Hypertension African American Adults - Research Paper Example

Hypertension African American Adults Number June 15, Faculty Hypertension has become a serious public health and clinical problem based on the high prevalence coupled with a premature onset of elevated Blood Pressure (Solomon et al., 2015). Hypertension poses a severe burden of co-morbid factors that end up resulting in resistance to pharmacological treatment. Such factors include diabetes mellitus, obesity, albuminuria and glomerular filtration rate that often occur in adults. The control rates of Blood Pressure are relatively small in African Americans compared to other major ethnicity/ race-sex groups. Proper antihypertensive treatment would require a comprehensive approach that constitutes multifactorial lifestyle modifications. Such changes may include alcohol and salt restrictions, increased physical activity and the loss of weight along drug therapy measures. Evaluating the existence of hypertension among patients requires a stratification of the patients with elevated Blood Pressure levels in terms of risk with the aim of establishing the hypertensive condition. The African American adults form an overwhelming majority of the patients with the hypertensive condition. Such a condition requires a combination of antihypertensive drug therapy to maintain the Blood Pressure below the target levels. The high-risk population in the United States has attracted several research studies that aim at reducing the hypertensive rates to manageable levels. The paper presents a comprehensive analysis of several qualitative, quantitative and evidence-based research articles that sought to address the problem and the informed view of the authors. The following PICO question was adequately addressed in the research paper: P-African American Adults; I- Lifestyle Modification (Diet and Exercise); C- Pharmacological Intervention; and O- Reduction in Rate of Hypertension African American Adults. Keywords: African American, Hypertension, Pharmacological, Lifestyle Modification, Chronic. Background Information Many genetic studies conducted in the recent past have indicated that the African American adults have a relatively high prevalence of hypertension. Several other studies conducted to establish the attitudes of the African American adults concerning the Genetic testing and treatment of Hypertension have indicated varied findings and conclusions. According to the Centre for Disease Control and Prevention in the United States, close to 70 million American adults have hypertension and the majority of these are Black American adults (Bruce et al., 2010). The number forms about 29% of the total American adult population and reports indicate that 52% of the total people with hypertension have had their conditions kept under medical control. About one of every three adults in America has prehypertension with abnormal blood pressure numbers. The statistics indicate that the disease costs the US government about $46 billion annually in terms of health care services, missed days of work and treatment. The findings of studies on Hypertension among the African Americans Indicate that women are as likely as men to contract the condition. Even then, hypertension has a higher prevalence for men than women for people of below 45 years of age. For people with above 65 years of age, the studies have established that women have higher chances of contracting than men (Fox et al., 2010). It is important to realize that high blood pressure levels vary by Ethnicity and Race. The Blacks are reported to have a much higher probability of developing the condition compared to the Hispanics and the Whites. Statistically, Black women have high blood pressure than men. High blood pressure has become a serious contributor of the deaths that are experienced annually in the United States. Different countries and non-governmental institutions including the World Health Organization Agency of the United Nations have redirected their focus in addressing the problem. The recent increase in hypertension cases among the African American have grown to a proportion that requires a modification of the lifestyle in terms of exercise and dieting. Pharmacological interventions and other medical efforts can be used to bring down the level of contraction and the consequential deaths (Chan, Stamler & Elliott, 2015). A fundamental question that the paper sought to address was the reasons why the hypertensive condition should be high in African American adults than in people of other races. Further, the possible pharmacological intervention and lifestyle modifications and their impact on the control of hypertension among the African American adults are also included. Review of Literature Why Hypertension? Hypertension has become a critical global health concern. The Centre for Disease Control reports indicate that one of every three American adults has high blood pressure. With no early signs, hypertension has become a chronic illness and a silent killer (Clark, Smith, Taylor & Campbell, 2010). People with hypertension have an increased risk of experiencing a stroke and the cardiovascular disease that have claimed many lives. People with hypertension have increased chances of contracting heart failure, renal failure, renal diseases, and myocardial infarction. Further, high blood pressure is one of the leading known causes of mortality and morbidity in America. There are several potential adverse outcomes that associate with a lack of control of blood pressure. Treating hypertension is not easy, and hence prevention measures are highly preferred. Despite the availability of treatment measures, only less than 50% of the people diagnosed with hypertension succeed in controlling their blood pressures within manageable levels. Most importantly, hypertension is highly preventable and can be managed with great success. African American Adults and Hypertension The Census Bureau in the United States reported in 2013 that there were about 45 million Black Americans in the US translating to 15.2 % of the total population. Hypertension is a global health problem, and its rates are steadily increasing among populations. Specific ethnic and racial groups are reported to have poorer outcomes and higher rates of hypertension than others. As of such, the African American adults living in the United States are known to have a greater rate of hypertension than other racial groups in the world (Fuchs, 2011). These adults are reported to have the highest cases of renal and cardiac diseases that closely relate to hypertension. Due to the alarming rate of hypertensive condition among the Black American adults, several institutions in the United States have termed the situation as being unfair and highly unacceptable. They have challenged the medical professionals and the government to offer quality health care to all patients and direct a strategic focus on the reduction of hypertensive conditions among the Black American high-risk population. The Black Americans are diagnosed with hypertension at younger ages compared to the Whites. Such people also end up having poorly controlled blood pressure. As a result, people from this race are reported to die of diseases like heart failure stroke and renal diseases than those of any other race living in the United States. Many researchers have devoted efforts to understanding the factors responsible for the high prevalence of hypertension among the African Americans. Of the many studies conducted in this area of great concern, the majority have indicated that Black Americans have higher degrees of diabetes and obesity, conditions that make them vulnerable to hypertension. Other researchers have suggested some genetic disparity among the races that are believed of make the African Americans highly sensitive to salt (Fuchs, 2011). While these factors may explain why African Americans are more prevalent to hypertension than other races, they may not tell with certainty the reasons why such conditions develop at a younger age. The cases of high blood pressure among the African American adults varies both by age and gender as follows (Harman et al., 2013): Age Men (%) Women (%) 20-34 11.1 6.8 35-44 25.1 19.0 45-54 37.1 35.2 55-64 54.0 53.3 65-74 64.0 69.3 75 and older 66.7 78.5 All 34.1 32.7 The normal blood pressure of a healthy person should be below 120/80mm Hg. The numerator represents the pressure when the heart beats. It is the systolic pressure (Harman et al., 2013). The denominator represents the pressure when the heart takes a rest between the beats. It is the diastolic pressure. On the contrary, the majority of Black American adults have their blood pressure of about 140/90 mm Hg. These are said to have high blood pressure that is greater than normal. Several other adults have blood pressure between 120 and 139/80-89 mm Hg and have a pre-hypertensive condition. Many African American adults that have hypertension are diagnosed with related diseases like kidney disease and diabetes. Keeping a lower than 130/80 mm Hg blood pressure is advisable for the people with these conditions. The hypertensive condition is reportedly higher among the elderly African Americans compared to those of middle age. Advanced age increases the vulnerability to conditions that trigger the development of high blood pressure among Black Americans (Hogan, 2011). The African American population forms the largest group of the elderly comprising men and women in the age bracket of above 75 years. The majority of these old people have chronic medical complications such as hypertension, diabetes, renal diseases and cardiovascular disease. The mortality rates among the elderly people with hypertension are much higher compared to the hypertensive middle-aged African Americans. The majority of the Black Americans associate the ability to complete daily tasks to being healthy and miss the opportunity to discover the ‘silent killer. There are delays in seeking medical care which when coupled with the stressful environments in which the African Americans live result in increased morbidity for chronic diseases and psychological stress. The African Americans are known to have a low health-seeking behaviour. Such a condition prevents the identification of hypertensive conditions among this population and, as a result, many people end up having unmanageable blood pressure. The reactions to hypertensive medication that in most cases is adverse for the elderly patients calls for a close attention when prescribing multiple medications (Hong, 2010). The poor health beliefs and practices among the Black Americans that can be associated with the socioeconomic factors that commonly cut across the race. These beliefs and practices are a contributing factor to the high prevalence of chronic ailments. The level of hypertension awareness, control and treatment among the African Americans is relatively small compared to that of the Whites in the United States. Reasons Why Hypertension is high in African American Adults No research so far has provided a definitive answer to the question why high blood pressure has become so common among the Black Americans when compared to other races. However, several factors believed to trigger the high rate of hypertension among members of this race has been identified. Such factors range from genetic-based explanations to environmental factors that researchers have attributed to the vulnerability of African American adults (James et al., 2014). The findings of several studies have shown that some genetic make-up of the Black Americans is a contributing factor to their high rates of hypertension. In connection with this proposition, some factual grounds have been established to back up the claim. For instance, in the United States, the medical professionals have discovered that the African Americans respond to hypertension drugs distinctly compared to other groups. Similarly, the Blacks living in the United States have been said to be genetically more sensitive to salt than other racial groups, a factor that increases their risk of developing hypertension. A list of genotypes and some intermediate phenotypes observed among the blacks are reported to be a cause of the disparity in high blood pressure. The Black Americans have been reported to have a relatively high renal retention of sodium and sensitivity to alcohol (Karim, 2015). The vulnerability of the African Americans to salt-depletive diseases, as propounded by the slavery hypertension hypothesis, can neither be refuted nor validated. The relationship between the genetic traits and renal outcomes have been studied with varied results for the Blacks and Whites living in the United States. A close link between the MYH9 region genetic variations on chromosome 22 and the focal segmental glomerulosclerosis has been reported among the blacks. The condition was initially attributed to ‘hypertensive nephrosclerosis and mostly found in Black patients with the end-stage renal disease. 74% of the Black Americans are said to have an attributable risk for the carriage of an MYH9 haplotype that increases the chances of developing hypertension relative to the 4% of the Whites. Scientifically, it is believed that some environmental factors unique to the experience of the African Americans in the United States are the cause of the high blood pressure. The Blacks around the world have high rates of hypertension that are relatively similar to those of the Whites. However, the difference is dramatic for the Blacks living in America where 41% of the black Americans have hypertension compared to the 27% of the Whites (Kountz & Kofman, 2015). It has been established with reasonable evidence that the Blacks living in the United States have more chances of being overweight relative to other black people living in Africa and elsewhere. The Blacks in the United States are known to have dwelt in an environment characterised by inequality and discrimination. Some experts attribute these economic and social factors to the disparity in the incidences of blood pressure among the Blacks. Since hypertension is a condition that can be inherited, the majority of the experts hold onto the belief that hypertension has been inherited by the African Americans from their parents who served during slavery. The Whites and Blacks that live in the United States have a reasonable difference in both habits and exposure to the environment that may account for their disparity in hypertension levels. Potential reasons for the high blood pressure condition rate among the African-American adults stems from their dietary habits, socioeconomic status, stress, social networks and health behaviors. The Black Americans are reported to have a 51% higher prevalence of obesity than the Whites, a condition that contributes to hypertension (Knafl, Schoenthaler & Ogedegbe, 2012). Reports from the National Health and Nutrition Examination Survey indicate a 24.9% of Black men and 15.9% of the Black women with hypertension linked to abdominal obesity. Being African American is said to be a risk factor for developing hypertension. Several other risk factors for the Black Americans include excessive weights, advanced age, having diabetes and history of high blood pressure in one’s family. Inactivity, low intake of potassium, high dietary fat and salt coupled with smoking add into the category of risk factors for the African American adults (Lewis, Askie, Randleman & Shelton-Dunston, 2010). The higher the number of risk factors to which one is exposed, the greater the chances developing the condition in future. Some behavioral aspects account for the disparity in the rate of contraction between the African American men and women. The psychological effects of obesity are known to result in intermediate Blood Pressure Phenotype that includes altered salt sensitivity, enhanced sympathetic activity and resistance to antihypertensive drug therapy. Lifestyle Modifications (Diet and Exercise) The primary means of treatment and prevention of hypertension among the Black Americans is the appropriate modification of lifestyle. Lifestyle changes range from increased exercise, reduced intake of alcohol, fat and sodium to the cessation of smoking. Lack of exercise and poor diet are risk factors that can be modified and present an excellent opportunity concerning provider interventions that can significantly reduce cardiovascular morbidity and obesity. The African American lifestyle patterns and dietary traditions have been a significant challenge to their ability to manage chronical diseases such as hypertension and cardiovascular disease (Lewis, Ogedegbe & Ogedegbe, 2012). The overall weight control and diabetes prevention measures have been abortive owing to the poor dietary traditions among the African Americans. The high rate of hypertension among the Black Americans can be controlled through modifications of the lifestyles that do not support healthy behaviors. The majority of the Black Americans are known to have a great affinity for pork products that have a high salt content, thick gravies and fried chicken that are traditional festive foods. On average, the African Americans have lower fibre and higher-fat diets compared to the Whites (McFayden, 2014). To effectively manage the aspects of hypertension that relate to lifestyle and diets, Black Americans should be encouraged to put in place alternative dietary measures that reflect cultural traditions. Instead of using Macaroni and Cheese that pose threats, the African Americans should alternatively use reduced-salt and low-fat cheese together with skim milk. Baked chicken or Oven fried chicken is preferable to fried chicken that has high-fat contents. Instead of using the commonly preferred potato salad, low-fat mayonnaise, herbs, olive oil, and mustard dressing should be used alternatively. The Pound cake that is often found in the African American diet should be replaced with the Angel food cake while smoked turkey neck can be used preferably in the place of pork. It is common that many African American adults with the hypertension condition have diabetes and calls for specific changes in lifestyle. In terms of alcohol restriction, the patients should be restricted to one drink in a day for the women and two drinks per day for the men. Diet wise, the DASH diet should be implemented (Peters, Aroian & Flack, 2010). The patients should 4-5 servings of fruits and vegetables, and between 6 to 8 servings of whole grains every day. The intake of calcium should be increased to 1250 mg, Potassium 4700 mg, and Magnesium 500 mg daily. Reduction in the intake of cholesterol to 150 mg a day and limit the intake of saturated fat to 6% of daily calories is highly recommended. The intake of sodium should be restricted to 2.4 grams a day. Physical exercise is highly recommended for the Black Americans with hypertension since exercise is not a common practice among this group. The patients should engage in between 30 and 45 minutes of moderated physical activity at least four days a week. To improve the overall cardiovascular health, the patients are highly advised to cease smoking. The loss of weight and maintenance of a healthy weight are recommended under lifestyle modifications. Patients should maintain a mass body index of between 25 and 19 kg for every square metre. Pharmacological Interventions Combination therapy is required by many hypertension patients with the majority requiring first-line therapy to attain the necessary Blood Pressure goals. However, the choice of combination therapy among the African American hypertension patients is different. Within this group, the responsiveness of patients to monotherapy with angiotensin receptor blockers, ACE inhibitors and beta blockers are less than the patient responsiveness calcium and diuretics blockers. To correct these differences, diuretics should be added to the neurohormonal antagonists (Thomopoulos, Tsioufis, Makris & Stefanadis, 2010). The first-line combination therapy is necessary for the African American patients whose systolic and diastolic blood pressure goals exceed 15mm Hg and 10 mm Hg respectively. For the patients with uncomplicated hypertension, Thiazide-type diuretics can be used in drug treatment either alone or with a combination of drugs from other classes. There are, however, particular high-risk conditions that become compelling indication on the first use of anti-hypertensive drugs from various classes. The majority of African America hypertensive patients require two or even more anti-hypertensive treatments to achieve their blood pressure goals. There has existed a perception that it is medically difficult to reduce the Blood Pressure levels in Black American. However, this claim remains unjustified. It is clear from several studies that all anti-hypertensive drugs can effectively be administered in African American hypertension patients although a combination of several drugs may at times be necessary. The Angiotensin-Converting Enzyme (ACE) inhibitors and monotherapy B-blockers are known to have less Blood Pressure reduction effects among the Black Americans than in Caucasians (Ogedegbe, 2012). The Calcium Channel Blockers and diuretics have reportedly higher effectiveness in lowering Blood Pressure among the African American patients than other classes of drugs. Research has shown that when compared to the Caucasians, the African American adult patients have a higher chance of developing cough and angioedema when administering ACE inhibitors. There are required counselling and treatment approaches that are sensitive to the various factors that contribute to high blood pressure among the African American Adults. Many studies have indicated little intervention time during routine clinical visits among the Black hypertension patients (Chan, Stamler & Elliott, 2015). That necessitates the need for follow-up visits in the pharmacological interventions for reducing the frequency and severity of high blood pressure among the African American population. The importance of providing a culturally competent outpatient care as a particular intervention in treating hypertension African American patients has been repeatedly observed in many recent studies. Reduction in rate of Hypertension in African Americans The severity and magnitude of uncontrolled hypertension coupled with the economic and personal costs it imposes on the nation and individuals call for a special attention to reducing it. Reducing the rate of hypertension in the African Americans requires a combination of both pharmacological and non-pharmacological measures (Karim, 2015). The high rate of hypertension among the Blacks in America has become a question of their access to proper medical care, hypertension awareness, treatment and control and the proper counselling. The non-pharmacological measures will include guidance and counselling to the Black American population and the entire American population on the possible risk factors and how they can avoid them. Campaigning against hypertension by advocating for a change in lifestyle and behavior among the populations can help reduce the highly dangerous condition. Guidance programs should not just target the patients but also the youths and others who have the potential for developing the condition. Lifestyle modification is one of the most productive reported non-pharmacological ways of reducing hypertension rates. The National Nutrition Policy concerning the management of hypertension should promote strategies that are safe, efficient and feasible in reducing the rate of high blood pressure among the high-risk population. An effort to have the rate of high blood pressure among the African Americans must be taken a hand in hand with measures that are aimed at reducing other conditions that are causative agents. The reduction in obesity, the avoidance of psychological stress and diabetes should be prioritized to ensure that the rate of hypertension declines in the future. Studies have indicated low awareness of hypertension among the African American population (Franklin, Allen, Pickett & Peters, 2014). With the levels of consciousness remaining as low as they have been purported to be, the rate of high blood pressure would certainly remain high. Creating awareness of hypertension on both prevention, control, and treatment cannot be undermined in ensuring that the rate declines into the future. A more focused and equitable access to medical care among the African Americans should be prioritized, and an improvement of their socioeconomic status may help lower the level of stress among the people. An increase in the number of medical professionals in the area to match the relatively high cases of chronic illnesses can help improve the state of access to proper health care. Conclusion The rate of hypertension among the African Americans living in the United States is highest ever known in the world. High Blood Pressure in the US varies with ethnic and racial groupings. Although many pieces of research have been conducted to establish the actual cause of Hypertension, not a single cause can be attributed to the condition with certainty. The findings of many medical researchers indicate that the disparity in the rates of hypertension in the Black Americans and other races is attributable to some genetic composition and environment. The socioeconomic factors such as discrimination and economic inequality based on the race have severally been identified as causative agents among the African Americans. Poor dietary behaviors among the Blacks are also a possible cause of their high blood pressure rate. Both pharmacological and lifestyle modification measures can be adopted to reduce the level of hypertension development among the populations. Change of diet and body exercise are the key best known non-pharmacological techniques for reducing the severity of hypertension. The rate of high blood pressure among the African Americans varies between men and women of distinct ages with thorough severity and frequency being experienced in people with advanced age. Hypertension is not curable. Rather, it can be managed. References Bruce, M., Beech, B., Edwards, C., Sims, M., Scarinci, I., & Whitfield, K. et al. (2010). Weight Status and High Blood Pressure Among Low-Income African American Men. 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