Unit 12: Hypertension Disease Profile - Health & Social Care

This report provides a comprehensive disease profile of hypertension, a leading cause of morbidity and mortality worldwide. It covers the definition of hypertension according to the 2018 guidelines, its etiology including primary and secondary causes, and the importance of accurate blood pressure measurement for diagnosis. The report details the diagnostic process involving patient history, examination, and laboratory tests, along with relevant imaging modalities. It also discusses the epidemiology and pathophysiology of hypertension, emphasizing the interplay of environmental, genetic, and cardiovascular changes. Furthermore, the report outlines treatment strategies, including drug therapy using diuretics, ARBs, ACE inhibitors, and lifestyle modifications such as diet, exercise, and smoking cessation. The document concludes with references to support the information presented, offering a detailed overview of hypertension and its management.

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DISEASE PROFILE
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TASK 3:
DISEASE PROFILE: HYPERTENSION
Introduction
Hypertension and related complications are the leading cause of morbidity and mortality
worldwide. The discussion of this global epidemic is of clinical value. The current paper is a
disease profile of hypertension including but not limited to diagnosis, pattern, pathophysiology,
risk factors, clinical manifestations, epidemiology, prevention, treatment and control of the
disease. The paper will review current and relevant research on the issue and present a review of
the data and discussion.
Definition
According to the new 2018 guidelines by the American Heart Association and the
American College of Cardiology, hypertension is defined as blood pressure measurement of
more than 130/80 mmHg (LeFevre, 2018). However, it is recognized that blood pressure within
any population occurs within a continuum and any value is an arbitrary threshold. Blood pressure
usually rises with age, especially systolic blood pressure and vary with risk factors. A functional
definition thereby is a blood pressure whereby the benefits of treating outweigh the hazards and
cost (Walker & Colledge, 2013).
Etiology
Blood pressure control in the body is one of the systems under homeostatic control.
Blood pressure is a product of cardiac output and total peripheral resistance (Waugh & Grant,
2014). Any abnormality that increases cardiac output or peripheral resistance will cause an

increase in blood pressure. Hypertension can be classified as primary or essential hypertension in
which there no cause can be isolated or secondary hypertension in which an identifiable
secondary disorder causes increased blood pressure (Delacroix, Chokka, & Worthley, 2014).
95% of hypertension is essential hypertension (Walker & Colledge, 2013).
Secondary hypertension can be caused by several factors including:
 Pregnancy-induced hypertension also termed pre-eclampsia
Preeclampsia is related to increased blood volume during pregnancy causing a high cardiac
output (Karumanchi & Granger, 2016).
 Primary renal diseases
The kidneys are involved in blood pressure control through the renin-angiotensin-
aldosterone system and any disorder of the renal system can cause sodium and water retention,
increasing the cardiac output and blood pressure afterward (Peralta et al., 2012)
 Endocrine diseases including pheochromocytoma, hyperthyroidism, Cushing’s disease,
primary hypothyroidism, primary hyperaldosteronism, acromegaly and
hyperparathyroidism (Melmed, 2016).
 Drugs including oral contraceptives, steroids, sympathomimetic drugs, and NSAIDs.
Evaluation of hypertension should, therefore, consider the above-mentioned etiologies.

Diagnosis
Diagnosis of this disease involves complete patient assessment through history and
examination and taking blood pressure measurements.
History and examination
Relevant history and examination should be taken for a patient suspected of having
hypertension. This is specifically important as one intent to find the cause if it is secondary
hypertension, assess for complications of hypertension and increase the index of suspicion
(Walker & Colledge, 2013).
The history will elicit lifestyle and risk factors for hypertension (Walker & Colledge,
2013). A sedentary lifestyle is one of the risk factors. The diet history including excessive salt
intake increases chances of hypertension. Smoking is an independent risk factor for all
cardiovascular and respiratory diseases including hypertension. Essential hypertension and some
forms of secondary hypertension have a genetic component and may run in families. A complete
family history of hypertension or any cardiovascular disease is important. A good history may
elicit those with drug-induced hypertension or alcohol-induced hypertension. Other forms of
hypertension will present with features of the primary disorder for example (Walker & Colledge,
2013);
 Paroxysmal headaches, palpitations and sweating in pheochromocytoma
 Moon facies, truncal obesity, hirsutism and other symptoms of Cushing’s syndrome
 Heat intolerance, excessive sweating, palpitations among other presenting features of
thyrotoxicosis.

The history should also explore to rule out any complications associated with hypertension.
Presence of certain pathologies could be due to the exposure of body tissues to high blood
pressure. They include arteriosclerosis leading to angina and coronary heart disease, stroke in the
central nervous system, hypertensive retinopathy leading to visual disturbances, cardiac
arrhythmias, and hypertensive cardiomyopathy, and renal failure due to damage to kidney
vessels (Glynn & Drake, 2017).
Examination findings that help to diagnose hypertension include signs such as body habitus
in Cushing’s, pulse characteristics in coarctation of the aorta, abdominal bruits in renal vessels
stenosis, enlarged kidneys among others (Glynn & Drake, 2017). Most of these signs are due to
primary disorder causing secondary hypertension or as a complication of hypertension.
Blood pressure measurement
The decision to treat hypertension in a patient assumes the benefits outweigh the hazards.
Since treatment is lifelong, very accurate blood pressure measurement needs to be done before
someone is labeled hypertensive (LeFevre, 2018). The patient should avoid things that can
elevate blood pressure before measurement including avoiding caffeine, smoking or exercise 30
minutes before the measurement. The patient should also have an empty bladder prior to
measurement (LeFevre, 2018). Appropriate measurement involves:
1. Using a blood pressure machine that is effective, well maintained and calibrated properly.
Using faulty machines leads to erroneous measurement that can cause more harm than
good.
2. Blood pressure should be measured while the patient is seated. Standing measurement is
done in special circumstances for example in diabetics and the elderly to pick out postural
hypotension.

3. Measurement should be done on a free arm with no tight bandages or clothing
4. The arm should be loosely supported at the level of the heart.
5. Measurement should be done using the correct cuff size.
6. When measuring the pressure should be lowered slowly at about 2 mmHg per second and
read to the nearest 2 mmHg at the disappearance of the koracoff sounds (phase v).
7. Two measurements have to be taken with at least two minutes interval and the average of
at least two measurements taken. This is the patient’s blood pressure.
Laboratory tests and imaging are also of use in the diagnosis of a hypertensive patient. The
tests done include urinalysis for blood, protein, and glucose, blood urea, electrolytes and
creatinine, blood glucose, serum total and HDL cholesterol, thyroid function tests and a 12-lead
ECG (Walker & Colledge, 2013). Imaging modalities of use include chest radiography to detect
cardiomegaly, heart failure and coarctation of the aorta, an echocardiogram to detect an atrial-
ventricular disorder, and abdominal ultrasound to detect renal pathologies (Walker & Colledge,
2013).
Epidemiology of hypertension
Hypertension is a worldwide epidemic and is the leading cause of leading risk factor for
death in the world. It causes 7.5 million deaths per year, an estimated 12% of all deaths in the
world (Kumar, 2013). 2012 WHO statistics estimated that the prevalence was higher in males at
29.2% than in females at 24.8%. this is shown by a statistic that states that 90% of men who by
55 or 65 years who have not developed hypertension will do so by 85 years of age (Kumar,
2013). Although it was previously linked to those with rick and lavish lifestyles, hypertension is
a disease that affects all socioeconomic divisions.

Pathophysiology of hypertension
Pathophysiology of hypertension is an interplay of environmental, genetic and structural
cardiovascular changes that eventually predispose to ad lead to hypertension. The discussed
pathophysiology will, however, focus on essential hypertension as secondary hypertension is a
consequence of another primary disorder. The hallmarks include increased vascular resistance,
stiffness and increased response to stimuli (Burnier & Wuerzner, 2015).
Blood pressure is a product of total peripheral resistance and cardiac output. Person’s
with hypertension will have a raised cardiac output or an increased peripheral resistance or both.
Increased peripheral resistance due to reduced vessel compliance and vessel stiffness is the
reason for increased blood pressure with age (Safar & O'Rourke, 2012). The vascular resistance
can be increased if there is an increased in sympathetic discharge causing vasoconstriction or an
increase in cytosolic calcium.
Reduction in renal sodium handling is another recognized mechanism of hypertension
(Hall et al., 2012). The decreased sodium excretion causes an increase in fluid volume hence
increasing cardiac output which in turn raises the blood pressure. At this elevated pressure, the
kidneys excrete more sodium but at the expense of an already elevated blood pressure (Hall et
al., 2012). These mechanisms are linked to a modifiable risk factor that enhances genetic
predispositions. Such factors include stress, obesity, smoking, physical inactivity and high salt
consumption (DeMarco, Aroor, & Sowers, 2014). The evidence linking these factors to the
development of hypertension is strong proving their association.
Treatment of hypertension
Management of hypertension involves both drug therapy and modification of risk factors.

Drug therapy
Drugs used in the treatment of hypertension work by reducing the peripheral resistance,
reducing the cardiac output or both. The most commonly used drugs include diuretics,
Angiotensin II receptor blockers, angiotensin-converting enzyme inhibitors, beta blockers,
vasodilators, calcium channel blockers, central-acting drugs, alpha blockers and combined beta
and alpha-adrenoceptor blockers (Luehr et al., 2012).
Thiazide diuretics are used to lower cardiac output by increasing sodium and water
excretion at the kidney (Katzung, Masters, & Trevor, 2012). They reduce the risk of heart failure
and stroke in these patients. loop diuretics have also been used with potassium-sparing diuretics
added to reduce hypokalemia (Carter & Ernst, 2017).
Drugs that reduce the peripheral resistance include ARBS, ACE inhibitors, and
vasodilators. They essentially cause vasodilation or prevent vasoconstriction. This lowers the
peripheral resistance and blood pressure drop (Katzung, Masters, & Trevor, 2012). Adrenoceptor
blockers cause a positive inotropic effect on the heart increasing rate and contractility hence
increasing the cardiac output. This thereby raises the blood pressure (Katzung, Masters, &
Trevor, 2012).
Risk reduction
Modifying one’s lifestyle has shown to reduce the progression of hypertensive
complications and prevent the same (Eckel et al., 2014). These include a healthy diet with a
reduction in salt intake and saturated fats with increased fruits and vegetables in one’s diet. The
other is a reduction in alcohol consumption which is on its own a cause of secondary
hypertension (Peng, Wu, Jiang, Jin, & Zhang, 2013). Weight reduction is another proven strategy

as obesity and high BMI are associated with worse prognosis (Jensen et al., 2014). This can be
done by increasing physical activity and diet (Huai et al., 2013). Cessation of smoking is also
associated with reduced risk of arterial hypertension (Leone, 2015).
References
Burnier, M., & Wuerzner, G. (2015). Pathophysiology of Hypertension. In Pathophysiology and
Pharmacotherapy of Cardiovascular Disease (pp. 655-683). Adis, Cham.
Carter, B. L., & Ernst, M. E. (2017). Diuretics in Hypertension. Hypertension: A Companion to
Braunwald's Heart Disease E-Book, 211.
Delacroix, S., Chokka, R. C., & Worthley, S. G. (2014). Hypertension: pathophysiology and
treatment. J Neurol Neurophysiol, 5(250), 2.
DeMarco, V. G., Aroor, A. R., & Sowers, J. R. (2014). The pathophysiology of hypertension in
patients with obesity. Nature Reviews Endocrinology, 10(6), 364.
Eckel, R. H., Jakicic, J. M., Ard, J. D., De Jesus, J. M., Miller, N. H., Hubbard, V. S., ... &
Nonas, C. A. (2014). 2013 AHA/ACC guideline on lifestyle management to reduce
cardiovascular risk: a report of the American College of Cardiology/American Heart
Association Task Force on Practice Guidelines. Journal of the American College of
Cardiology, 63(25 Part B), 2960-2984.
Glynn, M., & Drake, W. M. (2017). Hutchison's Clinical Methods E-Book: An Integrated
Approach to Clinical Practice. Elsevier Health Sciences.

Hall, J. E., Granger, J. P., do Carmo, J. M., da Silva, A. A., Dubinion, J., George, E., ... & Hall,
M. E. (2012). Hypertension: physiology and pathophysiology. Compr Physiol, 2(4),
2393-2442.
Huai, P., Xun, H., Reilly, K. H., Wang, Y., Ma, W., & Xi, B. (2013). Physical activity and risk of
hypertension: a meta-analysis of prospective cohort studies. Hypertension, 62(6), 1021-
1026.
Jensen, M. D., Ryan, D. H., Apovian, C. M., Ard, J. D., Comuzzie, A. G., Donato, K. A., ... &
Loria, C. M. (2014). 2013 AHA/ACC/TOS guideline for the management of overweight
and obesity in adults: a report of the American College of Cardiology/American Heart
Association Task Force on Practice Guidelines and The Obesity Society. Journal of the
American college of cardiology, 63(25 Part B), 2985-3023.
Karumanchi, S. A., & Granger, J. P. (2016). Preeclampsia and pregnancy-related hypertensive
disorders. Hypertension, 67(2), 238-242.
Katzung, B. G., Masters, S. B., & Trevor, A. J. (2012). Basic and Clinical Pharmacology
(LANGE Basic Science). McGraw-Hill Education.
Kumar, J. (2013). Epidemiology of hypertension. Clinical Queries: Nephrology, 2(2), 56-61.
LeFevre, M. (2018). ACC/AHA Hypertension Guideline: What Is New? What Do We Do? Am
Fam Physician, 97(6), 372-373.
Leone, A. (2015). Smoking and Hypertension. J Cardiol Curr Res, 2(2), 00057.
Luehr, D., Woolley, T., Burke, R., Dohmen, F., Hayes, R., Johnson, M., ... & Marshall, M.
(2012). Hypertension diagnosis and treatment. blood pressure, 140(90), 90.

Melmed, S. (2016). Williams textbook of endocrinology. Elsevier Health Sciences.
Peng, M., Wu, S., Jiang, X., Jin, C., & Zhang, W. (2013). Long-term alcohol consumption is an
independent risk factor of hypertension development in northern China: evidence from
Kailuan study. Journal of hypertension, 31(12), 2342-2347.
Peralta, C. A., Norris, K. C., Li, S., Chang, T. I., Tamura, M. K., Jolly, S. E., ... & KEEP
Investigators. (2012). Blood pressure components and end-stage renal disease in persons
with chronic kidney disease: the Kidney Early Evaluation Program (KEEP). Archives of
internal medicine, 172(1), 41-47.
Safar, M. E., & O'Rourke, M. F. (Eds.). (2012). The arterial system in hypertension (Vol. 144).
Springer Science & Business Media.
Walker, B. R., & Colledge, N. R. (2013). Davidson's Principles and Practice of Medicine E-
Book. Elsevier Health Sciences.
Waugh, A., & Grant, A. (2014). Ross & Wilson Anatomy and Physiology in Health and Illness
E-Book. Elsevier Health Sciences.

DISEASE PROFILE: PNEUMONIA
Introduction
Pneumonia is an infection of the lung. The current discussion is a disease profile of
hypertension including but not limited to diagnosis, pattern, pathophysiology, risk factors,
clinical manifestations, epidemiology, prevention, treatment and control of the disease. The
paper will review current and relevant research on the issue and present a review of the data and
discussion.
Etiology
Pneumonia is classified as being either community- acquired or hospital -acquired, with
community-acquired pneumonia (CAP) being the more prevalent (Walker & Colledge, 2013).
The most common causes of CAP is bacteria. Other causes include chemical ingestion and
viruses. In most cases, however, no pathogen is isolated hence prediction of the most likely
pathogen based on age groups is relevant
Bacterial pneumonia in neonates is most commonly caused by Group B streptococcus,
Escherichia coli, Klebsiella species, Enterobacteriaceae (Cilloniz et al., 2016). in the preschool
going children Chlamydia trachomatis, Streptococcus pneumoniae, Haemophilus influenzae type
b, Staphylococcal aureus. In the school going children the most likely pathogens are
Mycoplasma pneumoniae and Chlamydia pneumoniae (Cilloniz et al., 2016). In adults, the
commonest causes are Streptococcus pneumoniae, Haemophilus influenzae type b,
Staphylococcal aureus. In immunocompromised individual organisms such as p. jirovecii and
Pseudomonas should be checked (Cilloniz et al., 2016). Globally, however, Streptococcus