Discussion Cases
1 Leon
While biological causes for the difference between whites and blacks’ biological mechanisms regarding blood pressure have been speculated as being the cause of higher rates of hypertension among blacks in America, the fact that African Americans as opposed to Africans have higher rates of hypertension suggests that environment has more to do with it than biology (Fuchs, 2011). Environmental factors and daily living habits of African Americans are more than likely the main contributing variables to higher hypertension rates in this population. Environmental factors can include stress and anxiety stemming from racial tension in the U.S. that leads to high blood pressure for blacks in the country. Lifestyle habits can also impact the health of this population: diet and lack of exercise can contribute to hypertension as well (Lindhorst, Alexander, Blignaut & Raynor, 2007). Many diets in America are high in sodium, which can increase blood pressure, and an African American like Leon who likes to consume nachos and hot dogs and undoubtedly other salty foods regularly is bound to have higher blood pressure.
The significance of an elevated systolic pressure, even in the absence of diastolic hypertension, is that it means the patient has a higher risk of suffering from cardiovascular disease. A higher systolic pressure has been associated with hypertrophy in the left ventricle of the heart and a need for more oxygen in the heart muscle, which, if untreated, can lead ultimately to heart failure. So a high systolic pressure is not acceptable even if diastolic hypertension is not present—it is still a troubling sign that needs to be adequately addressed. Other problems that could arise from high systolic pressure include atherosclerosis and a possible aneurysm.
The mechanism of action of the two classes of drugs Leon was prescribed for the management of his hypertension—diuretics and an ACE inhibitor—focus on getting the sodium out of the body and limiting the body’s ability to constrict blood vessels, respectively. The diuretics flush the system by triggering the body’s renal secretion of water and sodium. The ACE inhibitor blocks the body from turning angiotensin I into angiotensin II. As there is less angiotensin...
References
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Fuchs, F. D. (2011). Why do black Americans have higher prevalence of hypertension?: an enigma still unsolved. Hypertension, 57, 379-380.
Lindhorst, J., Alexander, N., Blignaut, J., & Rayner, B. (2007). Differences in hypertension between blacks and whites: an overview. Cardiovascular Journal of Africa, 18(4), 241-247.
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