AGGREGATE STUDYReducing Hypertension in Hispanic men (age 50-80) in Orange CountyBy Synthia De Jesus

HYPERTENSION• Hypertension is recognized as having a risk factor for

cardiovascular disease, including stroke, and coronary heart disease. It is easily missed, as in many instances it is asymptomatic and known as the “silent killer.”

• It is defined as a sustained rise in BP above 140/90 mmHg on more than one occasion for a diagnosis to be made. Patients are advised to have home readings recorded in order to ascertain what is happening to their BP and determine the best course of action for that individual.

(Bostock-Cox, 2013)

COMORBIDITIES WITH HYPERTENSION

• Heart Failure

• Heart Attack

• Heart Disease

• Stroke

• Diabetes

• Chronic Kidney Disease

• Peripheral Vascular Disease

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HEALTHY PEOPLE 2020• HDS-1 Increase overall cardiovascular health in the US population.

• HDS-2 Reduce coronary heart disease deaths.

• HDS-3 Reduce stroke deaths.

• HDS-4 Increase the proportion of adults who have had their blood pressure measured within the preceding 2 years and can state whether their blood pressure was normal or high.

• HDS-5 Reduce the proportion of person in the population with hypertension.

• HDS-5.1 Reduce the proportion of adults with hypertension.

HEALTHY PEOPLE 2020 CONT.

• HDS-8 Reduce the mean total blood cholesterol levels among adults.

• HDS-9 Increase the proportion of adults with prehypertension who meet the recommended guidelines.

• HDS-10 Increase the proportion of adults with hypertension who are taking the prescribed medications to lower their blood pressure.

• HDS-15.2 Increase aspirin use as recommended among men aged 45 to 79 with no history of cardiovascular disease.

• HDS-16 Increase the proportion of adults age 20 years and older who are aware of the symptoms of and how to respond to a stroke.

• HDS-24 Reduce hospitalizations of older adults with heart failure as the principle diagnosis.

GLOBAL STATISTICS

• There are least 970 million people worldwide who have elevated blood pressure (hypertension).

• In the developed world about 330 million people have hypertension, as do 640 million in the developing world.

• In 2025, it is estimated there will be 1.56 billion adults living with high blood pressure.

(World Heart Federation, 2014)

GLOBAL STATISTICS CONT.

• 9.4 million deaths each year, or 16.5% of all deaths can be attributed to high blood pressure. This includes 51% of deaths due to stroke and 45% of deaths due to coronary heart disease.

• Low-and middle-income countries are disproportionally affected: over 80% of CVD deaths take place in low- and middle-income countries and occur almost equally in men and woman.

• An estimated 17.3 million people dies from CVDs in 2008, representing 30% of all global deaths. Of these deaths, an estimated 7.3 million were to coronary heart disease and 62.2 million were due to stroke.

(WHO, 2014)

NATIONAL DATA• 67 million American adults (31%) have high blood pressure- that’s

1 in every 3 adults.

• Only about half (47%) have their conditions under control.

• Nearly 1 in 3 American adults have prehypertension.

• Men 55-64 have 64% chance of getting high blood pressure in their lifetime while woman are 69.3%.

• Men 75 and older have 66.7% chance of getting high blood pressure while woman at a 78.5%.

(CDC, 2014)

HISPANIC DATA• (CDC) found that Hispanics with hypertension are less likely to be

aware of their condition (Hispanic Business, 2014).

• Among Hispanic American adults with hypertension, only about half (49.8%) are aware of their condition and less likely to have their hypertension under control (17.3%), compared to non-Hispanics blacks (29.8%) and non-Hispanics whites (29.8%) with high blood pressure (Hispanic Business, 2014).

• Age-adjusted prevalence of hypertension for Hispanic Americans is 25.1% (Hispanic Business, 2014).

• Among Hispanics who experience a stroke, 72% had high blood pressure, compared to 66% in non-Hispanic males (AHA, 2014).

POPULATION DATA NATIONAL AND STATE

• Total US population: 316,128,839

• Persons of Hispanic or Latino Origin: 16.9%

• Florida population: 19,552,860

• Persons of Hispanic or Latino Origin: 23.2%

(US Census Bureau, 2014)

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ORANGE COUNTY • Orange County Population:

1,225,267

• Persons of Hispanic or Latino Origin: 23.2%

(US Census Bureau, 2014)

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HEALTH BELIEFS• Physical and mental illness may be attributed to imbalance between person and

environment.

• Men refuse taking medications thinking they have to tolerate pain.

• Most Hispanic men refuse to go to the hospital because of time they have to take from work.

• Folk illnesses are associated with member of particular group: • antojos- cravings• ataque de nervios- dramatic outburst

• Cold or hot medication brings the individual back to balance.

• Problems are treated with prayer.

• Reluctant to share belief and problems with nurse or physicians.

(Kemp, 2005)

ECONOMIC ISSUES• Undocumented immigrants live in the US.

• One in seven Americans or more than 47 million people living under or close in line of poverty and Hispanics are the third largest group (22%), (47%) under 18, and (8%) are seniors.

• 39% of young Hispanics children families recline SNAP benefits compared to families of black (45%) and white (74%).

• Large number of eligible Hispanics (59%) have not applied for SNAP.

(Hispanic Institute, 2014)

SOCIAL FACTORS

• Getting accustomed to American Society

• Stress of living to a new country

• Inability to speak the language

• Lack of knowledge of available resources

• Unemployment

• Fear of deportation

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PROBLEM• Lack of knowledge of resources

on hypertension treatment

• Potential for complications related to hypertension

• Lack of physical activity due to increase workload of the heart

• Increased stress due to work and life in the US

• Lack of health insurance

(Hispanic Institute, 2014)(Photo: image@www.bing.com)

HYPERTENSION IN THE HISPANIC COMMUNITY

• Hispanic tend to eat more rice, less pasta and ready-to-eat cereal, than their non-Hispanic counterparts (Diet, 2014).

• Drink more whole milk, less vegetables, and eat more beef (Diet, 2014).

• Diet based on fats, saturated fats, and cholesterol causing a high rate on diabetes (Diet, 2014).

• Awareness and diagnosis lag significantly, particularly those without health insurance (Medical Express, 2014).

• Most Hispanic live a sedentary lifestyle.

• They embrace opportunities to get together with family, friends, and extended family.

RISK FACTORS ON HISPANICS

• 75% of men and 72% of women age 20 and older are overweight or obese (AHA, 2014).

• National Health and Nutritional Examination Survey reported 65% of men and 74% women do not participate in leisure-time physical activity (AHA, 2014).

• 30% adult Hispanics have diabetes and don’t realize it (AHA, 2014).

• Prevalence of diabetes age 24 and 74 was 2.4 times greater than non-Hispanic whites (AHA, 2014).

• 48.1% of men and 44.7% of women have total cholesterol levels above 200 mg/dL (Medscape Nurses, 2006).

• Total of 13,526 hypertension-related deaths were reported among all Hispanics, compared to 209,833 among all non-Hispanics whites (Medscape Nurses, 2006).

HYPERTENSION RELATED DEATHS IN ORANGE

COUNTY • Hypertension- age-adjusted from 2011-2013: 250 (8.5%)

• Cardiovascular Disease- age-adjusted from 2011-2013: 6,030 (202.3%)

• Coronary Heart Disease- age adjusted from 2011-2013: 2,970 (99.2%)

• Heart Attack- age-adjusted from 2011-2013: 656 (21.8%)

• Heart Failure- age-adjusted from 2011-2013: 362 (12.5%)

• Stroke- age-adjusted from 2011-2013: 1,022 (34.8%)

(Florida Charts, 2014) (Florida Charts, 2014)

PRIMARY PREVENTION• Provide bilingual resources like

pamphlets

• Educate on cause of hypertension

• Awareness of Hispanics at risk

• Stats on hypertension

• Educate on stressful occupations

• Healthier foods

• Herbal remedies

• Exercise

• Learn how to operate the blood pressure monitor.

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SECONDARY PREVENTION

• Blood Pressure screening

• Survey on eating habits, race, and job occupations

• Test community on knowledge on how to manage blood pressure

• Lab work: A1C and lipid profile

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TERTIARY PREVENTION• Seek medical professional to treat

hypertension

• Reduce body weight through diet and exercise

• Smoke and alcohol cessation

• Monitor weight/blood pressure readings

• Pharmacological interventions to lower blood pressure

• Treat comorbidities like diabetes, hyperlipidemia, and obesity

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RESOURCES

• American Heart Association

• Orange County Health Department

• Centers for Disease Control and Prevention

• YMCA

(AHA, 2014)

CONCLUSION

No single remedy or assistance will prevent the risk of hypertension 100% if the individual doesn’t do their part. By promoting healthy habits, adopting healthy lifestyle, being informed, reducing risks, taking medications as prescribed, and being committed, the Hispanic population can reduce further issues with hypertension. Nurse need to recognize about the Hispanic population in Orange County by being aware of the culture and lifestyle in order to develop and implement ways to prevent hypertension.

REFERENCES• American Heart Association (AHA). (2014). Hispanics and heart disease,

stroke. Retrieved from http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Hispanics-and-Heart-Disease_UCM_444864_Article.jsp.

• Attar, G. (2010). Cormorbidities in hypertension. Livestrong.com. Retrieved from http://www.livestrong.com/article/145105-comorbidities-in-hypertension/.

• Bostock-Cox, B. (2013). Nurse prescribing for the management of hypertension. British Journal of Cardiac Nursing, 8(11), 531-536.

• Centers for Disease Control and Prevention (CDC). (2014). High blood pressure. Retrieved from http://www.cdc.gov/bloodpressure/facts.htm.

• Diet.com. (2014). Hispanic and Latino diet. Retrieved from http://www.diet.com/g/hispanic-and-latino-diet.

REFERENCES CONT.• Florida Charts. (2014). Hypertension deaths. Retrieved from

http://www.floridacharts.com/charts/DataViewer/DeathViewer/DeathViewer.aspx?indNumber=0381.

• Healthy People 2020. (2014). Heart disease and stroke. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=21.

• HispanicBusiness.com. (2014). Uncontrolled blood pressure highest among Hispanics, prompting new national hypertension project. Retrieved from http://www.hispanicbusiness.com/2007/9/12/uncontrolled_blood_pressure_highest_among_hispanics.htm.

• Kemp, C. (2005). Mexican and Mexican-Americans: Health beliefs and practices. Refugee Health. Retrieved from https://bearspace.baylor.edu/Charles_Kemp/www/refugees.htm.

• Medical Express. (2014). Hypertension going untreated in US Hispanic community. Retrieved from http://medicalxpress.com/news/2014-03-hypertension-untreated-hispanic.html.

REFERENCES CONT.• Medscape Nurses. (2006). Hypertension-related mortality among Hispanics

subpopulation- United States, 1995-2002. Retrieved from http://www.medscape.com/viewarticle/524462_2.

• The Hispanic Institute. (2014). 5 key economic issues for Latinos in 2014. Retrieved from http://www.thehispanicinstitute.net/node/6346.

• US Census Bureau. (2014). U.S. population. Retrieved from http://quickfacts.census.gov/qfd/states/00000.html.

• World Health Organization. (2014). Cardiovascular diseases. Retrieved from http://www.who.int/mediacentre/factsheets/fs317/en/.

• World Heart Federation. (2014). Hypertension. Retrieved from http://www.world-heart-federation.org/cardiovascular-health/cardiovascular-disease-risk-factors/hypertension/.