Hypertension in African American
Introduction
African Americans are unduly affected by high blood pressure, and its complications have become more severe in these populations. It is the most common condition among African Americans compared to any other ethnic group in Unite States Hypertension is systolic blood pressure above 140mmHg and a diastolic reading of 90mmHg. Healthcare sectors have tried to study the trends, and the course of hypertension in African Americans and have come up with reasons for higher rates of hypertension and other related heart conditions among these populations. Low literacy levels, low education levels and low paying jobs
The burden of High Blood Pressure among African Americans men
The preference for hypertension in African Americans is high compared to whites, Hispanic, and Mexican American men. According to the Centers for Disease Control and Prevention (CDC), 27% of African American men have reported having hypertension compared to 17% and 15% among Mexican Americans men. Despite awareness programs, a variety of treatment programs (pharmacological approach) and control measures of the condition among African Americans increasing over time, the rates of hypertension among them remain the highest. This has been associated with non-compliance with antihypertensive medications and low economic factors. Among 56% of the African Americans who received antihypertensive from 2003 to 2008 period, only 30% of them had their blood pressure stabilized. This shows that the levels of non-adherence are still high (Centers for Disease Control and Prevention). This calls for interventions to increase awareness among African Americans to mitigate the risk factors associated with high blood pressure.
The morbidity rates surrounding high blood pressure among African Americans has been reducing over time following interventions from the health care sectors. However, the relative trend today shows that the percentages of African Americans who die of essential hypertension, hypertensive heart disease and hypertensive renal disease are still higher compared to other ethnic groups.
Factors Attributed to Hypertension among Africans Americans
Hypertension in African Americans can be associated with various general risk factors as well as factors that affect African Americans in specific. There are numerous cardiovascular and renal conditions whose prevalence is mostly registered in African Americans compared to other ethnic groups in the USA. Among them are hypertension related to cardiovascular disease and end-stage renal failure (Taylor et al.). Increased high blood pressure prevalence among African Americans can be associated with the factors discussed below.
- Lifestyle and Environmental Issues
The racial differences in environmental exposure and lifestyle associated practices among African Americans have been attributed to increased risks for hypertension and other related cardiovascular disorders. Despite the low levels of research regarding these risk factors, primordial preventions have been successfully lowered the risk of hypertension among those with adverse history of high blood pressure (Taylor et al.). A sedentary lifestyle is among the most mentioned factor whose effects directly complicate hypertension. Exposure to environmental toxins such as gasoline and lead increases the risk of high blood pressure. For instance, blood lead concentration in African Americans is higher than in other ethnic groups in the United States. The majority of people living under low socioeconomic status have a larger intake of contaminants in the lead based paints in their old housing. African Americans are the majority among people of small socioeconomic classes, and they have low literacy levels (Taylor et al.). Other chemicals that pose threats to African Americans’ health include cadmium and arsenic.
- Dietary intake
A single meal cannot be taken as a representative of dietary habits that may predispose one to hypertension. Various organizations, for example, Dietary Approaches to stop hypertension, have studied dietary patterns among African Americans. People with a body mass index of 25 and above 30 are termed as overweight and obese (American Heart Association). These groups of people have increased risk for cardiovascular diseases such as hypertension.
- Physical activity
The majority of African Americans have had reduced physical activities compared to other ethnic groups. American Heart Association notes that they are less involved in physical living and extended exercises as the majority of them assume a sedentary lifestyle. Physical activities reduce blood pressure, thus lowering the risk of hypertension. Geriatrics outdoor activities reduce stress and depression and stress, which are among the significant causes of outdoor activities such as physical leisure time expenditure, which improves vascular function (American Heart Association). Sitting time behaviour in people with low socioeconomic poses the highest risk to cardiovascular conditions as these groups lack work-related exercises.
- Sleep
Fragmented sleep and altered sleep patterns where most people spend a lot of time in light sleep have been associated with high blood pressure. The greater extent of sleep disturbances has been registered among African Americans, which predisposes them to hypertension and increases mental disorders. Taylor et al. note that higher rates of altered diurnal blood pressure dipping among African Americans can be associated with a low socioeconomic status where sleep hygiene is low, thus abnormal diurnal blood pressures. Analysis of the impact of sleep patterns on the control of diurnal blood pressure could be useful in providing relevant solutions for improving blood pressure in Africans Americans.
- Psychosocial factors
African Americans are mainly predisposed to various socioeconomic factors and chronic stressors such as discrimination, low economic levels, discrimination and relationship stresses compared to non-Hispanic whites. These contribute significantly to their mental ill-health and increases hypertension and other cardiovascular conditions. According to Taylor et al., interventions on stress-related as well as pathophysiologically related hypertension, may reduce the risk of hypertension. Participation in stress-relieving activities that are cost-effective can modify the threat posed by psychosocial factors (Taylor et al.). The addition of momentary ecological assessment would help in coming up with interventions to reduce modifiable factors that will minimize the risk for hypertension and related cardiovascular conditions.
Pathogenesis and Pharmacological Approaches
- Pathogenesis of hypertension in African Americans
Hypertension in African Americans is a compelling disease as a single and the most significant risk factor for cardiovascular and renal conditions. This has significantly increased the rates of related conditions such as strokes, thus the association of high mortality rates to hypertension. Persistent end-stage renal conditions increase the high risk for left ventricular hypertrophy and finally leads to renal failure. Hypertension causes more aggressive end-organ phenomena and is associated with genetic and multifactorial environmental influences. Obesity in African Americans, especially women, is one of the many factors related to hypertension.
- Treatment of hypertension among African Americans.
Pharmacological studies
There have been issues antihypertensive medication adherence, according to the CDC research works. Taylor et al. note that the poor antihypertensive drug adherence accounts for the large percentage of uncontrolled blood pressure among the African American population. Self-reports provided during various epidemiological studies suggest that the African Americans registered the lowest adherence to antihypertensive medications (Taylor et al.) There is a need for intervention and health education to minimize direct unintentional non-adherence and intentional non-adherences to drugs caused by negative beliefs concerning medications.
Clinical trials of medications to determine the effectiveness of various antihypertensive agents are underway to eliminate doubts that the cause of persistent high blood pressure is not ineffective medications. The majority of African Americans with chronic hypertension prefer hydrochlorothiazide rather than chlorthalidone. The pharmacology of both drugs shows that the former is more superior and has a longer half-life compared to chlorthalidone (Taylor et al.) This also explains the reason for not achieving the desired blood pressure control and related cardiovascular conditions.
Pharmacogenetic Approach
Various organizations have conducted research to identify the influence of genetic on hypertension and hypertension-related cardiovascular conditions. According to Sessoms et al., APOL1 risk variants are associated with increased risk for end-stage renal diseases and renal progression, which are directly related to hypertension. Randomized trials on the effectiveness of various pharmacological regimen on individuals of different genetic makeup, for example, between African Americans and Hispanic Americans. African Americans with West African ancestry have registered a marked reduction in blood pressure with ACE – inhibitors (Sessoms et al.). However, despite that African Americans are heterogeneous, most of the antihypertensive agents have no difference in mechanism of action between them and the Whites?
Hypertension Awareness, Treatment and Control
Hypertension management among African Americans has taken three different approaches to mitigate the course and effects of hypertension. There are questions regarding masses awareness, which enquires to determine whether their physicians have told individuals that they are hypertensive, their treatment modalities, and the control measures for high blood pressure.
Hypertension Awareness
Hypertension awareness takes place if the person with high blood pressure has been told at least once by the medical practitioner that they are suffering from hypertension, they have self- reported having hypertension. Awareness also includes the medication one has taken for blood pressure in the past two weeks. Centers for Disease Control and Prevention compares the degree of awareness Among African Americans, the Mexican Americans, and the whites. The results show a significant change in awareness from African Americans to whites. The multivariate analysis found that the predictors of awareness among the African Americans men of possible hypertension. Some of the predictors include obesity, diabetes, and increasing age.
Hypertensive Treatment
This takes place when a person with hypertension awareness or lather a hypertensive person is taking prescribed medications for hypertension. According to Muntner et al., the analysis of Jackson Heart Study participants among the African Americans and the White showed that the whites still registered high treatment levels compared to the African Americans (764). The treatment has had various predictors, which include diabetes, hypertension-related cardiovascular disease, increasing age, being a smoker, and if the individual is using preventive care. Therefore, the research confirms that hypertensive African Americans are less likely to seek antihypertensive therapy compared to whites and Mexican Americans.
Hypertension Control
The aspect of hypertension control is when a hypertensive person receiving treatment attains a systolic blood pressure of 140mmHg and a diastolic blood pressure of less than 90mmHg. Hypertension control rates among African Americans have significantly increased (Centers for Disease Control and Prevention). More recent data from CDC show a considerable rise in control rates as follows; 46. 7% among the African Americans, 46.1% among the white and 35% among Mexican Americans. Still, the percentages of unattended hypertension remain high among African Americans, which calls for the need to continue with the awareness creation campaigns and develop relevant control measures for hypertension among African Americans.
Remedies of High Blood Pressure
The following healthy practices can lessen African Americans’ chronic high blood pressure. American Heart Association acknowledges that making healthy lifestyle changes is a significant milestone in curbing hypertension among African Americans. These practices include avoiding both active and passive smoking, attaining and maintaining a healthy weight, aim to consume sodium of up to the recommended amounts of sodium and potassium. Finally, involve yourself in physical activities on top of occupational activities to reduce obesity-related hypertension caused by a sedentary lifestyle (American Heart Association). In the case where one is already a hypertensive, it is vital to adhere to the prescribed treatment regimen.
Conclusion
The low socioeconomic levels affect their adherence to the healthcare regimen for stabilizing blood pressure. Even though numerous efforts to manage hypertension among African Americans, effective treatment remains complex and challenging to achieve. Adherence to antihypertensive regimen among African Americans remains under-researched. Many factors are associated with hypertension among African Americans, such as their genetic, morphological factors and low levels of adherence to the treatment regimen. Most of these are modifiable factors that, when solved, can result in a better prognosis of the condition to reduce its complications.
Work Cited
American Heart Association. “What about African Americans and high blood pressure.” American Heart Association Publication 10/07LS1466 (2007).
Centers for Disease Control and Prevention. “A closer look at African American men and high blood pressure control: A review of psychosocial factors and systems-level interventions.” Atlanta: US Department of Health and Human Services (2010).
Muntner, Paul, et al. “Hypertension in Blacks: unanswered questions and future directions for the JHS (Jackson Heart Study).” Hypertension 69.5 (2017): 761-769.
Sessoms, Jeanette, et al. “Provider adherence to national guidelines for managing hypertension in African Americans.” International journal of hypertension 2015 (2015).
Taylor Jr, Herman A., et al. “Toward resolution of cardiovascular health disparities in African Americans: design and methods of the Jackson Heart Study.” Ethn Dis 15.4 Suppl 6 (2005): S6-4.