Hypertension and Chronic Kidney Disease: Overview

Appel, L. J., Wright, J. T. Jr, Greene, T., Agodoa, L. Y., Astor, B. C., Bakris, G. L., Cleveland, W. H., Charleston, J., Contreras, G., Faulkner, M. L., Gabbai, F. B., Gassman, J. J., Hebert, L. A., Jamerson, K. A., Kopple, J. D., Kusek, J. W., Lash, J. P., Lea, J. P., Lewis, J. B., Lipkowitz, M. S., Massry, S. G., Miller, E. R., Norris, K., Phillips, R. A., Pogue, V. A., Randall, O. S., Rostand, S. G., Smogorzewski, M. J., Toto, R. D., Wang, X & AASK Collaborative Research Group. (2010). Intensive blood-pressure control in hypertensive chronic kidney disease. The New England Journal of Medicine, 363(10), 918-929.

In this article, the authors establish the effect of rigorous blood pressure regulation on the advancement of renal disease among patients of black origin. The study uses 1094 patients of black ethnicity with hypertensive chronic kidney disease, which is characterized by a diastolic blood pressure exceeding 95 mm Hg and a glomerulus filtration rate ranging from 20 to 65 ml per minute. The patients are enrolled in for four years in two treatment programs that involve either exhaustive or the normal blood pressure management. The patients are also allocated arbitrarily to three preliminary drug treatments that consist of beta-blockers, calcium pathway blockers and antagonists of angiotensin-converting enzyme. Thereafter, the patients without a diagnosis of end-stage renal disease (ESRD) join a second phase that entails a protocol-driven blood-pressure control that matches the previous outcomes. The cohort phase, which lasts between eight and twelve years, aims at monitoring the advancement of chronic kidney disease, which is typified by a twofold increase in creatinine quantities in serum, the identification of ESRD or loss of life.

In the trial phase, the average blood pressure is lower in the treatment group than the control group. However, the cohort outcomes reveal a blood pressure increase in the treatment group and a decrease in the control group. It is concluded that exhaustive blood pressure control does not have a substantial effect on the advancement of renal disease. However, the regimen can have an effect in patients with baseline proteinuria.

This paper is useful when investigating the impact of ethnicity on high blood pressure and associated renal ailments. The paper also provides an extensive insight on the effect of various treatments on the progression of kidney disease.

Jones, L. M. (2014). Reducing disparities in hypertension among African American women through understanding information seeking and information use. Web.

The author finds a basis for developing measures to lower the disparities in the health outcomes of hypertensive African-American women using three approaches. The first approach is to ascertain whether the African-American women seek health information on the internet while the second approach involves explaining the patterns observed and information obtained by African-American women. The third approach entails determining the suitability of a conceptual model in accounting for the variation of information usage among the women. Data are collected from 15 electronic records and a group of women in a church conference. Attributes of interest are the knowledge regarding hypertension, the desire to find information on the hypertension and use of the information in the self-management of hypertension. The relationships among information seeking behaviors are established using statistical analyses. It is established that the internet is useful in educating African-American women on hypertension. The conceptual model is also found to be pertinent to explaining the use of internet information in managing hypertension. However, the model is not accurate in estimating the number of women diagnosed with hypertension. It is concluded that the internet is a useful medium of communicating hypertension-related information to African-American women, which assists in the self-management of high blood pressure. It is also established that the frequency of internet use among the women is adequate to achieve the benefits of hypertension education.

This paper provides useful information on methods of enlightening the masses on hypertension. It highlights the internet as one of the media that health care providers can exploit to pass information regarding hypertension. This paper also reveals the prevalence of self-management of health conditions using information available on the internet.

Kauric-Klein, Z. (2012). Blood pressure knowledge in hypertensive hemodialysis patients. The CANNT Journal 22(4), 18-25.

In this paper, the author establishes the effect of the inclusion of blood pressure (BP) edification, observations, goal establishment and strengthening of the goals in educative nursing intervention on the management of blood pressure in patients undergoing chronic hemodialysis. The author tries to find the influence of the intervention on BP knowledge and whether the knowledge leads to enhanced management of BP. The study uses a randomized experimental design that involves 118 subjects from six HD sections in Detroit. The treatment includes two education gatherings on blood pressure followed by a 12-week intervention that consists of supervision, establishing of objectives and strengthening of the set objectives. During the intervention, the patients are required to keep an eye on their BP and the quantities of sodium and fluids ingested. The monitoring is achieved by keeping weekly reports of the data. The author performs weekly checks of the records to confirm that the established goals are met. The achieved goals are highlighted, and guidance is provided on ways of realizing the unmet objectives. Conversely, the patients in the control group receive regular care. It is realized that the patients already have adequate information regarding the management of blood pressure and that no significant changes in the knowledge are attained after the intervention. However, there is a substantial decline in systolic and diastolic blood pressures in the treatment group in comparison with the control group.

This paper reveals that education alone is insufficient in improving the management of blood pressure outcomes and additional measures such as setting goals and monitoring are vital. Therefore, this paper provides useful information to guide the provision of nursing care to patients on hemodialysis.

Kauric-Klein, Z. (2012). Improving blood pressure control in end stage renal disease through a supportive educative nursing intervention. Nephrology Nursing Journal, 39(3), 217-228.

The author emphasizes the relationship between high blood pressure and the mortalities of patients on hemodialysis. Therefore, the main objective of the study is to determine the effect of supportive nursing involvement such as supervising, placement of goals and emphasizing the attainment of the goals in the management of high blood pressure in patients on chronic hemodialysis (HD). The author uses a randomized clinical trial that involves 118 subjects from six HD groups in the Detroit region. The regimen includes two education gatherings on blood pressure followed by a 12-week intervention that includes supervision, establishing of objectives and reinforcing the objectives. The patients are observed for thirty days following the completion of the intervention. During the intervention, the patients are required to watch their blood pressure as well as the quantities of sodium and fluids ingested. The monitoring is achieved by keeping weekly records of the data. The author performs weekly checks of the records to confirm that the established goals are met. The achieved goals are highlighted, and guidance is provided on unmet objectives. The patients in the control group receive standard care. It is realized that systolic and diastolic blood pressures reduce significantly in the treatment cohort compared to the control group. It is, therefore, concluded that supportive nursing intervention improves the outcomes of BP management in hypertensive patients on chronic dialysis.

This article offers valuable information on the relevance of nursing interventions in improving the outcomes of patients on hemodialysis. The article clearly outlines the details that nurse practitioners need to pay attention to when guiding patients on the self-management of blood pressure. Overall, the study shows the effectiveness of nursing care in enhancing self-management practices among patients.

References

Appel, L. J., Wright, J. T. Jr, Greene, T., Agodoa, L. Y., Astor, B. C., Bakris, G. L., Cleveland, W. H., Charleston, J., Contreras, G., Faulkner, M. L., Gabbai, F. B., Gassman, J. J., Hebert, L. A., Jamerson, K. A., Kopple, J. D., Kusek, J. W., Lash, J. P., Lea, J. P., Lewis, J. B., Lipkowitz, M. S., Massry, S. G., Miller, E. R., Norris, K., Phillips, R. A., Pogue, V. A., Randall, O. S., Rostand, S. G., Smogorzewski, M. J., Toto, R. D., Wang, X & AASK Collaborative Research Group. (2010). Intensive blood-pressure control in hypertensive chronic kidney disease. The New England Journal of Medicine, 363(10), 918-929.

Jones, L. M. (2014). Reducing disparities in hypertension among African American women through understanding information seeking and information use. Web.

Kauric-Klein, Z. (2012). Blood pressure knowledge in hypertensive hemodialysis patients. The CANNT Journal 22(4), 18-25.

Kauric-Klein, Z. (2012). Improving blood pressure control in end stage renal disease through a supportive educative nursing intervention. Nephrology Nursing Journal, 39(3), 217-228.

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