HTN Care Teams

Hypertension During Adulthood There are different stages of adulthood. Adults are considered anyone over the age of 18. Young adults are ages 18 years to 35 years of age, middle- aged adults are from 35 years to 64 years of age, and the older adult is anyone age 65 and over (Edelman, Kudzma & Mandle, 2013). When reviewing things that could affect adults there are many things that change throughout the lifespan and hypertension is one of those things. There are risk factors at different ages and different things that become risk factors later in life. Hypertension is ever changing depending on who is or could be affected.Hypertension Hypertension or high blood pressure has to do with the measurement of pressure on the walls of the arteries. When measuring blood pressure, it is has two numbers as the reading. The top number or systolic, which measures the force when your heart beats and the bottom number or diastolic, which measures the force against the vessels when your heart is at rest (Center for Disease Control and Prevention [CDC], 2019). When these numbers get above 140/90 that is considered hypertension. There are three levels of blood pressure readings. Normal range is anything below 120/80, pre-hypertensive range is anything between 120/80 and 139/89, and hypertension is considered anything 140/90 and above (CDC, 2019). Hypertension Statistics Hypertension affects many adults in America. 1 in 3 adults in the United States are affected by high blood pressure (CDC, 2019). For those affected by hypertension only a little over half have their high blood pressure under control. Hypertension affects more people than are aware, 1 in 5 adults has high blood pressure and is unaware they have it. It is estimated that there are over 1 billion people worldwide that have hypertension, and many of them (2/3) live in low- and middle-income countries (World Health Organization [WHO], 2020). There are minimal differences of how many men and women hypertension effects. 1 in 4 men are affected, and 1 in 5 women are diagnosed with hypertension. Hypertension causes many premature deaths worldwide (WHO, 2020). Some of the research completed gave different age groups for adults. Fang, Gillespie, Ayala and Loustalot (2018) used ages 18 to 44 years of age, 45 to 64 years of age and 65 years of age and older as the groups in their work. Over the course of a four-year period the number of younger adults with hypertension was always significantly lower than those of the other two groups. This study also showed an increase in hypertension depending on education level. The less education that someone had, the higher the prevalence. Level of education was a grouping that was completed in this study and it was divided into 4 groups, less than high school education, high school graduate, some college, and college graduate or higher. As the level of education increased it showed a decrease in the frequency of hypertension (Fang, Gillespie, Ayala & Loustalot, 2018).Risk Factors There are many risk factors for hypertension. Some risk factors are modifiable, and some are not. Things that cannot be changed are family history, which affects every age group, age, those in the 65 and older age group are at a higher risk for hypertension, and other co-existing conditions such as diabetes and kidney disease also cannot be changed and affect every age group (WHO, 2020). Things that are modifiable are diet, physical activity, tobacco use, alcohol consumption, weight. When a diet consists of high sodium intake, high trans or saturated fat intake, and a low ingestion of fruits and vegetables these can lead to higher incidents of hypertension (WHO, 2020). The diet is a choice made by every adult and the things that are consumed can have an effect on the overall health of every adult. Physical activity or lack of physical activity is a choice made by every adult also. Everyone has busy lives and making time to be physically active is something that needs to be considered. When adults get older (65 years +) physical activity can become harder. Some people have to have things like knee replacement, or hip replacement surgery and that can affect the persons ability to be physically active. If people are not physically active that can lead to being overweight or obese. Being overweight or obese has an impact on blood pressure as well (CDC, 2019). Tobacco and alcohol use are a factor that has an effect on blood pressure across the lifespan as well. Again, this is a choice that every adult makes for themselves and depending on how much is consumed it could increase the risk of developing hypertension.Interventions There are various interventions to help treat hypertension. Some are as simple as a diet change and adding in some exercise. Also, tobacco and alcohol consumption are also on the list of interventions that can be made. Decreasing or stopping the intake of these products can help reduce blood pressure. These types of changes are easier to implement in younger adults who are not necessarily set in their ways yet (Kant, 2018). These are known as lifestyle changes. Other treatments could be medication that are prescribed by a care provider and distributed by a pharmacist. This would be something that would be monitored by a provider and adjusted accordingly as the medication either worked or did not. When medications are implemented there are multiple factors to be considered. Medications have to be monitored and reviewed for any type of interactions between allergies that might exist or other medications that are being taken (CDC, 2019).Collaborations When treating high blood pressure there are multiple facets to be explored. High blood pressure is the most common condition treated in primary care settings. When patients have a care team at their disposal outcomes seem to be more favorable. A patient care team could be just a provider and a pharmacist to help with medication management. The team of just a provider and a pharmacist has been successful at helping manage high blood pressure according to Santchi et al. (2017). There are other members that are considered helpful as well. Santchi et al. (2017) had physicians, pharmacists, and nurses working on the care team that met every 6 weeks to provide education on lifestyle, the disease, and medication adherence advice. The team-based care will help manage hypertension if utilized properly. Team-based care also showed a significant reduction in systolic pressure over a 4-month period according to Kravetz and Walsh (2016). This study had a patient care team of a physician, registered nurse, patient care tech and a pharmacist for medication management. Over time the medication compliance increased and there was a reduction in blood pressures. Having multiple team members available, at different levels of education, to assist the patient has proven to have better outcomes than the usual care provided only by a primary care provider (Kravetz & Walsh, 2016).Conclusion Having patient care teams so that patients have multiple resources available when they have questions or concerns seems to help reduce high blood pressure. Patient care teams could help alleviate some of the over scheduling of primary care providers and help patients have more satisfactory care. Hypertension is the most common problem treated during primary care visits and having a team that is well versed in how to care for this disease will hopefully help reduce the instances of further problems that result from not treating the high blood pressures.

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