Hypertension is a disease of the cardiovascular system that is characterized by elevated blood pressure above the normal values for a particular race and population. When hypertension is not managed, it leads to organ damage such as the heart and kidney. One of the main health problems that the black Americans face is hypertension. Cases of complications arising from hypertension are fewer in other ethnic groups as compared to the Africans (African-Americans and Heart Disease, 2016). Scholars have carried out many clinical trials to support these findings.
PICOT Question
This research aims to show whether patient education has any impact on the prevention and management of hypertension. This research is guided by the PICOT question: For hypertensive black patients (P), does patient education and usual care (I) compared to usual care alone (C) help in the prevention and management of hypertension (O)? Determining whether patient education is necessary for hypertension prevention and management has a significant impact on nursing care. Therefore, through this research, the importance of patient education regarding hypertension will be determined.
Delegate your assignment to our experts and they will do the rest.
Peters, R. M., Aroian, K. J., & Flack, J. M. (2006). African American culture and hypertension prevention. Western Journal of Nursing Research , 28(7), 831-854.
This is a qualitative study that was carried out to determine the beliefs and attitudes of the African Americans regarding self-care behaviors that prevent hypertension. For identification of themes that comply with the Planned Behaviour Theory, group discussions were utilized by the researchers. A thesis that was illustrated in the study was referred to as the “circle of culture”. This circle acts as a symbol for the boundaries that are created by the various cultures. The main finding of the study was that culture had a strong connection to the prevention of hypertension in African Americans. Apart from the major theme, other sub-themes were identified. They included inheritance of behaviors from one generation to another, accountability to other people within the culture and the negative notion towards people who behave in a way that is outside the circle of culture.
The main reason why this study is reliable is that many focus groups, five focus groups with thirty-four participants, were used to fill questionnaires about questions based on the theory of planned behavior. This study is related to the clinical intervention in the PICOT question since it gives the holistic view of the theory of planned behavior through illustrating the significance of cultural influence on the beliefs and attitudes that are linked to the health of the African Americans.
Ogedegbe, G., Tobin, J. N., Fernandez, S., Cassells, A., Diaz-Gloster, M., Khalida, C., ... & Schwartz, J. (2014). Counseling African Americans to Control Hypertension (CAATCH): cluster randomized clinical trial main effects. Circulation , CIRCULATIONAHA-113.
The data that is used in this article is based on the implementation of the multilevel interventions that are aimed at regulating the blood pressure in African Americans who are hypertensive. These patients access care in low-resource basic care centers. In this study, clinical studies involved randomized-clusters whereby thirty Community Health Centers (CHCs) were randomly assigned to the Usual Care (UC) or the Intervention Control. Those patients who were located at the IC were counseled about their lifestyle, were given patient education and their blood pressure was monitored at home. The monthly hypertension case rounds were attended by doctors who also got the patients' feedback about their blood pressure readings. On the contrary, those patients who were located at the UC were treatment guidelines for hypertension and printed education only. The conclusion of the study was that there exists little difference or no difference between the usual care that the African Americans with hypertension as compared to those practices that are based on interventions that are multi-component.
The main strength of this article is that it gives detailed information on how interventions that are multi-component such as monitoring blood pressure at home, giving counseling about the lifestyle, and patient education help in hypertension prevention and management. A drawback of this article is that it is only limited to the CHCs and does not give any information regarding community education about taking precautions against hypertension. This article is linked to the research since it shows the significance of providing lifestyle counseling, patient education, and application of printed education and its effect on the African Americans who are hypertensive.
Ferdinand, K. C., & Armani, A. M. (2007). The management of hypertension in African Americans. Critical pathways in cardiology , 6(2), 67-71.
Based on this article, the occurrence of hypertension in African Americans is the highest in the world. The article also illustrates that, at a young age, many African Americans develop hypertension as compared to the whites and they also experience severe complication due to hypertension. The tendency of blacks developing stroke that is non-fatal is 1.3 times that of whites whereas that of developing fatal stroke is 1.8 times. The death rate due to hypertension in the African Americans is four to five times higher than that in the whites. This paper states that the occurrence of hypertension and organ damage experienced due to hypertension is influenced by genes and the environment of an individual. This article confirms the idea that the major method of preventing hypertension among the African Americans is using patient education to influence the changes in their lifestyle.
The key strength of this article is that it provides guidelines that will aid in the achievement of the appropriate goals in blood pressure management through the use of combination therapy. Even though the various combinations and class of the antihypertensive drugs have been shown to be effective in blood pressure lowering, the choice of drugs that are used in the combination therapy of the African Americans might be different. The article also points out that in monotherapy, the response to angiotensin receptor blockers, ACE inhibitors, and Beta-blockers may be reduced as compared to monotherapy using calcium channel blockers and diuretics. However, the disparities that occur when using monotherapies are nullified when diuretics are mixed with neurohormonal antagonists. This paper states that Africa Americans who have a diastolic blood pressure of more than 10 mmHg above the normal, and systolic blood pressure of more than 15 mmHg above the normal should be put on the first-line combination treatment for hypertension. This article is related to the research since it provides ways through which hypertension can be prevented or treated during the early stages of the disease.
Flack, J. M., Sica, D. A., Bakris, G., Brown, A. L., Ferdinand, K. C., Grimm, R. H., ... & Nasser, S. (2010). Management of high blood pressure in blacks an update of the International Society on Hypertension in Blacks consensus statement. Hypertension, 56(5), 780-800.
This article reviews prevention and treatment guidelines for cardiovascular and hypertension, trials of blood pressure lowering in African Americans and pharmacological clinical endpoint trials of hypertension in the blacks. These trials were conducted based on the International Society on Hypertension in Black's statement that was released in 2003. Blood pressure lowering in the whites was also considered. In this paper, African Americans with hypertension are divided into two groups. The two groups are primary prevention and secondary prevention. Based on this article, when either the systolic blood pressure or diastolic blood pressure increases by less than 10 mmHg above the normal blood pressure readings, then monotherapy using a calcium channel blocker or a diuretic is preferred. On the other hand, when the systolic blood pressure (SBP) increases above the normal value by more than 15 mmHg, and the diastolic blood pressure (DBP) by more than 10 mmHg above the normal value, then monotherapy is preferred. In addition to the combination therapies, the paper emphasizes on comprehensive modification of lifestyle in the African Americans when the SBP is more than 115 mmHg and DBP is more than 75 mmHg.
The significance of this paper is that it avails vital updates in the clinical trials of hypertension over the last ten years among African Americans. It is related to the research question since it states ways in which hypertension can be prevented and gives a recommendation about the drugs that can be used and also the lifestyle modifications.
Warren-Findlow, J., Seymour, R. B., & Huber, L. R. B. (2012). The association between self-efficacy and hypertension self-care activities among African American adults. Journal of community health , 37(1), 15-24.
The management of chronic diseases requires an individual to carry out various types of self-care behaviors. One psychological concept, self-efficacy is linked to the ability to manage the chronic diseases. This article looks at the relationship between the management of hypertension using self-efficacy and six self-care behaviors that are prescribed for hypertension. 190 Africans Americans with hypertension were interviewed about the hypertension self-care activities that they are involved in and their self-efficacy. The relationship between complying with the self-care behaviors of hypertension and self-efficacy was developed. The study showed that productive self-efficacy was related to increased compliance to medication, taking meals with low salt levels, taking part in physical activities, carrying out techniques to manage weight and abstaining from smoking. The findings also illustrated that self-efficacy in hypertension is greatly linked with compliance with either five or six of the self-care activities that are prescribed for the African Americans that have hypertension.
The paper shows two important factors that are essential in blood pressure regulation and improvement of self-care in hypertension. These include making the African Americans become positive and assured that hypertension can be managed and that they are aware of the necessary self-care practices that should be practiced. Medical practitioners should identify the various self-care activities and help the African Americans practice them in order to regulate their blood pressure. In relation to the PICOT question, this paper is crucial since it gives an insight into the self-care practices that can be used to intervene in African Americans that have hypertension.
African-Americans And Heart Disease, Stroke. (2016). African-Americans and Heart Disease, Strock. Heart.org. N.p., 2016. Web. Retrieved from http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/African-Americans-and-Heart-Disease_UCM_444863_Article.jsp#.V-jLq4h97cs
This article points out that occurrence of hypertension among the African Americans is high. Hypertension raises the chances of an individual developing stroke and heart disease. Moreover, diabetes and hypertension increase the chances of an individual developing stroke. This article suggests that the blacks possess a gene that increases their sensitivity to salt, elevating the possibility of acquiring high blood pressure. This paper also emphasizes the importance of keeping track of the changes in blood pressure which is achieved through educating the African Americans on the ways of measuring their blood pressure. The article urges African Americans to notify their doctors of the changes in their blood pressure values so that the physicians can advise them on the changes in case the treatments have to adjust and also where lifestyle changes are necessary.
The study shows that a number of factors contribute to developing hypertension. Obesity affects most blacks and increases the chances of developing hypertension. Even though patients are given medication, educating them on the ways to lose weight aids in the prevention and management of hypertension. Advising patients to reduce the consumption of red meat and carbohydrates contributes significantly to a reduction in cases of hypertension. Based on the PICOT question, this article is relevant since it shows that patient education on the co-morbid conditions such as diabetes and obesity help blacks to prevent and manage hypertension.
References
African-Americans And Heart Disease, Stroke. (2016). African-Americans and Heart Disease, Strock. Heart.org. N.p., 2016. Web. Retrieved from http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/African-Americans-and-Heart-Disease_UCM_444863_Article.jsp#.V-jLq4h97cs
Ferdinand, K. C., & Armani, A. M. (2007). The management of hypertension in African Americans. Critical pathways in cardiology , 6(2), 67-71.
Flack, J. M., Sica, D. A., Bakris, G., Brown, A. L., Ferdinand, K. C., Grimm, R. H., ... & Nasser, S. (2010). Management of high blood pressure in blacks an update of the international Society on Hypertension in Blacks consensus statement. Hypertension, 56(5), 780-800.
Ogedegbe, G., Tobin, J. N., Fernandez, S., Cassells, A., Diaz-Gloster, M., Khalida, C., ... & Schwartz, J. (2014). Counseling African Americans to Control Hypertension (CAATCH): cluster randomized clinical trial main effects. Circulation , CIRCULATIONAHA-113
Peters, R. M., Aroian, K. J., & Flack, J. M. (2006). African American culture and hypertension prevention. Western Journal of Nursing Research , 28(7), 831-854.
Warren-Findlow, J., Seymour, R. B., & Huber, L. R. B. (2012). The association between self-efficacy and hypertension self-care activities among African American adults. Journal of community health , 37(1), 15-24.
