Quantifying Hypertension Indicators Through Informatics, Diana Sanchez

Doctor of Nursing Practice

The purpose of this quality improvement project was to create optimal quality indicators for hypertension measures using evidence-based practice to improve metric percentages, improving hypertension management for the practice. Implementing associated interventions for the quality measures and providing the interprofessional team with fundamental knowledge of inclusion and exclusion criteria and will empower the team with knowledge, improving patient care.

An expert panel was chosen to conduct a series of three PDSA cycles for systematic measurement until desired quality indicators were achieved, within a three-month duration. The expert panel consisted of the head physician, a physician assistant, the facility administrator and …

Health Insurance Plan Design And Chronic Disease Management, Daniel E. Feldman

Electronic Theses and Dissertations

Each year, Americans spend more money on health care than any other industrialized nation, despite comparable mortality rates for people with risk factors for heart disease. The reasons for this lack of health care value in the US are numerous and complex – including market distortions like supplier-inflated pricing and regulatory structures that enable consumers to utilize ubiquitous, high-cost medical technologies that yield uncertain benefits. Health insurance, once thought to be an insignificant contributor to rising health spending, has changed considerably in the past few decades in ways that make it more accessible and more generous in coverage. Health insurance …

Cardiovascular Disease, Samantha Kohler

Nursing Student Class Projects (Formerly MSN)

The purpose of the presentation is to expand on cardiovascular disease and the pathophysiology contributing to the disease process. The presentation allows for further education on modifiable risk factors, and the most common causes of cardiovascular disease. Cardiovascular disease is one of the main causes of death in the world (Najafipour, Afshari & Rostamzadeh, 2018). When diagnosing patients with cardiovascular disease they often have more than one modifiable risk factor. The modifiable risk factors are hypertension, diabetes, high cholesterol, obesity, smoking, and low physical activity (Najafipour et al., 2018). The purpose of the arteries of the heart is to provide …

Empowering Newly Diagnosed Patients With Hypertension In Reducing Complications Through Self-Managed Care, Ana Pacis

Doctor of Nursing Practice Final Manuscripts

Background: High blood pressure affects millions of people, including children and adults. According to the Centers for Disease Control and Prevention (CDC), about 1 in every 3 adults or approximately 75 million American adults are affected with high blood pressure. High blood pressure often does not cause any signs and symptoms, which is why it is also known as the “silent killer,” and many people are not aware that they have elevated blood pressure (AHA, 2017). If high blood pressure is not controlled, it can lead to other heart diseases such as stroke. It can also cause other health problems, …

Baseline Health Assessment Of A Rural Delta Community, Sydney Mitchell

Honors Theses

The Lower Mississippi Delta is characterized by poverty, chronic health issues, health disparities, and food insecurity. The rural Delta communities are primarily African American, experiencing disproportionately higher rates of poverty, job loss, and chronic health problems. Historically, chronic health issues have persisted in these areas over time, including obesity, hypertension, and diabetes, which have only seemed to increase in this region. The food environment in this rural region tends to assist in the creation of the largely obesogenic population which, in turn, contributes to the increased prevalence of diabetes and hypertension and a lower quality of life. Many residents in …

The Role Of Central Ace2 And Nrf2 In Sympatho-Excitation: Responses To Central Angiotensin Ii, Anyun Ma

Theses & Dissertations

Sympatho-excitation is a key characteristic in cardiovascular diseases such as chronic heart failure (CHF) and primary Hypertension (HTN). Evidence suggests that increased sympathetic tone is closely related to activation of the Renin-Angiotensin-Aldosterone system (RAAS) in the central nervous system. An underlying mechanism for sympatho-excitation is thought to be oxidative stress resulting from Angiotensin II (AngII) type 1 receptor (AT1R) activation. Over the past several decades, pharmacological targeting of components of the RAAS have been used as standard therapy in CHF and HTN. However, additional therapeutic strategies are necessary to control these diseases. Oxidative stress is regulated, in part, by the …

Addressing Hypertension Health Literacy In Black Individuals Who English Is Their Second Language, Uche Olateru

Doctor of Nursing Practice Projects

Hypertension is a primary preventable risk factor for cardiovascular disease. Despite advances in preventive and treatment measures, related to blood pressure control, the prevalence of hypertension in the United States remains high among Black People of immigrant and non immigrant communities. Healthcare is increasingly complex, and health literacy problems have increased due to demands by healthcare stakeholders for patients to assume a more independent role in taking charge of their health. A quality improvement project was conducted in a Faith based community to improve the knowledge of participants about hypertension. The objective of this project was to enhance lifestyle management …

Factors Affecting Blood Pressure Target Outcomes For Veterans Using Home Telehealth, Vincent Boom

Theses and Dissertations

Hypertension is the most common diagnosis among Veterans, contributing to approximately 15,000 veterans hospitalized for stroke every year. The high prevalence of hypertension found in the Veteran population suggests a need to better define the risks and benefits associated with the diagnosis and treatment of hypertension. The U. S. Department of Veteran Affairs (VA) home telehealth program provides chronic care management for hypertension to facilitate Veteran access to care. Existing evidence suggests Veterans’ monitoring of blood pressure at home may selectively assist in managing hypertension. This secondary analysis of data used a self-management lens to assign meaning to traditionally demographic …

Evaluating The Clinical Impact Of Providing Home Blood Pressure Monitors To Patients With Elevated Or High Blood Pressure, Theresa La Guardia Asmus

Doctoral Projects

Many clinicians continue to diagnose hypertension based on office-based readings, despite the 2015 United States Preventive Services Task Force recommendation for the use of home or ambulatory blood pressure monitoring to confirm the diagnosis of hypertension prior to initiating treatment. Without obtaining blood pressure readings outside of the clinic environment, it is impossible to correctly diagnose hypertension, particularly regarding masked hypertension and white coat hypertension.

Stanford Health Care implemented a quality improvement project that provided patients with a home blood pressure device to monitor out of clinic blood pressure readings. The purpose of the project was to improve clinical care …

The Relationahips Between Health Behaviors Of Women And Health Locus Of Control Among Black Caribbean Women And Black American Women With Hypertension, Camelle Charles

Theses & Dissertations

Background

Millions of Caribbean women have migrated to the United States, and a sizeable number of these women and Black American women suffer from hypertension and other cardiovascular health problems. This research showed the comparison of health behaviors of both groups of women and the difference in their health outcomes. Today, there are more migrants in the world than ever before; an estimated 272 million international migrants in 2019, which is an increase in 51 million since 2010 (United Nations, 2019) and Caribbean migrants are a substantial portion of this pool. Approximately 4.4 million Caribbean immigrants reside in the U.S. …

Improving Medication Adherence In African American Adult Females With Hypertension, Donald Welch

Doctoral Projects

The World Health Organization (WHO) reported that adherence among patients with chronic diseases averages nearly 50% in developed countries (Lam & Fresco, 2015). Medication non-adherence is recognized as a significant public health issue that leads to poor health outcomes and added healthcare costs. Multiple African American adult females with hypertension have a high prevalence of non-adhering to their treatment plan. Numerous factors lead to poor medication adherence, including socioeconomic factors, therapy-related factors, patients-related factors, condition-related factors, and health system/healthcare team-related factors (Lam & Fresco, 2015). Medication adherence can lead to a decreased risk of adverse outcomes such as stroke and …

The Impact Of Culturally-Tailored Education On Knowledge And Behavior Related To Screening And Lifestyle Management Of Blood Pressure In African Immigrants, Sarah Erskine

UNLV Theses, Dissertations, Professional Papers, and Capstones

The number of African Immigrants in the United States is increasing. The prevalence of hypertension among Blacks, including African Immigrants are high. In addition to the increased susceptibility to hypertension, lack of disease awareness and unhealthy lifestyle are documented barriers to achieving adequate blood pressure control. The purpose of this project was to determine the impact of implementing a 30-minute, culturally-tailored, evidence based educational session on hypertension to promote knowledge and initiate behavior change in African Immigrants. This was a descriptive, cross-sectional study. Blood pressures were measured and survey instruments such as the Hypertension Evaluation of Lifestyle and Management scale …

Effect Of Lifestyle Modifications On Blood Pressure And Bmi In Overweight Or Obese Adults With Primary Hypertension, Mariska Vandenbergh

Evidence-Based Practice Project Reports

Hypertension (HTN) and obesity contribute to poor cardiovascular outcomes which can be managed with diet and exercise lifestyle changes. In addition, self-awareness (SA) of eating patterns can be a useful tool to promote adherence to lifestyle changes. The purpose of this project was to determine the effect of lifestyle education, the DASH diet, and tools to increase SA for adult clinic patients who were overweight with hypertension. The REAP and PIH tools were utilized to increase patients’ SA of their diagnosis and current dietary habits. A literature search over five databases was conducted and analyzed thoroughly. National guidelines strongly recommend …

The Epidemiology And Burden Of Cardiometabolic Risk Factors In A Young Emirati Population, Fatima Abobakr Hussein Mezhal

Dissertations

The United Arab Emirates (UAE) has experienced rapid economic growth that was paralleled by a drastic rise in non-communicable diseases (NCDs); primarily cardiovascular diseases (CVDs), which account for 40% of mortality in UAE. CVDs have complex etiology, interplay, and accumulation of many risk factors. Understanding the clustering and interrelationships between common risk factors like obesity, deglycation, dyslipidemia, hypertension and central obesity, and the associations with social and lifestyle determinants are warranted. The study aimed to estimate the burden of cardiometabolic risk factors (CRFs), their interrelationship, and their associations with other social and lifestyle determinants in a young Emirati population. Data …

Self-Monitoring Of Blood Pressure In Community – Dwelling Senior Adults, Laura N. Love

Doctoral Projects

Unregulated hypertension is a public health concern. Hypertension is a chronic disease affecting adults across the lifespan. Although hypertension is easy to diagnose and treat, rates of blood pressure control continue to be low (AHA, 2017). Because of this, it is imperative to employ novel strategies for blood pressure control; especially in high risk populations. The purpose of this evidence-based, project was to determine whether self-monitoring of blood pressure (SMBP) improves knowledge about hypertension, while also increasing the frequency of SMBP. Another outcome of interest was a reduction in mean systolic blood pressure for the cohort. The project enrolled participants …

Improving Blood Pressure Control Among Patients Diagnosed With Hypertension In A Primary Care Setting, Eriko Apriliando

Doctoral Projects

Hypertension affects over 38% of adults or approximately 103 million Americans, costing around $131 billion annually in treatment and loss of productivity. It is also an independent risk factor for coronary events, heart failure, stroke, and end-stage renal disease contributing to 410,624 United States (U.S.) deaths in 2014. The American Heart Association (2016) has released the Measure Accurately, Act Rapidly, and Partner with Patient (MAP) protocol in order to address this issue. This project focused on implementing parts of the MAP protocol. The purpose was to improve blood pressure (BP) control of patients diagnosed with hypertension in a primary care …

An Initiative To Educate And Support Young Adults Diagnosed With Hypertension, Page Tomlinson

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

An Initiative to Educate and Support Young Adults Diagnosed with Hypertension

Page Tomlinson, BS, RN, DNPc

Background: Hypertension is a common diagnosis in the US with significant long-term effects. While guidelines for optimal hypertension management exist, young adults lag behind older adults in treatment and control³. The young adult is arguably more capable of lifestyle changes, primarily due to fewer physical limitations than older adults. Promotion of disease self-management is the most effective way to engage young adults in seeking control over their blood pressure^1,2. Lifestyle modification as a young adult decreases costs of care and …

Evidence Based Treatment For Excessive Alcohol Consumption And Concurrent Hypertension, Kimberly Ann Ward

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose. Excessive alcohol consumption is a preventable risk factor for hypertension, heart disease, and stroke. Though alcohol-related deaths number 88,000 annually in the U.S., alcohol use has the lowest treatment rate of behavioral health disorders at 10%. Excessive alcohol consumption may compromise treatment of hypertension by primary care providers (PCP). This project aims to increase awareness of the hypertension and excessive alcohol use connection and promote screening of alcohol consumption.

Methods A protocol for improving alcohol screening and concurrent hypertension management was developed including: in-person educational presentations; patient education materials; and the use of motivational interviewing. Practice change was assessed …

Association Between Maternal Depressive Symptoms And Hypertension Among African American Mothers In The Intergen Study, Xiaosong Gao

Public Health Theses

Purpose: The purpose of this paper is to examine the association between maternal depressive symptoms and hypertension among African American mothers from the InterGEN study.

Data Source: The Intergenerational Blood Pressure (InterGEN) Study was a longitudinal study which enrolled 250 African American mother-child dyads based in Southwest and Central Connecticut.

Methods: We used logistic regression models to examine the association between depressive symptoms and hypertension, and adjusted for educational level, employment in the past 6 months, and Race-Related Events Score (RRES). We used growth curve modeling to examine the association of systolic blood pressure (SBP) and diastolic blood pressure (DBP) …

Prevalence, Awareness And Control Of Hypertension And Diabetes Among Hiv Positive And Negative Patients At The Military Hospital Of Douala, Cameroon, Duane Killian Madziva

Public Health Theses

Background: With anti-retroviral therapy (ART) prolonging the survival of people of living with HIV/ AIDS, other chronic co-morbidities such as hypertension, and diabetes are becoming an increasing problem. Studies on hypertension and diabetes in Sub-Saharan Africa are still limited, even with the growing concern of Africa’s dual burden of chronic and infectious diseases. As such, we aimed to determine the prevalence, awareness and control of hypertension and diabetes among people living with and without HIV/ AIDS in Cameroon. Methods: This was a hospital-based cross-sectional study conducted at the Military Hospital of Douala, Cameroon. Participants aged 21 – 65 years were …

Health Literacy And Health Beliefs With Adherence To Antihypertensive Medications In An Urban African American Cohort, Karen Ranae Dukes

Walden Dissertations and Doctoral Studies

African Americans aged 40 to 65 are more likely to be diagnosed with hypertension, and adherence to prescribed antihypertensive medication regimens is important in controlling their blood pressure levels. The purpose of this quantitative study was to examine the relationship between health literacy and sociodemographic and clinical factors with adherence to antihypertensive medications among African American adults. The theoretical framework for this study was the health belief model. A quantitative research design was used with participants recruited from churches with African American congregations in the city of Detroit. A convenience sampling method was used to obtain a sample of 79 …

Association Between Metabolic Syndrome And Second Primary Cancer Among Colorectal Cancer Patients, Olukayode Ayodeji Agbeyomi

Walden Dissertations and Doctoral Studies

Colorectal cancer (CRC) is the third most common diagnosed cancer in both women and men in the United States. The gradual increase of incidence of second primary cancer (SPC) among CRC individuals has been a concern in recent times. Many CRC survivals have been forced back to be hospitalized for life-threatening cancers that are nonmetastatic cancers of CRC. Literature has suggested that there may be a relationship between metabolic syndrome (MetS) and CRC cases. The importance of early surveillance, detection, and treatment of SPC in CRC patients is significant to achieve better survival rates. The aim of this retrospective quantitative …

Role Of Sodium And Potassium In The Diet Of School-Aged Children In Ireland: Findings From The National Children’S Food Survey Ii, Eoin James Morrissey

Theses

A high sodium to potassium intake ratio (Na:K) resulting from a diet high in sodium and low in potassium can increase the risk of elevated blood pressure or hypertension in children, potentially leading to increased CVD in adulthood. The objective of this thesis was to estimate sodium and potassium intakes and Na:K in school-aged children (5-12y) in Ireland using data from the nationally representative National Children’s Food Survey II (NCFS II) (2017-18). The thesis study collected detailed dietary intake data for 600 children using 4-d food records and also collected spot urine samples from 95% of these participants. Sodium and …

Hypertensive Self Care: An Educational Tool For Advanced Practice Nurses, Kelisia Burks Mckay

Walden Dissertations and Doctoral Studies

Poorly controlled hypertension is a serious public health problem. Persons with high blood pressure are required to perform a variety of self-care behaviors. Advance practice nurses can improve health outcomes for hypertensive patients when they provide self-care education along with prescribing appropriate medications needed to treat high blood pressure. The purpose of this study was to educate rural advance practice nurses about hypertension medication and self-care management using the Hypertension Self-Care Activity Level Effects (H-SCALE) and the 8th National Joint Committee (JNC- 8) hypertensive guidelines. Twelve primary care advanced practices nurses (APN's) participated in an educational presentation that included pre …

Accelerometer-Measured Physical Activity And Sedentary Time Among Samoan Adults And Associations With Type 2 Diabetes And Hypertension, Parmida Zarei

Public Health Theses

Objectives: (1) To describe accelerometer-measured physical activity among Samoan adults; (2) to determine associations between physical activity and type 2 diabetes and hypertension; and (3) to assess adherence to global physical activity recommendations.

Participants: Three hundred eighty-five Samoan adults aged 30-72 years.

Setting: Participants were recruited from 23 villages on the Samoan island of ‘Upolu (eight urban, seven peri-urban, and eight rural).

Measurements: Self-reported demographic information including age, census region of residence, and occupation was collected. Anthropometric measurements including weight and height were taken in light island clothing, and body mass index was calculated. Sedentary time, light-intensity physical activity, and …

The Effects Of Exercise On Pressure Natriuresis, Janet Komolafe

All Graduate Theses, Dissertations, and Other Capstone Projects

Hypertension is a disease of high global burden and a leading risk factor for cardiovascular diseases and related deaths. The pressure natriuresis mechanism, which is an intrinsic response in the kidneys which increases urinary sodium excretion when renal perfusion pressure increases, plays a central role in the long-term regulation of mean arterial pressure. Studies have shown that a sustained impairment of the pressure natriuresis mechanism results in high blood pressure, making hypertension a disease of the kidneys.

Since exercise is recommended as a non-pharmacological treatment to manage hypertension, it is important to understand the means by which exercise is beneficial …

Novel Mechanisms Of Nitric Oxide Activation In The Kidney, Randee Sedaka

All ETDs from UAB

Globally, adult sodium consumption has far exceeded daily intake recommendations, leading to one in ten cardiovascular deaths. Given the rise in hypertension prevalence, uncontrolled hypertension with antihypertensive medication use, and significant associations between high salt intake and high blood pressure, there is a need to better understand the mechanisms involved in hypertension. Nitric oxide synthase 1 (NOS1) is a well-established regulator of fluid and electrolyte balance in the renal collecting duct (CD) with highest activity in the inner medulla (IM). We previously reported that high salt (HS) intake stimulates CD endothelin B receptor (ETBR)/NOS1-dependent generation of NO, thereby inhibiting the …

A Pilot Study: Observations Of Patients Participating In Heart Failure Shared Medical Appointments While Receiveing Nutrition Education, Hannah Hugo

All Master's Theses

The purpose of this pilot project was to examine descriptive statistics from patients who participated in heart failure (HF) shared medical appointments (SMAs) at a mid-sized heart center in the Northwest, in which nutrition education was provided by an RD. Information collected included blood pressure (BP), heart rate (HR), weight, scores from the Minnesota Living with Heart Failure (MLHF) Survey, and the Atlanta Heart Failure Knowledge (AHFK) questionnaire. Due to small sample size and lack of control group, simple descriptive statistics, such as mean and median were used to examine the data. Three of the participants were female and 4 …

Pheochromocytoma: A Systematic Review Of The Diagnosis, Treatment, And Risk Factors, Brandon A. Singletary

All ETDs from UAB

ABSTRACT Pheochromocytomas and extra-adrenal paragangliomas (PGLs) are forms of neuroendocrine tumors which when left untreated lead to debilitating complications of cerebral hemorrhaging, stroke, and death. Typically, the tumors present with symptoms of episodic headaches, sweating, and palpitations, however hypertension is considered one of the more predominant signs. As a result of the rarity of the disease and wide range of symptoms, there are often difficulties in screening and diagnosis to identify these tumors. While there are many case studies and results in small populations, large epidemiologic driven studies are limited. To date the majority of large-scale studies exist in countries …