Heart diseases are the leading cause of deaths in the Unites States. Hypertension and coronary heart disease (CHD) are associated, since different pathophysiologic mechanisms connect the two diseases. Hypertension is one of the leading risk factors of CHD, which is caused by atherosclerosis, that is the narrowing of the arteries. About half a million people die from CHD in the USA, where half of deaths occur beyond hospitals usually within the first hour of symptoms.

Public Health Issue and its Importance to Public Health

Hypertension is a leading global health and economic issue causing more than 50% of all strokes and ischemic heart diseases resulting in over 8 million deaths annually. Hypertension mainly affects poor and middle-income people, mostly in South East Asia, China, India and Pacific regions, which carry 8 out of 10 cases of cardiovascular disease, half of which is in the working class.

Heart failure due to hypertension results in significant morbidity and mortality. It shows a threading of pathological events beginning with atherosclerosis, left ventricular hypertrophy, CHD, heart failure and eventually heart disease.

The above sequence has got both clinical and experimental support, since it involves an overlap of mechanisms, which are involved in the development of the disease, which includes diseases of target organs, namely the brain and the kidney. It has led to the rising acknowledgement of vital functions of nitric oxide synthase and oxidative stress in the growth of heart failure. Treating and preventing hypertension can reduce heart failure by half (Yip, 2009).

County, State and National Epidemiological Data

In this paper, the state of Kentucky is analyzed, which is rated eleventh in the country by cardiovascular mortality, where cardiovascular disease is the leading cause of deaths. Reports show that in 1996, out of all deaths amounting 40%, 32% were caused by heart disease and 7% by cerebrovascular one. It represents about 15,000 deaths. In the following year, 1997, white males in Kentucky reported the highest heart disease rate, and white females recorded the highest rate of cerebrovascular disease. 

High blood pressure, cigarette smoking, obesity, high blood cholesterol and physical activity are modifiable risk factors of CHD. To reduce and control these risk factors, health care providers and physicians should provide guidance and counseling, as well as educating people influenced by these factors. It can make them alert and increase awareness of signs and symptoms of heart disease, and promote a change in behaviors. 

Kentucky was the highest rated state in smoking prevalence from 1995 to 1997 with almost a third of all adult Kentuckians being smokers. There are more smokers among men than among women, while contrary to the previous reports, racial differences have changed resulting in whites smoking more than nonwhites. Reports dating from 1994 to 1996 saw an increase in smoking rates in all age groups except for those aged 35-44. There has been an increased rate of smoking from 21.7% in 1994 to 31.6% in 1996 among people aged 18-24, and from 33.8% in 1994 to 38.1% in 1996 among those aged 25-34, and even the oldest age groups of 65-74 and 75+ have recorded a 3% increase in smoking rates. Eastern Kentucky has very high rates of smoking, where most restaurants have smoking zones.

Almost 25% of the Kentuckians have acknowledged that they have been diagnosed with hypertension by a physician. Cases of self-reported hypertension amounted 50.8% among people aged 65 and over, 35.8% among 45-64 year-old people, and 15.8% among those aged 18-44. Taking into account gender, women recorded 32.1% and men 3.9%. The lack of physical activity for at least 20 minutes, three or more times a week leads to a sedentary lifestyle. In Kentucky, in 1996 and 1997, 67.7% of residents over 18 years recorded sedentary lifestyles. It was due to the lack of leisure time. The sedentary preference rates were expected to increase with age in 18-24 year-old group recording 50.4% and 85.4% in the age group aged 75 and more.

Relevant Healthy People 2020 Objective and Specific Targets

One of the key topic areas of Healthy People 2020 objectives is heart disease and stroke (HDS). The main areas targeted by HDS are to increase and improve the cardiovascular health among the U.S. population and to reduce deaths caused by coronary heart disease with a target of 100.8 deaths per 100,000 people.

Other targets include reducing stroke deaths from 42.2 to 33.8 deaths per 100, 000 population, which is a 20% improvement estimate. Increasing the number of adults, whose blood pressure has been measured within two consecutive years, can state whether their blood pressure is normal, high or low through analyzing from 90.6% to 92.6% of all adults over 18 years. Other targets are increasing people, whose blood cholesterol is checked, and reducing the proportion of those with hypertension from 74.6% to 82.1% and from 29.9% to 26.9% respectively.

The reduction of high total blood cholesterol levels by 10% among people aged over 20 was another target. Developing and increasing the population of adults with hypertension, who meet the required guidelines, as well as those, who use the prescribed medication aimed to lower their blood pressure from 70.4%  and 77.4%, is a 10% improvement projection respectively (Yip, 2009).

Contribution of One Distal Factor to the Behavior of Individuals

Smoking and heart disease are two related aspects, where smoking increases blood pressure resulting in hypertension. The majority of people only associate smoking with cancer of the lungs and breathing difficulties. In fact, about 30% of heart disease deaths in the U.S. have a direct link to cigarette smoking, especially CHD among the youth, who form a high percent of smokers. For example, in Kentucky, the smoking rate of the group aged 18-24 was 31.6%, while that of the group aged 25-34 was 38.8% in 1996. It can be compared with 15.8% of self-reported cases of hypertension in 1993. The Kentucky study represents a culture, where a third of adult Kentuckians are current smokers with an increasing rate of smoking with age due to sedentary lifestyles. There is a correlation between smoking rates in Kentucky and hypertension. 31% of people are current smokers as compared to 24.4% being told by a physician that they are hypertensive (Secker, 2008).

Through the increased smoking rates in Kentucky, a survey done in 1993 indicated that 88.6% of the Kentuckians over 18 years have a risk factor leading to cardiovascular disease. It was followed by another survey in 1994, which showed that the Kentucky population had above the U.S. average of cardiovascular risk factors of smoking, sedentary lifestyle, and hypertension (Secker, 2008).

Realistic Intervention Helping to Address the Issue

High blood pressure can be prevented using approaches, which target the general population and people, who are at a higher risk of hypertension. Preventive intervention measures employed earlier in life give the longest potential for avoiding risk factors that lead to hypertension and decreasing blood pressure-related problems in the society (Yip, 2009).

In this paper, there is an analysis of intensive and targeted strategies, which are more focused on getting an improved decrease in blood pressure for those at a higher chance of developing hypertension, namely for individuals with a family history of hypertension, African Americans, people with a high–normal blood pressure, obese and overweight people, and those, who consume excess alcohol and have a sedentary lifestyle. For such people, there are health care settings, senior centers of health and religious organizations, which are well equipped with screening and referral programs.

Connection between the Intervention and the Consideration of Distal Factor

Researchers have analyzed most people, who have sedentary lifestyles and are cigarette smokers, which are strong cardiovascular risk factors. Preventing and stopping smoking are the best lifestyle change ways of preventing most cardiovascular diseases. It is because smoking causes the impairment of endothelial function, inflammation, lipid modification, arterial stiffness, and a changing in antithrombotic and prothrombotic factors, which determine the onset and growth of the atherothrombotic process, which leads to cardiovascular complications.

Smoking results in a hypertensive feeling by stimulating the sympathetic nervous system. Due to speeded-up atherosclerosis, such smokers tend to acquire chronic hypertension, such as malignant and renovascular hypertension (Yip, 2009).

Findings of the Research Study Supporting the Intervention

Increasing physical activity, losing weight, moderating alcohol intake and decreasing the intake of dietary sodium are the most effective ways of the prevention of hypertension. For example, in a study, where people were assigned to a weight loss group and reduced their weight by 3.5 k, their systolic and diastolic blood pressures decreased by 5.8 and 3.2 mmHg, respectively. After 7 years of follow-up, hypertension was 18.9% in the weight loss group and 40.5% in the control group. The findings point to an indication that weight loss interventions work longer even after the termination of the active process.

Relation of the Intervention to Essential Services of PH

By looking at people, who are at an increased risk of hypertension, monitoring the health status by identifying and solving community health problems serves as one of the main services of public health (PH). It goes to informing and educating people about health issues affecting them and ways of getting out of them, namely engaging in physical activity and avoiding sedentary lifestyles.

Intensive and targeted interventions help to strengthen services of PH though coming up with plans and policies improving the health of individuals and the whole community. Policies and plans go well through the enforcement and regulations of law, which ensure health protection and safety. The diagnostics and investigation of health issues and hazards in the society go hand in hand with taking care of the most predisposed individuals and groups in line with targeted intensive interventions.

The involvement of community corporations  in identifying and solving their problems echoes intensive interventions, as well as links people to necessary personal health care services through the assurance of the services, when they are not available. It includes the provision of the community with a qualified public and personalized workforce, which researches new areas of knowledge and innovation to offer solutions to health issues. The last essential service of public health, which is well-reflected in intensive and targeted interventions, is the evaluation of how effective, accessible and competent personal and community-based health services are.

Conclusion

The relationship between hypertension and coronary heart disease is a common one. It follows some pathophysiological mechanisms connecting the two diseases. Hypertension exacerbates atherosclerosis and a complication, namely left ventricular hypertrophy, which results in coronary reserve disease and causes the increment in myocardial oxygen consumption. Both lead to myocardial ischaemia (Escobar, 2002). For this reason, hypertensive individuals should be checked for risk factors associated with atherosclerosis and other damaged arterial areas than just the coronary one. It is because mortality and complication rates among patients with myocardial infarction result from hypertension.

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