Hypertension in African-Americans

Hypertension in African-Americans Introduction Hypertension is a condition that occurs due to chronically high blood pressure in the arteries, making the heart do extra work in maintaining blood circulation. Hypertension is more prevalent in African-Americans more than any other group in the United States. AfricanAmericans are also at an increased risk of developing complications arising from hypertension such as cardiovascular damage, heart attack, stroke, and dementia. Possible explanations for the increased rates include genetic factors, environmental, and a combination of both. Other factors which place one at increased risk of developing hypertension include age, obesity, smoking, family history of hypertension, diabetic condition and, high dietary salt and fat. Lifestyle change is the best method of managing high blood pressure. Healthy lifestyles include intake of foods containing less salts, increased physical activities, reduced alcohol consumption, weight loss, and adhering to a healthy diet. High blood pressure prevalence in African-Americans is highly correlated to lack of proper disease management.

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“Commonsense Illness Believes, Adherence Behaviors, and Hypertension Control among African-Americans” Definition of the Problem The prevalence rate of high blood pressure has been on the rise in the United States for the last one decade. The prevalence rate is particularly more pronounced in African-Americans in spite of modern therapeutic measures and management options. Thus, the number of hypertensive African-Americans with controlled high blood pressure continues to be very low.

Hypertension can be managed by different methods such as drug therapy, regulated diet, physical activities, and weight loss. Other methods such as stress management have shown some effectiveness in managing hypertension (Hekler et al, 2008). Strategies targeting the attitudes and habits in promoting compliance to appropriate high blood pressure management options have not been well utilized, especially lifestyle changes. These observations necessitated this research to enhance comprehension of factors that determine compliance to behaviors that impact on hypertension. In this study, Hekler and other researchers assessed the adherence of African-Americans to self-regulation and other hypertension management procedures such as compliance to medication, minimization of stress and observation of healthy lifestyle. The basis for this study was founded on Leventhal’s commonsense model of self-regulation which addresses a common person’s perception of disease such as “identity, causes, consequences, time-line, and controllability/cure” (Hekler et al, 2008, p. 392). The aim of this was to identify and evaluate lay perceptions of high blood pressure among a sample of African American to connect those perceptions to compliance and hypertension management.

Hypotheses of the Study

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The study assessed the various believes to test various assumptions about high blood pressure. The assumptions tested included; factors that underlie development and control of hypertension can be classified into stress related and medical related, with stress being the major factor. Patients who uphold the medical belief would comply with medical interventions and healthy lifestyle habits while those upholding the stress related perceptions would be active in stress reduction habits (Hekler et al, 2008). Other disease believes such as identity, consequence and chronic timeline influence compliance to medication, healthy lifestyles and stress relieve habits, which in turn influence blood pressure.

Method A study sample of 102 African-Americans who were hypertensive, with blood pressure above 140/90 mmHg, were recruited from a population of 232 patients attending Chandler Health Center. The participants were more than 45 year old and had mental and communication competence to be interviewed. Assessment was by one-hour interview to individual participants and relevant demographic data, year of diagnosis, and medications used were obtained from the patient. Other patient data such as systolic and diastolic pressure were extracted from medical records. The researchers designed interviews to obtain individual patient’s commonsense beliefs about their blood pressure to reflect the basic elements of diseases like identity, time-line, causes, consequences, and control. The researchers classified disease treatment into three groups, which included compliance to medication, lifestyle modification, and stress relieves habits. Medical compliance was assessed by quantifying the frequency of missing medication while compliance to healthy behaviors was examined through patient self-report responses. The behavior responses were then categorized into those aimed at relieving stress and lifestyle behaviors (Hekler et al, 2008).

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Results of the study The researchers found the mean duration since participants were diagnosed with hypertension to be 19.2 years. Most of the participants (88%) were under hypertension medication at the time of being interviewed, whereas 69% of the patients had uncontrolled hypertension (Hekler et al, 2008). The study also found most of the participants either overweight or obese. Compliance to medication increased with age and older patients had low stress believe perceptions and consequences. Patients with higher education levels showed higher abilities in labeling high blood pressure and connecting the symptoms with the disease. The researchers also established body mass index to be having a positive effect on medical believe model and consequences. The number of years an individual has been hypertensive had no correlation to the beliefs or the blood pressure, while gender influenced the medical perceptions, stress believe model, and consequences. Marital status had an impact on lifestyle behaviors.

From the study, the researchers established that medical beliefs perceptions correlated to lifestyle behaviors and systolic blood pressure while the stress believe perceptions were associated with stress relieve habits (Hekler et al, 2008). Lifestyle behaviors showed an inverse correlation with systolic blood pressure and a negligible relationship to diastolic blood pressure.

The researcher were further able to ascertain that stress belief perceptions and consequences led to development of stress relieve behaviors, while medical beliefs yielded lifestyle changes. Age was determined as the only factor that influenced compliance to medications.

Conclusion From the study, the researchers were able to ascertain that stress is the major factor associated with high blood pressure development and control, and that the factors that lead to development of hypertension and that help in its control are medical related. When patients relate

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hypertension to medical believes, they are more likely to comply with medications and healthy lifestyle habits. Patients who relate hypertension to stress conditions engage in habits that minimize stress. The study also showed that patients developed stress relief habits when the severity of the consequences was understood. In addition, desirable lifestyle behaviors and medical attitudes led to decreased systolic pressure. The researchers thus demonstrated the necessity of addressing the cause and management aspects of hypertension among the AfricanAmericans (Hekler et al, 2008).

Strengths and weaknesses of the study The study’s strength was based on examination of cause/ control models, therefore helping in determining other behaviors. The self-report of patient compliance provided a simple and cheap method of assessing behaviors. However, as it was a cross-sectional study design the researchers could not adequately address causal beliefs (Hekler et al, 2008). This was a potential weakness for the design because assessing causes using cross-sectional design can only depict causal behaviors. The data generated could not be generalized across the population. The data would have effectively suited the entire population if the researchers had demographic information for patients who were not included in the study sample to determine the generalizability of the data. The method of measuring behaviors was based on self report by the patients, thus there was a likelihood of overestimating the responses.

Implications of the Study to Nursing Practice The study findings could be utilized by the nurses in addressing the beliefs AfricanAmericans have about hypertension to aid in decreasing its prevalence (Alexander, Fawcett & Runciman, 2000). The efforts should be targeted both at medical and lifestyle factors, and at stress related attitudes. The nurses have a great role in providing primary healthcare services to

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help in managing high blood pressure through patient counseling and education. This study could help in developing primary and secondary prevention strategies to aid in hypertension management. Nurses could thus help in managing hypertension by promoting behavior change, adherence protocols, better compliance and prescriptions, and regular follow-ups. It is therefore imperative for nurses to develop culturally sensitive clinical approaches to address the problem of hypertension.

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References Alexander, F. M., Fawcett, N. J. & Runciman, J. P., (2000). Nursing practice: Hospital and home: The adult, 2nd edition. Philadelphia, PA: Elsevier Health sciences.

Hekler, B. E., Lambert, J., Leventhal, E.M., Leventhal, H., Jahn, E. & Contrada, J. R.,(2008).

Commonsense illness beliefs, adherence behaviors and hypertension control among African Americans. Journal of Behavioral Medicine, 31: 391-400.

Izzo, L. J., Black, R. H, & Goodfriend, L. T., (2003). Hypertension primer: Essentials of high blood pressure. “From the council on High Blood Pressure Research, American Heart Association”-Port, 3rd edition. Dallas: Lippincott Williams & Wilkins.