Hypertension is a disease so common that many people ignore it. It's mostly a silent, symptomless problem that only receives attention from its sufferers when a disease perceived as more serious-heart disease, kidney disease or stroke - arrives. That's when many patients begin to take seriously the damage being done to their bodies by high blood pressure.
According to the Centers for Disease Control and Prevention (CDC), 67 million American adults - one in three- have high blood pressure. The CDC estimates high blood pressure contributes to nearly 1,000 deaths a day and accounts for an estimated $156 billion in healthcare services, medications and lost productivity. However, small lifestyle changes can positively impact blood pressure levels and improve health, according to Assistant Professor Zorica Kauric-Klein of the Wayne State University College of Nursing, who has spent more than a decade researching hypertension.
"Although awareness and treatment for hypertension has improved over the last few decades, the percentage of patients who have controlled hypertension is still very poor," Kauric-Klein says. "The most recent statistics indicate that 30 percent of the U.S. population is still unaware that they have hypertension. A lot more work still has to be done, because many people do not know the ranges of normal blood pressure or goals for BP treatment."
Normal blood pressure for adults, according to the CDC, is less than 120/80 mmHg. High blood pressure is considered 140/90 mmHg or greater. Prehypertension is classified as blood pressure greater than 120/80 and less than 140/90 mmHg. The goals for treatment are less than 140/90 mmHg for the general population and less than 130/80 mmHg in patients with diabetes or chronic kidney disease.
The cause of hypertension is unknown in 90 percent of cases, Kauric-Klein says, but major risk factors for hypertension include increased age; African American heritage; obesity; a family history of high blood pressure; excessive salt intake; excessive alcohol use; tobacco use; and diabetes.
"Obesity is a major risk factor for the development of hypertension and yet many people are not aware of this," Kauric-Klein says. "The sad thing is we are now starting to see hypertension in children and adolescents which is directly related to obesity. It is really sad to see that a nation so rich in resources is allowing its health to deteriorate because of poor lifestyle choices. Eating a heart-healthy diet, maintaining a healthy weight, exercising daily for 30 minutes, limiting the amount of salt intake in the diet, quitting smoking, reducing alcohol intake to moderate levels and stress reduction can all help decrease high BP.
"It is amazing to me that many people do not see the relationship between these risk factors and the development of hypertension," Kauric-Klein continues. "A lot of it has to do with the fact that hypertension is oftentimes a silent disease and many people are unaware that they have the disease or the risks that are associated with the disease. It is our job as health care professionals to improve awareness of hypertension and its associated risks, and to help people to learn how to successfully manage and treat high blood pressure."
Kauric-Klein recently was the guest speaker at a webinar sponsored by the Michigan Primary Care Transformation Project (MIPCT) for nursing case managers. MIPCT aims to improve health in the state, make care more affordable and strengthen the patient-care team relationship. MICPT focuses on primary practice redesign and team-based care as an integral part of successful care management delivery. The care management team helps patients work toward their personal health goals by incorporating self-management principles and providing health education customized to the patient's health literacy level and cultural preferences. The goal is to utilize the team-based concepts to help patients achieve the best health status possible.
"Health care providers must be sympathetic to patients," Kauric-Klein says, "and recognize societal factors that can be barriers to effective treatment." For example, the patient may not have the funds for blood pressure medications; may eat a lot of fast food loaded in salt because access to fresh food is limited; or may not have an adequate environment in which to exercise. Understanding the patient's situation can improve the provider-patient relationship which can, in turn, improve motivation on the part of the patient to become more engaged in care.
"Hypertension is a disease that is still poorly controlled in the U.S. population," Kauric-Klein says. "Its prevalence has resulted in unnecessary cardiovascular morbidity and mortality in the general population. Lifestyle changes can do a lot to improve blood pressure in the general population. By monitoring blood pressure, reinforcing blood pressure goals and reinforcing lifestyle changes, nursing in collaboration with a health care team, can do a lot to improve blood pressure control. "
To arrange an interview with Professor Kauric-Klein, contact Carol Baldwin, associate director of communications for the College of Nursing, at carol.baldwin@wayne.edu or 313-577-9703.