Hypertension in the Auburn and Opelika Area

Running head: HYPERTENSION IN THE AUBURN AND OPELIKA AREA 1

Hypertension in the Auburn and Opelika Area

Anna Nunn, Jessica Haynes, Elise Dewey, Megan Naylor, Ansley Smitherman, Samantha Fetner, Kayli Obert, Miriam Arusei, Bethany Piskorz, and Elizabeth Nielsen

Auburn University School of Nursing

Introduction

Blood pressure is the force that blood exerts on arterial walls as it circulates throughout the body. It is measured in millimeters of mercury (mm Hg). There are two types of blood pressures reflected in the reading, the top number is systolic blood pressure and bottom number is the diastolic blood pressure. Systolic pressure is the pressure exerted in the arteries when the heart beats while diastolic pressure is the force on arteries between beats. Normal blood pressure should normally be less than 120/80 mm Hg (less than 120 systolic AND less than 80 diastolic) for an adult age 20 or over (American Heart Association, 2010).

The Auburn Housing Authority is a local community in Lee County. The majority of the residents are of African American descent (Centers of Disease Control and Prevention, 2010). High blood pressure is common in African Americans, therefore, it is important for them to learn ways of preventing and managing this disease. High blood pressure may not show signs and symptoms and, therefore, may not be immediately diagnosed. Regular screening is highly recommended to enable early diagnosis and management. Possible signs and symptoms of hypertension include: headaches, nervousness, sweating and flushing, but these symptoms are not conclusive (American Heart Association, 2010). Several factors lead to development of high blood pressure, therefore, assessment of the entire community is important when teaching about hypertension. In studying the trend of hypertension within the Auburn Housing Authority, the following components should be considered: type of community, climate, environmental factors, food supply chains, housing and sources of shelter, industries and occupations, age, gender, racial and ethnic backgrounds, income, educational level, morbidity and mortality rates, transport services, recreational facilities, health care systems, social services, health organizations and age-related planning groups.

Hypertension, also called high blood pressure, occurs when blood exerts excessive force on blood vessels. Hypertension is diagnosed after three separate blood pressure measurements, each exceeding 140/90. The risk of complication is greater as blood pressure rises. Diagnosis of high blood pressure is divided into three stages: pre-hypertension, stage 1-hypertension and stage 2-hypertension (Ignatavicius & Workman, 2010).

Blood Pressure Classification

Blood Pressure
Category / Systolic
mm Hg
(upper #) / Diastolic
mm Hg
(lower #)
Normal / less than 120 / and / less than 80
Pre-hypertension / 120 – 139 / or / 80 – 89
High Blood Pressure
(Hypertension)
Stage 1 / 140 – 159 / or / 90 – 99
High Blood Pressure
(Hypertension)
Stage 2 / 160 or higher / or / 100 or higher

About 1 in 3 adults in the United States have high blood pressure (Centers for Disease Prevention and Control, 2010). According to recent statistics, Alabama ranks 3rd in incidence of high blood pressure and comprises 33% of the total cases of hypertension in the United States (Health Statistics, 2010). Hypertension affects more than 50 million Americans and is the most common reason for adults to visit physicians. According to the Centers for Disease Control and Prevention, essential hypertension is the 13th ranked killer of both Americans and Alabamians. In 2005 in America, hypertension killed 29,282 people at a rate of 9.9 per 100,000 while in the state of Alabama, hypertension killed 1,225 of the residents at a rate of 8.9 per 100,000 people (Alabama Rural Health Association, 2009). The 2000 Census identified the leading cause of death in Lee County, Alabama to be heart disease, with 26.8% (12,583 people) of the population dying from this disease. The number one contributor to heart disease is hypertension, making it the leading killer of Alabamians and Americans. Management of high blood pressure can lead to a longer life (Moser, 2005).

High blood pressure, especially when developed in individuals before age 50, increases patient risk for several complications, including heart and coronary artery damage, which can lead to heart attack, congestive heart failure, atherosclerosis, stroke, kidney damage, vision loss, erectile dysfunction, memory loss, angina and fluid build-up in the lungs. If left untreated, hypertension can reduce life expectancy by ten years or more (American Heart Association, 2010).

Several factors contribute to the development of blood pressure complications. Primary high blood pressure affects 90% of the total population, and certain factors contribute to its development. These risks include:

§  Age. The risk of high blood pressure increases with age. Through early middle age, high blood pressure is more common in men. Women are more likely to develop high blood pressure after menopause. Hypertension is seen to have increased in the country’s 55-64 year-olds. Also, 50.2% of men 55-64 years of age have diagnosed hypertension, while 54.4% of women in the same age group have diagnosed hypertension. Additionally, 65% of the country’s men over 75 years of age have diagnosed hypertension, while 80.2% of woman had diagnosed hypertension (Centers for Disease Control and Prevention, 2008).

§  Race/Sex. Race and sex play a key role in determining one’s risk for hypertension. In 2006, 49.2% of men over 20 years of age in the country and 51.5% of women over 20 years of age had hypertension. Recently, there has been an increase in the prevalence of hypertension among women. Also, 68.7% of African American males over 20 years of age had hypertension, and 68.0% of African American females over 20 years of age had hypertension (Centers for Disease Control and Prevention, 2008).

§  Family history. High blood pressure can be genetic.

Other risk factors include: obesity, lack of physical activity, smoking and excessive consumption of salt. These factors can be controlled by the individual. Secondary hypertension has a known origin and can be caused by pre-existing kidney abnormality like tumors, abnormality of the aorta or narrowing of arteries (Centers of Disease Control and Prevention, 2010). Secondary high blood pressure affects 5-10% of the population. High blood pressure can be controlled through medications such as angiotensin-enzyme inhibitors, beta-blockers, calcium channels blockers and use of diuretics. Lifestyle modifications, including exercise, proper diet, low sodium consumption and smoking cessation, can decrease blood pressures significantly. Treatment with certain medications depends on severity of disease and racial background (Lilley, Harrington, & Synder, 2007).

Auburn is located in Lee County, Alabama. It is considered a “college town” and is the home of Auburn University, which facilitates about 25,000 students. The city has been marked in recent years by rapid growth and is currently one of the fastest growing metropolitan areas in Alabama and has been the nineteenth-fastest growing metro area in the United States since 1990. In 2009, it was also ranked in the top ten best places to live in the United States by the U.S. news (Mullens, 2009).

The southwest and west regions of the city are marked by rolling plains. The city lies in Western Lee County and is bordered by the city of Opelika to the northeast and by Chambers County to the north. Auburn’s climate is marked by mild winters, hot, muggy summers, and moderate autumns and springs. The city receives a significant amount of rainfall (on average, 52.6inches) per year with drier weather in the late summer and early fall. Severe storm activity is common from the late winter through early summer (U.S. climate data, 2010).

Season Ave. High (degrees) Ave. Low (degrees)

Winter 58 36

Spring 74 52

Summer 89 69

Fall 78 54

Annual 75 53

Average annual temperature: 64 Degrees Fahrenheit

Average annual rainfall: 56.29 Inches

Average annual Snowfall: 25 Millimeters

Although Auburn is fairly flat and good for outdoor exercising due to its many parks and recreational facilities, the climate is a major problem in the summer. With temperatures up to100 degrees Fahrenheit in the summer and early fall, outdoor exercise is difficult for residents. Dehydration may occur very quickly when outdoors for a short time. In addition, fear of heat stroke may prevent people from exercising during the summer. The elderly population of the Auburn community is at a greater risk for heat stroke because they already may have underlying health conditions like diabetes, hypertension and cardiovascular complications. Research however shows that frequent exercise is a key to reducing incidence of cardiovascular diseases and hypertension (Wheaton, Chin, Xin & He, 2002).

When discussing hypertension, it is helpful to understand some physiology of the human body. One of the many ways the body regulates temperature is by circulation of the blood. Excessive heat may distress the individual, causing increased blood pressure. According to some reports, the body also becomes less efficient above certain temperatures, which increases the amount of work the body must do. This results in higher blood pressure (Crandall, 2008). Environmental factors play a role in the risk for hypertension, therefore Auburn’s location and culture need to be considered. In a country where obesity, over-eating, and lack of exercise are becoming more and more common, the nation’s risk for developing hypertension is greatly on the rise. To make matters worse, Lee County, Alabama is located in the southern part of the country, where unhealthy eating habits, such as consuming large amounts of fried, salty and greasy foods and a sedative lifestyle, increase occurrence of hypertension. Salty foods contribute to a rise in blood pressure because when salt enters the body, fluid also follows. Therefore, large amounts of fluid are taken into the vessels, increasing blood pressure in the arteries (Langcuster, 2007, para.12). Humans need less than one half teaspoon, or 2g/day, of salt, but the average intake of salt per day in the United States is about two teaspoonfuls, 10-12 g/day (Moser, 2005). A sedentary lifestyle often leads to overweight individuals and obesity. Arteries compensate for extra body weight by “shrinking” so that blood can evenly be distributed throughout the body. This creates added resistance against the heart muscle as it must work hard to pump the body’s blood to further distances. The end result of this action is hypertension (Langcuster, 2007, para. 15).

Hypertension can be confusing, but it is important to understand it even when the cause cannot be identified. Libraries are a great resource to learn more on hypertension. The Auburn Public Library is located at 749 East Thach Avenue (City of Auburn). It is open Monday through Thursday from 9:00 am to 9:00 pm, Friday and Saturday from 9:00 am to 5:00 pm and Sunday from 2:00 pm to 6:00 pm. For questions concerning services, contact the library at (334) 501-3190. The Auburn University Ralph Brown Draughon Library is another great resource for information on hypertension. It is located at 231 Mell Street and can be contacted at (334) 844-4500 or online at www.lib.auburn.edu. The Auburn University library is open from Sunday at 1:00pm until Friday night at 6:00pm. It is open Saturday from 9:00am to 6:00pm (Auburn University Libraries, 2010). The Lewis Cooper Jr. Memorial Library is another library available to residents of Lee County. It is located at 200 South 6th Street in Opelika, Alabama and can be contacted for more information at (334) 705-5389 (City of Opelika, 2010). Their hours are Monday and Tuesday8:30 am - 7:30 pm, Wednesday through Friday 8:30 am - 6:00 pm, Saturday 9:00 am - 5:00 pm and Sunday 1:00 pm - 5:00 pm (City of Opelika, 2010). Although there is much to learn about hypertension at these libraries, it is vital that patients speak with their health care provider if there are any questions about a medical condition.

“Many people have high blood pressure for years without knowing it. Most of the time, there are no symptoms, but when high blood pressure goes untreated, it damages arteries and vital organs throughout the body. That’s why high blood pressure is often called the ‘silent killer’” (Diagnose and monitor high blood pressure, 2010). Making regular visits to family physicians or free health clinics can identify hypertension early, making it easier to manage. At these visits doctors and/or healthcare providers may prescribe medication, provide education and elicit support. A service offered year-round by the Auburn University School of Nursing is free blood pressure screenings and other health promotion activities at many locations throughout the Auburn area. Individuals can be screened at one of the Auburn Housing Authority clinics at the Boykin Gym on Mary Brooks Drive, Porter Community Building on Porter Avenue, Sparkman/EASE house on Commerce Drive, and Ridgecrest at the end of Julie Street. These clinics provide those with limited healthcare access a convenient and cost-free way to manage and monitor their health.

East Alabama Medical Center (EAMC), located in Opelika Alabama, is a 352 bed hospital with various services offered to the community. EAMC has been named one of the 100 Top Heart Hospitals in the nation, making it an excellent resource for those suffering with hypertension. One service provided for detection and management of hypertension is EAMC’s cardiology services. This program allows selected cardiologists employed with EAMC to offer services in the community setting at smaller doctors’ offices located in the surrounding counties. At these offices, they can screen for hypertension and other cardiac concerns (EAMC history, 2010). Another service provided by EAMC is the HealthPlus Fitness Center, located approximately five miles from the hospital, which is a facility that provides the “tools you need to improve your health and fitness safely and effectively” (HealthPlus Fitness, 2009). Also, dieticians from EAMC work hard to educate the community about proper nutrition and eating habits. For those who have financial difficulties, EAMC provides social services to help those acquire the healthcare needed to manage their hypertension (Nutrition and food services, 2010).