Three Biggest Takeaways Assignment Help: How to Answer This Question

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Original Question

The three biggest takeaways from this article are? In the United States and worldwide, cardiovascular disease is the leading avoidable cause of premature death and disability. Cardiovascular disease, principally myocardial infarction and stroke, accounts for > 900,000 annual fatalities nationally and >10 million globally. The United States suffers 9% of cardiovascular disease deaths among 4.5% of the world’s population. Prevention and management of cardiovascular disease involves therapeutic lifestyle changes and adjunctive pharmacological therapies of proven benefit. Uncontrolled hypertension is a major risk factor for stroke and myocardial infarction. Health providers should be aware that uncontrolled hypertension is one of the most common, serious, and increasing conditions in their patients. Nationally, adults over the age of 18 include 249.2 million people, of which 119.9 million have hypertension. Myocardial infarction accounts for 25% of all deaths and stroke about 16.5%. Stroke is fifth in all-cause mortality, accounting for 133,000 United States deaths. Most strokes in the United States are ischemic and this trend is rapidly becoming globalized. Nationally, myocardial infarction costs $11.5 billion and stroke $18 billion annually. This is due, in part, to stroke being a greater cause of disability. Most developed countries have experienced consistent declines in mortality from myocardial infarction and stroke for decades, which no longer seem evident. Early declines were attributable mainly to primary prevention, though more recent declines were attributable to more aggressive diagnoses and treatments. These data have contributed to the adage of living longer but not healthier. There is an increasingly urgent need for primary prevention as United States life expectancy is no longer increasing, due largely to the stoppage and possible future reversal of decreasing trends in cardiovascular mortality. Further support that health providers should consider the need for primary prevention is the fact that sudden cardiac death accounts for 50% of deaths from cardiovascular disease and is the first symptomatic event in ≥ 25% of cases. In addition, for 76% of stroke patients, the initial presenting symptom is the stroke itself.1 Hypertension has long been deemed “the silent killer,” as most patients affected are unaware of their condition until its first presenting symptom of myocardial infarction or stroke. Control of hypertension is effective and, at least in theory, straightforward. Before the Hypertension Detection and Follow Up Program only about 50% of patients were aware of their hypertension, and of those, only 50% were actively treated. Of that group, only 50% received effective treatment. Thus, one-eighth of all patients were effectively treated. Today, 54% are aware of their hypertension, 40% are actively treated, and 21% have their hypertension adequately controlled. Guidelines have been developed in many countries throughout the world, and all tend to emphasize the need for strict control. Using the most recent American Heart Association and American College of Cardiology guidelines, the values of healthy individuals are less than or equal to 130 millimeters of mercury (mmHg) for systolic blood pressure and less than or equal to 80 mmHg for diastolic. With these definitions, hypertension affects > 45% of the US adult population.2 In the randomized Trials of Hypertension Prevention, 2 of the 8 therapeutic lifestyle changes showed significant benefits. These were weight loss and increased physical activity, and salt reduction.3 In addition to therapeutic lifestyle changes of proven benefit, many patients with hypertension, especially in the United States, need drug therapies to achieve their blood pressure goals. In lipid management use of single therapy with an evidence-based dose of high-intensity, statins will suffice. In contrast, for hypertension control, most patients require 2 or 3 blood pressure medications to achieve the recommended targets. It has been found that 50% respond to the maximum dose of 1 drug, 65% to 2, and about 75% to 3 drugs of proven benefit. The federally funded Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial tested the most promising drug therapies for hypertension. The drug therapies that showed statistically significant and clinically important benefits were diuretics, angiotensin-converting enzyme inhibitors or blockers, and calcium channel blockers.4 Another clinical challenge is metabolic syndrome, which includes central adiposity, high triglycerides, low high-density lipoprotein cholesterol, elevated fasting blood glucose, and hypertension.5 Metabolic syndrome is a chief risk factor for myocardial infarction and stroke in the United States, which is the heaviest society in the world. Nationally, metabolic syndrome is present in 40% of adults above age 40. This figure increases with age until 70, possibly due to selective early mortality. For these patients, blood pressure must be controlled, as they are at high risk for myocardial infarction, stroke, and kidney disease. Both health providers and patients should be aware of the variability of blood pressure from day to day and from morning to night. Hence, effective treatment is complicated by the health provider’s need to produce an algorithm for each of his or her patients. In addition, the patient must take an active role in monitoring their blood pressure. For this, the Omron blood pressure monitor is recommended by the American Heart Association and American College of Cardiology.2 We concur that blood pressure should be checked each morning and night and whether to administer a particular drug or its dose should be adjusted accordingly based on the average of 3 readings taken about 5 minutes apart. The most reliable detection of the most plausible small to moderate benefits of drugs has been from large scale randomized trials.6 In randomized trials of hypertension and their meta-analyses, mild to moderate is defined as systolic ≥ 140 or diastolic ≥ 90. Drug therapies produce 4-5 millimeter reductions, which produce statistically significant and clinically important reductions in risks of a first myocardial infarction of 14% and first stroke of 42%.7 Many hypotheses have been formulated concerning this apparent shortfall in randomized trials because observational studies suggest larger reductions in myocardial infarction and similar reductions in stroke than the randomized trials. One plausible hypothesis is the shorter duration of treatment and follow-up in randomized trials than observational studies. Health providers should note that the Systolic Blood Pressure Intervention Trial was a large-scale randomized trial. Participants assigned at random to a goal of systolic blood pressure of 120 millimeters had significant reductions in cardiovascular disease compared with those assigned to a goal of 140.8 Further, this trial was terminated prematurely due to a statistically extreme reduction in risk for the primary composite cardiovascular endpoint of myocardial infarction stroke, acute coronary syndrome, congestive heart failure, or cardiovascular death. Health providers may also note and implement early detection of hypertension through screening. In addition, health providers can achieve control of blood pressure through therapeutic lifestyle changes and multiple adjunctive drug therapies to reduce the risks of myocardial infarction or stroke. Most guidelines recommend frequent self-monitoring by patients using the Omron and adjusting their doses and drugs. In addition, societal changes would lead to dietary improvements and better control of hypertension. Currently, therapeutic lifestyle changes of proven benefit combined with multiple pharmacologic therapies for those with blood pressure > 130/80 and pharmacotherapy initiated for those with blood pressure ≥ 140/90 are safe and effective. Although uncontrolled hypertension remains alive and well in the United States and worldwide, strict attention to these issues by health providers has the potential to “kill the old silent killer.”

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