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1 Definition
High blood pressure is a common disorder in which blood pressure remains
abnormally high (a reading of 140/90 mm Hg or greater) (Princeton, 2009).
According to the nurses dictionary, high blood pressure is elevation of the
arterial blood pressure that is, the rise of the arterial blood pressure above the
normal range expected in a particular age group. It may be of unknown origin
(essential hypertension) or from disease (secondary hypertension).
High blood pressure can affect all types of people. There is a higher risk of
high blood pressure if there is a family history of the disease. High blood
pressure is more common in African Americans than Caucasians. Smoking,
obesity, and diabetes are all risk factors for hypertension. When no cause is
identified, it is called ‘Essential hypertension’ (Williams B et al, 2004).
High blood pressure that results from a specific condition, habit, or medication
is called ‘Secondary hypertension’. Too much salt in your diet can lead to high
blood pressure. Secondary hypertension may also be due to: adrenal gland
tumor, alcohol abuse, anxiety and stress, arteriosclerosis, birth control pills,
Cocaine use, cushing syndrome, diabetes, kidney disease, ( glomerulonephritis
inflammation of kidneys), kidney failure, renal artery stenosis, renal vascular
obstruction or narrowing), medications ,appetite suppressants, Certain cold
medications, corticosteroids, migraine medications, hemolytic-uremic
syndrome, henoch-schonlein purpura, obesity, pain, periarteritis nodosa,
pheochromocytoma, pregnancy (called gestational hypertension), primary
hyperaldosteronism, renal artery stenosis, retroperitoneal fibrosis, wilms' tumor.
( Williams B et al, 2004).
Congestive Heart Failure: High blood pressure is the number one risk factor
for congestive heart failure (CHF). CHF is a serious condition in which the
heart is unable to pump enough blood to supply the body's needs. In most cases,
these emergencies arise because high blood pressure has not been adequately
controlled. (S Ross, et al 2004).
The amount of potassium in the diet is also important. Potassium works with
sodium to regulate the body’s water balance. Research has shown that the more
potassium and less sodium a person has in his/her diet, the greater the likelihood
that the person will maintain normal blood pressure. However, the evidence
does not suggest that people with high blood pressure should take potassium
supplements. Instead, potassium rich foods should be eaten everyday (Midgley
et al, 1996).
A newer area of interest is the relationship between calcium and high blood
pressure. People with a low calcium intake seem to be at increased risk for
hypertension. Everyone should meet the Dietary Reference Intake (DRI) for
calcium every day. For adults, this is 1,000 mg per day. For adults over 50,
1,200 mg is recommended ( J. Anderson, L. Young and E. Long, 2009).
According to Nuria Homedes and Antonio Ugalde, very little is known about
compliance to hypertensive treatment in the third world but there is generally
low levels of adherence to prescribed therapy. This has raise questions about
the quality of care provided to hypertensive patients. Nurse-patient relationship
is an important component in ensuring compliance of hypertensive patients to
prescribed therapy. In the African setting there is a strain in this relationship
which is also an important factor of noncompliance to therapy. In Africa there is
insufficiency of specialised nurses in hypertensive care. This has led to an
increased rate of heart attack, stroke and other adverse effects of the disease in
Africa.
2.7.3 The situation in Cameroon
2.8 Reasons for non-compliance to drug prescribed therapy
Various explanations have been proffered to explain why such a large
percentage of patients have resistant hypertension, including secondary
hypertension and endogenous resistance to treatment. However, the main reason
for inadequate control of BP is poor compliance with the treatment regimen,
both pharmacological and behavioural (e.g, weight reduction, sodium intake
restriction, and exercise). Understanding the reasons for patient noncompliance
with antihypertensive medication is essential if BP is to be more effectively
managed.( Johnson R,1993).
Much of the earlier research focused on identifying patient characteristics of
noncompliant individuals and the complexity of the medication regimen. BP
control typically requires more than one antihypertensive medication and the
frequency of dosing may vary. The complexity of the drug regimen effects
compliance; compliance among hypertensive patients improves considerably
when drugs are prescribed just once a day. In addition, many patients
experience unpleasant side effects from their medication that may be
unacceptable in a largely asymptomatic disease. This is often reported as one of
the main reasons for non or partial compliance. However, more recent studies
have focused on patient's decisions and the complex relationship between the
patient and physician as possible mediating factors for compliance.
Psychological and emotional factors of the patient may also play an important
role in determining compliance with medication. In this issue the Ross et al
examine the psychological and emotional effect of illness perceptions and
treatment beliefs on patient compliance to antihypertensive medication. Patients
who believed in the necessity of the medication were more likely to be
compliant with antihypertensive therapy than those who felt it was unnecessary.
This interesting study also demonstrates that patients who have a higher
emotional response to illness and believe they have lower personal control over
the disease are less likely to be compliant.