Hypertension

Definition/Background:

Hypertension, or high blood pressure, is a condition where the force of blood pushing against the arterial walls (over the long-term) is high enough to potentially cause health problems such as heart disease, a heart attack, or a stroke (Mayo Clinic 2016). Blood pressure is elevated based on how much blood is pumped out of the heart (more blood increases pressure) as well as how narrow the arteries are (the narrower the artery the higher the pressure)(Mayo Clinic 2016). It is possible that an individual can have hypertension without experiencing symptoms; however, there can still be damage to blood vessels or the heart despite a lack of symptoms (Mayo Clinic 2016). Most people eventually experience hypertension at some point of their lives, and as an easily detectable condition, doctors are able to detect and begin to treat it quickly (Mayo Clinic 2016). Blood pressure readings are generally measured by doctors before they treat patients for anything, which makes the condition highly monitored in the medical world.

There are two types of hypertension, primary, where there is no detectable cause of the high bloop pressure but it develops gradually over time, and secondary, caused by a different underlying condition that causes blood pressure to spike (unlike in primary hypertension)(Mayo Clinic 2016). High blood pressure is more commonly found in these groups of people: elderly, African-American, overweight, inactive, tobacco-users, and alcoholics (Mayo Clinic 2016).

Historical Context:

The first medical advancements involving high blood pressure began with the ability to measure it. There was early recognition by the life insurance industry of the risks involving blood pressure level and its effects on the heart (Kotchen 2011). The first person to measure arterial pressure was Reverend Stephen Hales in 1733, when he performed the measurement on a horse (Kotchen 2011). In the 1800s, sphygmographic devices were improved, non-invasive ways to measure blood pressure in humans (Kotchen 2011). The sphygmomanometer became an important measuring tool in the world of science.Unfortunately, as technology to measure blood pressure improved and more research conducted on the matter surfaced, the negative consequences of high blood pressure became well-known and apparent, especially to insurance companies. As a result, companies began to require blood pressure measurements for insurance applicants (Kotchen 2011).

After its beginning in 1972, the National High Blood Pressure Education Program (NHBPEP) created 4 task forces. Task force I focused on hypertension’s definitions, standards of care, and effective treatment regimens; task force II focused on developing a plan to educate health professionals; task force III focused on designing a program of public education (Kotchen 2011). Lastly, task force IV focused on the impact of the program on the existing healthcare system and the resources required for the program’s success (Kotchen 2011). Since then, hypertension awareness, treatment, and control rates have all improved in the U.S. and mortality rates for stroke and heart disease have declined significantly (Kotchen 2011). This success can likely be attributed to improved measures of hypertension control.

Controversy/Different Perspectives:

One issue regarding the condition is the issue of whether or not it is beneficial to tamper with our body’s natural response to age, which is to elevate blood pressure. That being said, it is difficult to argue against the obvious negative health consequences of hypertension; however, some individuals still believe this treatment and recognition of the condition is overworked, and should not be considered or treated because it is a natural body response. In 1931, when researchers were hard at work and insurance companies were paying heavy attention in regards to hypertension, John Hay wrote of the hypertension focus, “The greatest danger to a man with high blood pressure lies in its discovery, because then some fool is certain to try and reduce it” (Hay 1931, 46). While this offers an outdated perspective, it gives a glance into the history of identification of disease and treatment of it, as it is clear that the entire population was not sold on the effects of hypertension.

Another controversy surrounding the topic involves the insurance companies and their attention to high blood pressure as a risk for taking on a client. Hypertension is not grounds for outright rejection from insurance companies, but it likely raises the premium and makes it more difficult to deal with the company. This also creates a problem with costs, as there is a clear cost difference for patients experiencing hypertension. Therefore, as will be discussed in the next controversy, the black population being more susceptible to hypertension makes th population more susceptible to paying higher insurance costs, another way in which historical trauma is evident in the situation. (http://www.business-standard.com/article/pf/if-your-insurance-policy-application-is-rejected-113022600559_1.html)

Likely the most major controversy surrounding the condition is identified in “Therapy of Hypertension in African Americans” by researchers John Flack, Samar Nasser, and Phillip Levy. In this article, they state, “Hypertension in African Americans is a major clinical and public health problem because of the high prevalence and premature onset of elevated blood pressure (BP) as well as the high burden of co-morbid factors that lead to pharmacological treatment resistance.” Essentially, hypertension is not only diagnosed more often in this population, but it is also treated and controlled less often. Lower than any other ethnic group, overall control rates are 29.9% for non-Hispanic Black men (Flack 2011, 83). This is likely due to the fact that a majority of African American hypertensive patients require a combination of different drug therapies to control blood pressure (Flack 2011, 83). This presents a very difficult controversy because the black population is not only more likely to have hypertension, but is less likely to have it treated. This plays into the idea of difficulty of access to care for marginalized populations, which will be discussed in the section linking the concept to the politics of health.

Examples:

There are a plethora of examples especially pertaining to black hypertension patients and their inability to control hypertension, receive treatment, or adhere to treatment.

One such example stems from a man who has had trouble controlling his hypertension, despite physician support and medication. This suggests a larger problem than simple doctor care, because it is generally equal for blacks and whites in regards to medical and dietary treatment (Cooper 2010, 1260). Despite numerous different treatments, Mr. R has not been able to adhere to the medication or control the hypertension. The overall problem in this situation is the inability of doctors to grasp their patient’s culture differences, which suggests a historical trauma as well as structural violence of sort in this context.

(https://www.uptodate.com/contents/treatment-of-hypertension-in-blacks)

(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5210449/)

Politics of Health:

The condition of hypertension relates to the politics of health through historical trauma and structural violence. This mostly pertains to the treatment of the black population in relation to their increased susceptibility to hypertension. The black population has endured a historical trauma in this case because historically they have been marginalized in terms of getting treatment or accessing care. This creates a source of fear for the population, because it is more susceptible to a condition that needs treatment and control but has lesser means by which to do it. The population, therefore, can identify this historical trauma as a means by which to correct the system to better understand this population and its problems regarding hypertension. This is why structural violence also enters the conversation, because of the lack of cultural knowledge in physicians or lack of understanding of their patients, which shows itself as structural violence (for example Mr. R’s aforementioned situation). The public narrative the population has constructed is one of under treatment and lack of understanding from medical professionals, resulting in an under controlled hypertension problem in the population.

References:

Cooper, Lisa. “A 41-year-old African-American man with poorly controlled hypertension.” JAMA 301, 12 (2009): 1260-1272

Hay, John. “The Significance of a Raised Blood Pressure.” British Medical Journal, 2 (1931): 43-48

John M. Flack, Samar A Nasser, and Phillip D. Levy. “Therapy of Hypertension in African Americans.” American Journal of Cardiovascular Drugs 11, 2 (2011): 83-92

Kotchen, Theodore. “Historical Trends and Milestones in Hypertension Research: A Model of the Process of Translational Research.” Hypertension 58, 4 (2011): 522-538

Mayo Clinic Staff. “High blood pressure (hypertension).” mayoclinic.org. September 9, 2016