Public Health Intervention for Prevention of Hypertension
Introduction
This proposal will present a public health intervention to prevent hypertension in adults aged between 18 to 39 years in Burrow in Furness. The application proposes a study intended for the prevention of hypertension among adults aged 18-39 years due to the alarming increase in the number of emerging hypertension cases within this age limit in Burrow in Furness as well as in the entire United Kingdom.
Hypertension is the globe’s top risk issue for cardiovascular disease that originates from collective social, environmental and genetic factors (Fenton, 2020). The prevention of hypertension is easily achievable by use strategies such as the population or targeted-based strategies. This strategy involves interventions to promote mindfulness, treatments and control in persons. It requires interventions aimed at achieving a small decrease in blood pressure within the whole population. As such, having a care source, encouraging adherence, and lessening therapeutic inertia are linked to increasing blood pressure (BP) control rates.
A substantial period has passed since the 2011 National Institute for Health and Care Excellence (NICE) initiation that presented the high blood pressure guidelines in the United Kingdom. Following its recommendation of diagnosis, results have indicated that the prevalence of high blood pressure in England, including Burrow in Furness among the ages of 18 to 39 years is high and remains to rise. This prevalence is well-defined at the clinic SPB/DPB limit of >140/90 mm Hg, and it is at a rapid increase, thus posing a great concern to the municipality’s public health. Furthermore, with a well-defined SBP/DPB limit of 140/90 mm Hg, England’s prevalence of hypertension in adults, including this age limit is rising by 5000 cardiovascular cases annually. It is estimated that there will be a continuous increase in high blood pressure cases if caution is not taken to prevent this constant increase.
Suboptimal blood pressure control is the major attribute risk element for cerebrovascular and cardiovascular disease (CVD), including ischemic heart disease (55%), ischemic (50%) stroke and hemorrhagic (58%) and other types of cardiovascular diseases that is, peripheral arterial disease and heart failure (Fenton, 2020). Additionally, high blood pressure ranks highest in the kidney illness progression, the determinant of chronic kidney disease and the end-period of kidney illness besides dementia because of cerebral small vessel illness. Several pieces of research have given definite evidence that hypertension, in adults, and both genders, maintains a constant graded relation with the threat of dire nonfatal and fatal heart failure, stroke, ischemic heart disease, and noncardiac vascular disease, with no heterogeneity because of ethnicity, down to a blood pressure of 115/75 mm Hg (Fenton, 2020). Each 20-mm Hg rise of systolic BP (SBP) or a 10-mm Hg rise of diastolic BP (DBP) is related to the doubling of the threat of fatal CVD occurrence.
Various determinants cause hypertension-first, pathophysiological determinants. High blood pressure can be classified into primary and secondary types. The primary form accounts for the majority of occurrences (90%), and inadequate physical and exercise and poor diet seem to be the potentially and significantly reversible lifestyle causes (Fenton, 2020). A particular, sometimes a remediable determinant of high blood pressure can be noticed in 10% of adults, including those within our age limit focus of 18-35 years, called secondary hypertension. Most patients with secondary high blood pressure have a renal vascular illness or renal parenchymal or primary aldosteronism. In contrast, patients with primary hypertension have alcohol or drug-induced high blood pressure or unusual endocrine conditions (Fenton, 2020). If these people implement healthy living, there will be a marked reduction in new hypertension cases.
Next, the epigenetic and genetic predisposition. High blood pressure is a complex disorder that is influenced by a group of genes that influence blood pressure. Even though various monogenic types of hypertension have been recognised, for instance, Gordon’s syndrome in which single-gene transformations entirely explain the pathophysiology of high blood pressure, these conditions are rare (Royal College of Nursing, 2020). Common genetic mutations that influence blood pressure have recognised at over 300 free genetic loci. Nonetheless, these genetic mutants usually affect the order of simply 0.5 mm Hg DPB and 1.0 mm Hg SBP per BP-raising allele.
Next, lifestyle or environmental factors. High blood pressure is largely preventable and modifiable because of the strong influence of lifestyle or environmental determinants. The most significant aspects, which frequently are slowly presented in childhood and early adult stage are weight increase that leads to obesity, insufficient potassium intake, unhealthy diet, scarce physical exercise, alcohol or drug-intake and excessive dietary of sodium (Royal College of Nursing, 2020). A great prevention impact can be attained by aiming at the lifestyle areas of this population and joining more that one of these environmental transformations due to the individual’s blood pressure decreases being majorly addictive.
Lastly, the social-economic determinants of the population. Although high blood pressure results from a combination of genetic and lifestyle risk elements, social determinants also play a major role in contributing to the occurrence of this condition. These socio-economic factors are widely defined as the conditions in which individuals are born, grow, live, work, and age, as well as the systems, place to combat the illness. Socio-economic status indicates socially recognised economic aspects that influence the ranks that groups or persons hold in the stratified configuration of the society (Royal College of Nursing, 2020). These elements include occupation or employment status, income and wealth, access to health care, education and other factors. Even though social factors are frequently raised in discussions of disparities and inequalities, socio-economic determinants influence cardiovascular well-being generally in all persons. In England, there exists a strong relationship between socioeconomic factors and hypertension and health more so in the minority communities. As such, High blood pressure is largely prevalent among blacks than whites. The neighbourhood features can contribute to the prevalence of high blood pressure such that persons living in the most economically deprived societies are a greater risk of getting hypertension (Royal College of Nursing, 2020).
Aims and Objectives of the Proposal
The main focus of this proposal is to create awareness on the prevention of high blood pressure to minimise as much as possible the increasing events of the occurrence of hypertension.
The goals of this proposal include:
1. Review all the earlier study-based interventions related to the prevention of high blood pressure. After that, use these outcomes to update the content of a study questionnaire;
2. Present the current strategies aimed at the prevention of hypertension;
3. Use public health materials and promotion interventions that are linked to safer means of encouraging the prevention of high blood pressure;
4. Enhance awareness of the prevention of hypertension via several means including social media.
Underpinning Models/Concepts
High blood pressure can be prevented by the implementation of approaches that focus on the entire population and persons as well as groups that are at a greater risk of having this condition (Alqahtani, 2019). Environmental approaches are most likely to be the most effective means of preventing hypertension as compared to other strategies. Nonetheless, the strategies implemented at an early life are more likely to effectively prevent hypertension in society. The various approaches aimed at preventing high blood pressure are relayed below.
First, the population-based approach. This strategy is focused on achieving a decreasing shift in the distribution of BP in the entire population; thus, an important element for the comprehensive proposal of preventing high blood pressure. This method is a traditional strategy that is utilised in healthcare practices and aims to achieve a clinically significant decrease of blood pressure for persons with the hypertension condition as well as the prevention of the condition among all individuals. The approach originates from the public health mass lifestyle conditions. Its focus is on achieving smaller but significant lessening in blood pressure to the whole population, thus resulting in a minor downward shift in the entire blood pressure distribution (Alqahtani, 2019). Several studies argue that the population-based strategy gives a higher potential of preventing cardiovascular as compared to the targeted approach. This verdict results from the principle that a larger number of individuals exposed to a minor upsurge in cardiovascular threat may result in many cases other than a smaller population availed to a largely increased threat.
Lastly, the intensive targeted approach. This strategy focuses on attaining a greater drop in BP to those who are at a higher risk of having high blood pressure. Individuals with a greater threat to having high blood pressure include people who are overweight or obese, high sodium intake in the diet, excessive alcohol intake, a sedentary environment, and inadequate potassium intake (Alqahtani, 2019). Various researches indicate that this intervention is suitable in health care environments and faith-based groups that have referral programs and BP screening. Below are some significant ways in which lifestyle can influence the occurrence of hypertension.
Intake of unhealthy diet increases the chances of developing the hypertension condition; thus, people of all ages are urged to be mindful of their eating habits. The Dietary Approaches to Stop Hypertension (DASH) eating proposal is significantly effective in the prevention and control of high blood pressure (Alqahtani, 2019). The diet comprises of many whole grains, fruits, nuts, vegetables, low-fat dairy products, lean proteins and legumes. The intake of a low amount of sodium and the DASH diet prevents the development of high blood pressure as well as controls it.
Also, the consumption of much sodium enhances the development of hypertension. Henceforth, it is advisable to consume only the required amount of sodium. Addiction to sodium results from processed salted foods such as pastries, breads, cereals, salted meats, and canned goods (Alqahtani, 2019). Modelling researches indicate that a small reduction in salt consumption could prevent many deaths that result from hypertension.
Additionally, an increase in potassium consumption lowers the chances of developing high blood pressure as well as it assists in its control. Due to its blood-pressure-lowering effects, a rise in the potassium consumption is estimated to prevent cardiovascular occurrences, and many pieces of research have illustrated an inverse relation of potassium consumption to stroke and other types of cardiovascular events (Alqahtani, 2019). Improved potassium consumption can be attained by either the utilisation of potassium supplements or by an increase in potassium consumption. The latter strategy is advisable with the DASH meal-offering the everyday recommended consumption.
Furthermore, insufficient physical exercise also encourages the development of hypertension. Observational researches often have that engaging in physical activities assists in the prevention of hypertension and regulating blood pressure among patients with hypertension. Besides, modest levels of physical exercises have proved to reduce the threat of developing high blood pressure. Randomised experiments have suggested that the most effective physical exercise aimed at lowering BP is aerobic exercise. However, isometric and dynamic resistance physical activities are also effective. The mechanisms of physical exercises in preventing high blood pressure are unclear. However, they can include, insulin resistance, cardiac output, diminution of the sympathetic nervous system and renin-angiotensin system activity, improved endothelial function and decreased total peripheral vascular resistance (Alqahtani, 2019).
Moreover, obesity and overweight encourage the development of hypertension. The threat of high blood pressure constantly rises with increasing anthropomorphic measurements that are, waist to height ratio, waist to hip ratio and waist circumference in parallel to Body Mass Index (Alqahtani, 2019). Various studies have continuously demonstrated that the threat of high blood pressure in adults reduces with a reduction in body weight and vice versa. Various pathophysiological mechanisms have indicated to add to the development of high blood pressure in obese people. These pathophysiological mechanisms include oxidative stress, insulin resistance, chronic low-grade inflammation, adipokine disorders such as reduced adiponectin, high leptin, intestinal microbiota, increased sympathetic nervousness system and renin-angiotensin-aldosterone system activity, endothelial dysfunction and higher renal sodium intake with volume expansion.
Outline of Proposed Action Plan
The suggested action plan is segmented into four particular phases or sub-sections, and the designations are separated accordingly.
Sub-section 1 – Planning, Opening Research
– To perform a study using NICE collective learning databases. Performing this step will aid in knowing what works from earlier strategies, together with sections of improvement.
– Develop a study questionnaire by utilising previous statistics from earlier projects, existing local recovery societies, earlier academic studies, NICE guidelines and targeting persons who have applied the implementation of DASH diets in their meals.
– Develop comprehension of the lifestyle, socio-economical, pathophysiological and genetic determinants of high blood pressure within my intended population.
– Seeking and obtaining access to my intended population’s study to acquire a proper understanding of their knowledge about high blood pressure.
Sub-section 2
– Identifying the municipality’s leaders to assist in taking the lead of understanding the perception of the required objectives of the study concerning high blood pressure.
– Identifying the ‘peer leaders’ within this age limit.
– Providing the necessary training, advice and guidance to the municipality’s leaders, ‘peer leaders’ and all the personnel that will be involved in partaking the study.
Sub-section 3
– Distributing the questionnaires to the targeted population to acquire the needed information for comprehending their awareness of hypertension condition.
– Create a municipality’s leader and peer leader’s relationship with the members.
– Perform a mid-term evaluation with multi-agency partners, analyse feedback and several responses from questionnaires.
Sub-section 4
– Finalise the evaluation of the initiative.
– Give feedback to multi-agency associates to inform on future initiatives or practices.
– Promote the awareness of the hypertension condition, including the cause and prevention approaches.
Resources/Funding Issues
The funding for public health matters in the United Kingdom is chiefly the accountabilities of Local Authorities upon the introduction of the Health and social care Act in 2012 (McManus et al., 2019). As such, all the materials and other necessities for the study will be financed by the local authority and or this case it is the town municipality of Barrow-in-Furness.
The proposal recognised that there are many potential resource implications; however, this study will be of low spend. One of the resource implications is the number of health practitioners engaged in the proposal (McManus et al., 2019). It is approximated that the proposal will need at least two health specialist in lifestyle diseases. Multi-agency working and partnership are key to positive implementations in public health, as illustrated by the United Kingdom government. Creation of awareness also requires funding, and it was thought wise to allocate a significant amount to usages, such as the internet, that will help create awareness via social media.
Evaluation
The evaluation of interventions is a crucial aspect of the development and learning process which occurs at any Public Health Intervention (Royal College of Nursing, 2020). As such, this evaluation will assist the health practitioner, local government or authority, and multi-agency associates to comprehend the short, medium or long-term implications and effects of different approaches. Public health must be capable of demonstrating the effectiveness of the various approaches and the needed budget. Besides, the health and social care act (2012) urges the local authorities that cost-effectiveness is substantial regardless of the project.
A review can be performed around the rate of response acquired from the formulative study questionnaire. Also, reviewing with multi-agency partners offers an opportunity to acquire various viewpoints on the approaches and analyse all the challenges that may arise from the partnership. Performing these review with associates also offers support to the asset-based strategy performed (McManus et al., 2019). It is significant to note that a formal midpoint review should be held because it will enable all the associates to discuss honestly and openly concerning the initiative, successes, and challenges. Also, the midpoint review is of importance because it implies that any approach formed due to any incoming challenge can be incorporated into an action plan and thus assessed into the proposal’s finishing point. The proposal should also undergo short and long-term assessment (McManus et al., 2019). For instance, an assessment can be considered to gauge whether the peer-members relationship is active and substantial.
Conclusion
Notable progress has been made in comprehending blood pressure as a cardiovascular risk issue and appropriate strategies for the prevention of high blood pressure. It is seen that the chosen population are not old and therefore assumed they make a big part of the workforce population in that if the correct precautions are not taken to prevent the deaths of these population because of hypertension, the municipality, as well as the country, will undergo a loss due to the resulting deaths. Besides, in cases where the illness is being controlled, there is a lack of optimum working power as the illness weakens the immunity that is reducing the individual’s strength. It is notable from the provided evidence that there is a public health requirement of ensuring that only the correct information is circumnavigating in within the research. Also, there must be vivid guidance on the policy or legislation from the central administration. Lastly, it is prudent for these initiatives to be successful because it will be both beneficial at an individual and national’s level.
