Discussion Board

Complex/ multifactorial inheritance diseases are caused by the interaction of multiple genes and environmental factors. They are determined by various genetic and environmental factors. Most fairly common congenital anomalies and familial disorders are due to multifactorial inheritance. The complex inheritance disorder corresponds to the total genetic and environmental influences (Choobdar et al., 2019). The risk of a genetic trait is much higher in 1st-degree relatives who share an average of 50% of the affected person’s genes than in distant relatives, who possibly inherit only a few high-liability genes.

Hypertension is a common complex inheritance condition that I have encountered in my clinical practice. The heritability of hypertension is widely documented. I have observed that hypertension tends to run in families in clinical practice. Persons whose parents have a history of hypertension have a high risk of developing the disease, especially if both parents are affected. Nonetheless, the inheritance pattern of hypertension is unknown. According to Ahn and Gupta (2018), an increasing body of evidence supports the view that hypertension is a product of a complex interplay of epigenetic, genetic, and environmental factors. Genetic factors are considered to contribute to about 30–60% of blood pressure variation.

Health education for patients with complex inheritance disease is essential. Thus, when working with a patient with a complex inheritance health issue, I would first educate them on the disease process and the disease risk factors. Patient education interventions are associated with improved psychological outcomes, thus alleviating the general anxiety, distress, and depression attributed to having a complex inheritance disease (Ahn & Gupta, 2018). In addition, I would educate the patient on lifestyle modifications they should take to alleviate the impact of the disease, such as engaging in regular physical exercises, smoking cessation, moderate alcohol consumption, and healthy dietary habits (Chen et al., 2019). Furthermore, I would schedule regular health check-ups to evaluate the patient’s progress and examine any complications.

Some of the causes of secondary hypertension are a cluster of disorders with a Mendelian inheritance pattern identified as monogenic forms of hypertension. Monogenic hypertension refers to a sequence of hypertensive syndromes inherited by Mendelian laws (Ahn & Gupta, 2018). Genetic testing is sometimes needed to offer evidence for the diagnosis of hypertensive syndromes, for accurate classification, and targeted treatment interventions. Bao et al. (2020) assert that monogenic hypertension has been genetically dissected. A total of 37 pathogenic genes of 14 types of monogenic hypertension were identified. Most monogenic forms of hypertension are modifiable if accurate diagnosis is obtained and appropriate treatment interventions are implemented, unlike primary hypertension.

From the available genetic tests, I would use Non-Parametric Linkage Analysis to screen and diagnose hypertension. Linkage analysis seeks to trace the approximate location of a disease gene using the position of a known marker gene. The marker gene is a DNA sequence with a known physical location and an evident phenotype (Bao et al., 2020). Non-parametric linkage analysis is applied when information about the disease, like the genetic mode of inheritance, is unknown. The method is most useful in studying complex inheritance diseases, such as essential hypertension, where the mode of inheritance is not known. The DNP-prepared nurse can apply the information in practice by identifying patients with a positive family history of hypertension and referring them for a Non-Parametric Linkage Analysis. This will help identify if the patient has the genetic trait for hypertension. If the genetic trait is identified, the DNP nurse can develop a lifestyle modification plan comprising regular physical exercises and a low-sodium diet to minimize the risk of developing hypertension (Chen et al., 2019).

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References

Ahn, S. Y., & Gupta, C. (2018). Genetic programming of hypertension. Frontiers in pediatrics, 5, 285. https://doi.org/10.3389/fped.2017.00285

Bao, M., Li, P., Li, Q., Chen, H., Zhong, Y., Li, S., … & Cai, J. (2020). Genetic screening for monogenic hypertension in hypertensive individuals in a clinical setting. Journal of medical genetics, 57(8), 571-580. http://dx.doi.org/10.1136/jmedgenet-2019-106145

Chen, S., Sudharsanan, N., Huang, F., Liu, Y., Geldsetzer, P., & Bärnighausen, T. (2019). Impact of community based screening for hypertension on blood pressure after two years: regression discontinuity analysis in a national cohort of older adults in China. bmj, 366. https://doi.org/10.1136/bmj.l4064

Choobdar, S., Ahsen, M. E., Crawford, J., Tomasoni, M., Fang, T., Lamparter, D., Lin, J., Hescott, B., Hu, X., Mercer, J., Natoli, T., Narayan, R., DREAM Module Identification Challenge Consortium, Subramanian, A., Zhang, J. D., Stolovitzky, G., Kutalik, Z., Lage, K., Slonim, D. K., Saez-Rodriguez, J., … Marbach, D. (2019). Assessment of network module identification across complex diseases. Nature methods, 16(9), 843–852. https://doi.org/10.1038/s41592-019-0509-5

 

Identify a complex inheritance health issue you encountered in your clinical practice or personal life. How would you approach working with a patient of a complex inheritance health issue? Explain. Support your rationale with a minimum of two scholarly sources.

In a separate paragraph, refer to the complex inheritance health issue identified in DQ 1. Given available genetic tests, which would you use to screen and diagnose this issue? How can the doctoral-prepared nurse apply this information in practice? Explain. Support your rationale with a minimum of two scholarly sources.