SOC313: Social Implications of Medical Issues
Introduction
Hypertension contributes to a number of diseases. As per studies about 26% people of the world totaling about 1 billion in number are afflicted with hypertension (Kearney et. al). Since a large segment of the world population is expected to grow older by 2025, hypertension is likely to increase in the world within next 15 years. In the US, currently a recorded number of 73 million people are suffering from hypertension. Hypertension is regarded as the silent killer because people suffering from it do not show any external symptoms. Hypertension hardens arteries resulting in the higher risk for cardiovascular diseases, kidney failure and stroke. Hence it is imperative to keep hypertension under check following certain strategies. Further into the essay, I will discuss in depth about what hypertension is, its social and psychological impacts and how community based programs and interventions can help the afflicted to keep the illness at bay.
What is Hypertension?
In order to control hypertension, it is very important to know what exactly hypertension is. `Hypertension is commonly known as high blood pressure. When the heart pumps blood into our system, it puts pressure on the artery walls. When that pressure goes up beyond normal level in the arteries, it puts the heart to hard work in order for the blood to circulate in the body through the veins and arteries. Blood pressure is defined by two measurements, systolic and diastolic. When the heart muscles contract, the blood pressure spikes up to a maximum number and this is known as systolic and when the muscles relax, the blood pressure drops down to minimum and it is known as diastolic pressure. Normal blood pressure varies between 80-120mmhg. If a person has consistent blood pressure reading above 140/90 then that condition is called hypertension.
Hypertension: How widespread it is?
Hypertension is not a very uncommon phenomenon across the world. Around 26% of the world population suffers from hypertension. In US the figures are not better. In fact over the age of 20 one in every three American is a patient of hypertension. Every year almost 38 million or more people are diagnosed with hypertension. Almost 27000 people die every year due to hypertension related complications. 348,000 Americans who died in 2009 were suffering from high blood pressure. Almost $48 billion is spent annually after hypertension related diseases and $3.5 billion is lost due to loss of productivity. Only by reducing sodium or salt intake by 30%, the US can save 18 billion dollars health insurance costs. Younger men and older women are more prone to hypertension. Among the African-American men and women the chances of developing hypertension is much higher (43%) than their white counterparts (31%). (CDC Database, 2011)
Out of the 73 million hypertension patients in America it is estimated that 81.5 % of them are aware of their medical conditions and 74.9% are under some kind of treatment. Around half of the total patients keep hypertension under control. It is also found in various studies that by 2030 the situation will aggravate as the total patients will increase by almost 7% (American Heart Organization, 2011).
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Psychological Challenges
Studies show that different psychological and personality factors contribute to hypertension. The psychological challenges that patients combat to keep hypertension at bay include anxiety, suppressed anger, depression and suppressed hostility. There are three psychological factors found to be correlated with the risk of hypertension: the Negative Affect Hypothesis, the Suppressed Hostility Hypothesis, and the Emotional Defensiveness Hypothesis (Kevin T. Larkin, p 215). The Negative Affect Hypothesis is based on the observations derived from studying hypertensive patients whom the psychoanalysts described as neurotic patients prone to suffer from occasional spell of intense negative effect of anxiety, depression and anger. They also observed that suppression of anger or failure to vent out anger also leads to increased blood pressure. The Suppressed Hostility Hypothesis is based on the observations made by the psychoanalysts who have identified a difference between the reaction of hypertensive people to confrontation and that of people with normal blood pressure. The Emotional Defensiveness Hypothesis stems from the observation that hypertensive people avoid emotionally charged situations or circumstances like anything too stressful or too painful (Kevin T. Larkin, p 215).
Trait anxiety relates to the tendency of one suffering from anxiousness on daily basis. People characterized by high anxious traits are more nervous and high-strung than people with low anxious traits. Individuals with high anxiety traits suffer from chronic worry and look upon the world as dangerous. People with such anxiety disorders are more likely to suffer from hypertension (Kevin T. Larkin, p 216). However, there are lot of empirical studies which negate the association between anxiety and hypertension. Framingham study which lasted for almost half a century and was conducted among a huge population reported that anxiety and hypertension have positive correlation among men but there was not enough evidence to prove that anxiety and hypertension have a combined effect on women. Besides anxiety, anger is another psychological trait considered to be conducive to hypertension. However, many studies have found that high-trait anger and aggression have no connection with increased chances of blood pressure. But anger when suppressed may lead to hypertension (Kevin T. Larkin, p 216).
Depression is a personality trait linked with a feeling of inertia or lack of activity. Depressed people sleep more and work less and often complain about fatigue and loss of energy. It is a completely opposite psychological trait to anger and anxiety. If anger and anxiety are highly reactive, depression is referred as the defeat reaction. It is a common belief that depression and hypertension are associated. Though studies by Grewal et al. (2004) show some degree of association, most of the studies have found no relation between the two (Kevin T. Larkin, p 217).
Social Challenges
Lack of social support is often associated with high likelihood of early mortality rate and hypertension. In 1996 in a study conducted by Uchino et al. among a large group of people to determine the relationship between social support and hypertension, it was noticed that people with a big social circle and a larger family unit have considerably lower risk of high blood pressure than those with limited social circle. Interestingly in that study it was also observed that social circles like clubs reduce risk of hypertension among men but greater number of siblings reduces the risk of high blood pressure among women. The definition of social circle which reduces the risk of hypertension often varies among men and women (Kevin T. Larkin, p 249).
Religious belief also plays a role in developing hypertension. Few studies have shown that more involvement in the religious work and ability to forgiveness are associated with less blood pressure. This effect is more predominant among black people than whites. However, not many researches have been done on the social factor and hence more evidence gathering is required to establish a strong association between religious belief and forgiveness with lower hypertension chances (Kevin T. Larkin, p 251).
Community Programs
Founded in 1972 the National High Blood Pressure Education Program (NHBPEP) was purported to increase mass awareness about hypertension among common people and hypertensive patients so that the number of hypertension related ailments and deaths can be reduced. NHBPEP is comprised of federal agencies, voluntary medical associations, professional medical bodies, state health organizations and lot of small community based clubs. This program tries to identify the major factors behind high hypertension rates in the US and then design an action plan to educate the population about the requirement of changing lifestyle to reduce the chances of developing hypertension. It also educates people about the preventive measures to control blood pressure. NHBPEP’s major focus in last few decades was to spread awareness of the bad effects of hypertension and the requisite lifestyle changes to reduce the risk of the same. NHBPEP also tries to spread awareness about the treatment options. It organizes local small community events and makes people aware of how to treat a major high blood pressure attack or how to detect high blood pressure at home. NHBPEP also helps people already suffering from hypertension by organizing small local community events to teach them how to keep blood pressure under check. In last 3 to 4 decades of its operation it has slowly increased its base and now has reached out to the majority of the population. The mortality rate due to hypertension related illnesses has dropped down ever since. Although the overall number of hypertension cases has gone up in last three decades but the reduction in mortality rate in the same timeframe shows that there were some good effects of NHBPEP’s nationwide community based educational programs (NHBPEP, 2002).
Outside USA a similar kind of program was conducted in Germany during the same period as NHBPEP. National Blood Pressure Program (NBP) in Germany started in 1985. This program used to reach out to communities and in their first phase was facilitating detection of hypertension among the unknowing population. The examination of blood pressure at the work place or social communities was easy and so the program was very well-accepted. The NBP was able to run this program successfully and educated a huge percentage of the population aware of their medical condition. Only by making them aware the mortality rate was drastically reduced as those people started taking medical treatment. In the second phase NBP started conducting classroom presentations all across the nations in small community halls to make people aware about how to reduce chances of death if you have hypertension or how to follow a lifestyle which will keep your blood pressure under control. In the third phase they created a group called German Hypertension League by inviting cardiovascular specialists, scientists, and clinicians. This group was either already knowledgeable or was made knowledgeable in the area of hypertension. In the fourth phase, NBP started a free of cost public telephone service where anyone can call and get reliable medical and general information about hypertension from the German Hypertension League (J Hum Hypertens, 1996). The service is available to all during 6 days a week. NBP still continues to grow its presence among all and continues to spread awareness among all about do’s and don’ts of hypertension.
Intervention
Interventions are techniques or methods which help in reducing the risk of hypertension. It also helps the hypertensive patients keep high blood pressure under control. There are many proven interventions which if followed can reduce the risk of hypertension considerably. Common and proven interventions include an increase in physical activity, less alcohol consumption, less consumption of salt and weight loss. Here we will primarily discuss how weight loss and less intake of sodium can reduce the risk of hypertension.
1.0 Reduction in Dietary Sodium (Salt) Intervention
Salt is one of the biggest enemies of hypertension. It regulates the fluids in our body. A normal human being requires only 500 mg of sodium in our body daily (Elijah Saunders, 2011). However, in many cases we consume almost 10 times that amount per day. This becomes lethal for heart patients. It is established by many analysis and meta-analysis that even small percentage of reduction in the intake of sodium can reduce the systolic pressure significantly. Cutler and colleagues estimated that an average reduction of 77mmol/day in salt intake reduces on an average 1.9mmHg of systolic pressure. Another study called DASH (dietary approaches to stop hypertension-sodium trial) found that average intake of sodium from high level to medium level can cause a decrease of systolic pressure by 2.1mmHg (NHLBI, 2011).
Therefore, examining the sodium content on a food package before buying is recommended. Further since raw salt does more harm than the one assimilated into a cooked food, it is advisable to avoid salt shaker as much as possible during eating. Many of the fast foods and canned foods are very high on sodium and so the avoidance of these items will help keep the sodium level low in the body. Thus keeping check on the intake of sodium is likely to reduce the chances of hypertension related ailments.
2.0 Weight Loss Intervention
When hypertension is diagnosed, then one may either take prescribed medication or incorporate lifestyle changes to keep hypertension under control. According to the Centers for Disease Control (CDC) and National Institutes of Health (NIH), obesity or overweight is one of the major contributive factors to high blood pressure. Therefore, shedding even a small amount of weight is likely to lower blood pressure and control hypertension. However, a normal or underweight person who lives a sedentary life style and is not careful about diet may suffer from hypertension too. So it is important to follow a healthy life style composed of balanced diet and a routine exercise regimen. The clinical review “Clinical Guidelines for the identification Evaluation and treatment of overweight and obesity” also reinforces the fact that weight loss helps in the reduction of blood pressure (NHLBI, 2011). The result of a meta-analysis based on 11 studies shows that weight loss reduces systolic and diastolic pressure. 1KG reduction of body weight causes a reduction of 1.6mmHg in systolic blood pressure and 1.3mmHg of diastolic blood pressure (NHLBI, 2011). It has also been observed that weight loss not only helps in reducing blood pressure immediately, it also prevents blood pressure from increasing in the long run. It is a very effective way of reducing blood pressure among the obese people suffering from hypertension.
Conclusion
Hypertension is a very common disease with almost 1 in 4 individual across the world suffering from it. This paper has discussed in depth about what hypertension is, its social and psychological impacts and how community based programs and interventions help people to keep away from the illness. Hypertension refers to the medical condition of blood shooting up in in the arteries beyond normal when the act of blood circulation in the body through veins and arteries puts too much pressure on the heart. There are many socio and psychological factors contributive to high blood pressure. Suppressed anger, hostility, depression and lack of social support increase the chances of hypertension to a great degree. There are several blood pressure awareness community programs run by government bodies and voluntary organizations across USA and in other countries. Over the last few decades these community programs have reduced the mortality rate caused by hypertension by spreading awareness and showing people how to keep it under check. It is very important to keep hypertension under control by following certain intervention measures including weight loss and avoidance of salt. Some other intervention measures that help in the regulation of blood pressure are timely intake of prescribed medicines, reduction in smoking, incorporation of a good diet and de-stressing. Paying heed to the contributive factors and taking preventive actions by joining related community programs and following control strategies would surely bring about a positive result in terms of reducing hypertension cases around the world.
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