Comment on the two discussion posts below (1 paragraph for each, support your response with a rationale, and cite the source).
DISCUSSION 1
For many decades hypertension has been recognized as a major disease. One in every two persons ≥20 years in the USA has hypertension with only 39.64% on medications having well-controlled hypertension. Significant discrepancies exist in the burden and control rates in different subpopulation categories. Targeted interventions could help improve the prevalence and hypertension control rates in the USA (Chobufo et al., 2020). These numbers have made hypertension one of the highest contributors to disease and death in the United States. When not treated appropriately, or detected early enough, hypertension leads to other complications like myocardial infarctions, strokes, and even renal failure. The Eighth Joint National Committee (JNC 8) released recommendations on treatment thresholds, and medications when it comes to the management of hypertension in adults.
The first JNC 8 recommendation is: In the general population aged ≥60 years, initiate pharmacologic treatment to lower BP at systolic BP (SBP) ≥150 mm Hg or diastolic BP (DBP) ≥90 mm Hg and treat to a goal SBP <150 mm Hg and goal DBP <90 mm Hg. The second recommendation states that the target diastolic blood pressure to start pharmacologic therapy for patients younger than 60 years old is ≥90 mmHg. The third recommendation indicates that the target systolic blood pressure to start pharmacologic therapy for patients younger than 60 years of age is ≥140 mmHg. The fourth JNC 8 recommendation explains that in patients older than 18 years with chronic kidney disease, pharmacologic therapy is to be started to lower BP at a systolic blood pressure ≥140 mmHg or DBP ≥90 mmHg. The fifth recommendation is that the target blood pressure in beginning pharmacologic therapy for diabetic patients 18 years or older is <140 mmHg for SBP and <90 mmHg for DBP. The sixth recommendation states that initial drug therapy for nonblack patients should include a thiazidediuret ic, a calcium channel blocker, an ACE inhibitor, or an angiotensin receptor blocker. Recommendation number seven is that the initial drug therapy for black patients should include a thiazide-type diuretic or a calcium channel blocker. The eigth recommendation indicates that for patients 18 years or older with chronic kidney disease, initial or additional therapy should include an ACE inhibitor or angiotensin receptor blocker, regardless of race or diabetic status (Covell et al., 2015). Finally, the ninth JNC 8 recommendation proposes an algorithm for managing patients’ hypertension that is not controlled within one month of treatment. This last recommendation also states that when a goal is not achieved with one drug, a second one may be added for more effectiveness. If no results are noted with this second added drug then drugs from other classes can be added. However, angiotensin receptor blockers and ACE inhibitors should not be combined in the same patient.
DISCUSSION 2
Cardiovascular disease is the leading cause of death in the United states, and refers to many different heart conditions such as heart attack, stroke, heart failure, arrythmias, and heart valve problems (American Heart Association, 2017). The most common type of cardiovascular disease is coronary artery disease, which is classified by the build up of plaque in the walls of the arteries, called atherosclerosis, which makes it hard for blood to flow and increases the risk for heart attack (Centers for Disease Control and Prevention, 2022). The risk factors for heart disease include high blood pressure, high cholesterol, diabetes, smoking and secondhand smoke exposure, obesity, unhealthy diet, and physical inactivity (CDC, 2022).
The diagnosis for heart disease includes first performing a physical exam and conducting a health and family history. Many of the risk factors for heart disease are genetic, and it is crucial to assess current and past symptoms in order to accurately diagnose heart disease. The use of diagnostic testing such as blood tests, chest x-ray, ECG/EKG, holter monitoring, echocardiogram, stress test, CT scan, MRI, and cardiac catheterization are also used in the diagnosis for cardiovascular disease, and give a more accurate picture of an individual’s heart health (Fogoros, 2021). According to Fogoros, “Healthcare providers should rely on the information they obtain during their initial clinical evaluation to decide what in particular to look for, which test or tests are best suited to look for it, and if more than one test is needed, which order they ought to be performed in. This way, if you have a heart problem your healthcare provider can get to the right answer as expeditiously as possible, without exposing you to unnecessary expense or risk,” (Fogoros, n.p, 2021).
Treatment and management of heart disease includes lifestyle changes and medication. Lifestyle changes for heart health include eating a low-fat low-salt diet, excersizing for 30 minutes a day, smoking cessation and limiting intake of alcohol. Managing stress and getting treatment for depression can also be beneficial for treating or managing heart disease. If lifestyle modifications and medications are not enough, medical procedures or surgery may be recommended based on the type and extent of the heart disease (CDC, 2022).
