressure to stage 2 hypertension within 12 years. This rise can be associated with poor dietary habits or physical inactivity. For example, consuming food rich in fat results in the accumulation of cholesterol in the blood vessels. As time goes by, this cholesterol turns into plaque which prevents blood from flowing smoothly. As a result, a person’s blood pressure rises because it becomes difficult for the heart to pump blood through narrowed blood vessels by the plaque. As an FNP, it is my responsibility to teach my patient about the risk factors of high blood pressure and how to avoid them. I will use findings from this article to explain to my patients that many people end up being diagnosed with high blood pressure, but one can avoid this condition by engaging in healthy lifestyle behaviors. Practical application on managing hypertension
Study Outcomes from Yu et al.’s (2021) Study
Findings from this study revealed that during the 12 years, the blood pressure levels of 11,168 study participants (52.8%) had risen from a normal blood pressure to stage 1 hypertension. The pressure levels of another 5,004 participants (23.6%) had risen from normal blood pressure to stage 2 hypertension. Participants who were aged 60 years and above had a higher risk of being diagnosed with hypertension (2.8 times) than those aged 49 years and below. Among the study participants who had stage 2 hypertension at the end of the 12 years, 3,879 (77.5%) of them progressed from a normal blood pressure to stage 1 hypertension and stage 2 hypertension. The remaining participants (n=1501) moved from a normal blood pressure to stage 2 hypertension.Practical application on managing hypertension
Validity and Reliability of the Study Results
Study validity refers to the level of accuracy in research. A research paper is deemed valid when the study findings reflect what the researchers wanted to study. Yu et al.’s (2021) study is valid because the findings reflected the four courses of progression from normal blood pressure to stage 2 hypertension. Also, the methods employed by these researchers were accurate because the systolic and systolic blood pressure levels of all study participants were measured annually. Data collected by these researchers reflected what the researchers wanted to study. They found that an increase in a person’s age is directly related to an increase in the risk of being diagnosed with hypertension.
On the other hand, study reliability refers to the level of consistency in the data employed by the researchers. Reliability focuses on each step carried out by the researcher to establish the study results. Findings from Yu et al.’s (2021) study are reliable because the research paper was based on four courses of progression from normal blood pressure to stage 2 hypertension. The researchers measured the blood pressure levels of the study participants every year and recorded their pressure levels. These records were used to determine the course of progression from a normal blood pressure level to stage 2 hypertension. For example, the researchers established that at the end of the 12 years, 3,879 (77.5%) of the study participants progressed from a normal blood pressure to stage 1 hypertension and stage 2 hypertension. These findings show that the study methods employed by these researchers are reliable.
Biases in the Study
Yu et al.’s (2021) study does not contain any bias because the findings are based on the blood pressure readings of the study participants. Thus, study biases that could have allowed the researchers to skew the study results towards a certain outcome are not visible in this study. Generally, a study bias is defined as subjective criteria employed by researchers to influence the study results towards a specific direction. In most cases, these biases are subjective, whereby the researchers judge the study participants and use these judgments to record the study findings. In Yu et al.’s (2021) study, such is not possible because the research paper is based on recording a person’s blood pressure levels. The nature of this study makes it impossible for the researchers’ biases to influence the study results.
The Level of Evidence in Yu et al.’s (2021) Study
Evidence in this paper is level two. The research paper randomly selected the study participants from the National Health Insurance Service-Health Screening in South Korea. The evidence in a level 2 research paper is based on a well-designed randomized control study that usually recruits many study participants. Yu et al.’s (2021) paper is an example of a large multi-site randomized control trial paper that aimed to investigate the rate at which the study participants would progress from a normal blood pressure level to stage 2 hypertension. The researchers created four groups to explore the participants’ blood pressure rates. In the first category, it was hypothesized that the blood pressure levels of the study participants would progress from normal blood pressure to elevated blood pressure to stage 1 hypertension and stage 2 hypertension. The second category hypothesized that the blood pressure levels of the study participants would progress from a normal blood pressure level to elevated blood pressure and stage 2 hypertension. The third category hypothesized that the blood pressure levels of the study participants would progress from a normal blood pressure level to stage 1 hypertension and stage 2 hypertension. The last category hypothesized that the blood pressure levels of the study participants would progress from a normal blood pressure level to stage 2 hypertension.Practical application on managing hypertension
Conclusion
In conclusion, hypertension is a lifestyle disease caused by the accumulation of cholesterol in a person’s blood vessels, thereby making it difficult to pump blood. There is no medically approved cure for hypertension, but the condition can be managed through pharmacologic and nonpharmacologic interventions. Research papers on hypertension focus on identifying the risk factors of this disease and ways of managing age. Age is found to be one of the main risk factors of hypertension. As a person ages, the risk of being diagnosed with high blood pressure increases. However, one can avoid this condition by eating a healthy diet, exercising regularly, avoiding life stressors, and abstaining from alcohol and cigarette smoking. These nonpharmacologic methods are also used to manage the condition. Pharmacologic ways of managing hypertension focus on the use of medications, such as Lisinopril, which works by widening a person’s blood veins, thereby allowing blood to flow with ease. Practical application on managing hypertension