Hypertension refers to the medical term used in describing high blood pressure. Hypertension occurs when blood uses excessive force against the blood vessels, mainly due to narrower arteries. Hypertension is ranked among the leading health issues affecting the American population; presently, approximately 85 people in the U.S are estimated to have high blood pressure ( Weber et al., 2014) . There are several factors associated with causing hypertension, including stress and the kidney disease among others. Hypertension further increases the risk of such illnesses as stroke and the heart diseases, and often death. Based on previous studies on the disease in the American context, black adults have been found to be at a higher risk of developing high blood pressure by the age of 55 years compared to their White counterparts. The significant disparity in hypertension related and hypertension outcomes between Caucasians and African Americans has been observed for several decades. African Americans demonstrate an earlier onset of hypertension and higher levels of blood pressure compared to the Whites despite similar treatment and awareness levels across the two groups. Majorly, the higher cases of hypertension among African Americans are associated with such factors as congestive heart failure, end-stage renal disease, and higher cases of stroke. Further, most of these disparities develop by the age of 30, indicating the need for early interventions to combat the disease among the highly at risk group. This paper examines the problem of hypertension among African Americans. I selected the issue because despite the extensive efforts to address the problem in America, African Americans continue demonstrating higher rates of developing hypertension and other related complications. Hence, this handout seeks to educate African Americans about hypertension as well as the lifestyle changes that they should embrace to minimize risks of contracting the disease and enhance their quality of life.
Section 2: Description of the Audience
The handout targets all African Americans, but mainly focuses on children, adolescents, and young adults below 30 years since studies have demonstrated that members of the group are at risk of developing hypertension when they are as young as 30 years ( Weber et al., 2014) . The group is considered at high risk due to such factors as race, whereby African Americans show higher likelihood of developing hypertension, genetic factors, whereby individuals from families that have a history of hypertension are at an increased risk of developing the disease, and obesity, whereby more African Americans record higher cases of obesity compared to other racial groups in the U.S. Targeting the group is also important in addressing the health problem, since the interventions presented focus on prevention rather than treatment of those already affected, whereby prevention is considered more important and effective in combating the problem than treatment options. This is largely due to the fact that despite the extensive awareness and treatment procedures provided, African Americans still record disproportionately higher cases of hypertension and related complications.
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Section 3: The Problem of Hypertension among African-Americans
Description of the Health Issue
Hypertension occurs whenever the blood pressure goes beyond 130/80mmHg, whereby the normal blood pressure is 120/80mmHg according to the American Heart Association ( Zoellner et al., 2014) . Although race is one of the major factors that increase the risk of high blood pressure, several factors that are not racially based are linked to the condition, including family history of the disease, obesity, or being overweight. These risk factors are also known to increase the risk of the heart disease.
Although hypertension is considered a common problem in America, African Americans face a higher risk of developing the disease, a factor that is linked to the higher cases of diabetes and obesity among the members of the group. According to Luque, Ross, and Gwede (2014), African Americans have been found to possess a gene that makes them more sensitive to salt. In individuals who have been found to possess the gene, as little as an extra gram of salt is capable of raising blood pressure by as much as 5mmHg ( Barnidge, et al., 2015) . Other physiological changes associated with increasing the risk of hypertension include lower beta receptor sensitivity, higher alpha receptor sensitivity, increased endothelin, higher sympathetic nervous system activity due to stress, and lower urinary dopamine after salt loading. In addition to hypertension, African Americans demonstrate higher cases of the cardiovascular heart disease and other hypertension-related diseases, including the kidney disease, stroke, blindness, and dementia. Moreover, African Americans have been found to develop hypertension at relatively younger ages compared to any other group in the U.S.
Risk Factors
The high severity, prevalence, and incidence of hypertension among African Americans is attributed to a range of environmental and genetic factors that affect the group unlike the whites. Racial inequality is one of the factors that are considered to contribute to the high risk of acquiring hypertension among the African Americans ( Muntner et al., 2017) . Racial inequality is associated with several factors that are harmful to human health including social trauma, social and economic deprivation, occupational and residential segregation, racially targeted sale and marketing of such harmful commodities as alcohol and cigarettes, and poor and inadequate access to medical care.
Genetic and environmental factors are also associated with increasing the risk for hypertension among the African Americans. From the genetic perspective, African Americans have been found to have higher sensitivity to salt, which increases the risk for high blood pressure. Moreover, the reaction to high blood pressure drugs is different from that of other groups, thus making prevention of hypertension difficult ( Muntner et al., 2017) . From the environmental perspective, the experiences of the African Americans, including economic inequality, poverty, and discrimination contribute to high blood pressure. Other factors that increase the risk of developing hypertension include smoking, low intake of potassium, high dietary fat and salt, lack of physical activity, diabetes, family history of high blood pressure, excessive weight, and increased age. Individuals exposed to more risk factors are likely to have high blood pressure or acquire the disease in future.
Signs and Symptoms
One of the riskiest aspects of hypertension is that in most cases, it does not cause symptoms that can be easily noticed.
According to Lynch et al. (2014) , approximately one other of people with the diseases are unaware that they have it. Thus, the only way that one can tell that they have high blood pressure is through ensuring regular checkups. This is particularly essential if one’s family has a history of the disease. However, high blood pressure could present such symptoms as confusion or fatigue, severe headaches, chest pain, vision problems, breathing difficulties, presence of blood in the urine, irregular heartbeat, dizziness, and nose bleeding. These symptoms may indicate that blood pressure is rising, therefore increasing the risk of such complications as kidney failure, stroke, and the heart disease if hypertension in inadequately managed. A rare event, hypertensive emergency, may be detected through the presence of such signs as anxiety, chest pain, nausea, and a blurry vision.
Prevention and Treatment Options
The key factors that doctors use in determining the best treatment option in case of hypertension include the identified factors that cause the disease and the type of hypertension that one has. In case of primary hypertension, doctors often recommend lifestyle changes, including diet modifications and physical activity. If these interventions fail, doctors often prescribe medications. On the other hand, in cases secondary hypertension, doctors seek to establish the factors contributing to the heightened blood pressure and consider either administering alternative medications or recommending lifestyle changes in addition to the medication. Often, individuals try different medications before they can settle on one that works for their unique needs. However, there are common medications used in the management of hypertension, including diuretics, beta-blockers, ACE inhibitors, calcium channel blockers, Alpha-2 agonists, and Angiotensin II receptor blockers (ARBs) ( Whelton et al, 2016) .
Beta-blockers work by slowing down the heart beat, therefore minimizing the amount of blood pumped through the arteries with each pump, thus lowering the blood pressure. They also work by blocking particular hormones in the body that are likely to raise blood pressure. On the other hand, diuretics, also known as water pills, work by helping the kidneys to eliminate excess sodium from the body. Excessive fluids and high sodium levels in the body are associated with increasing blood pressure. Hence, as the sodium is eliminated from the body, the excess fluid in the bloodstream moves into the urine, therefore helping to lower blood pressure.
ACE inhibitors work by preventing the body from producing angiotensin, a chemical that causes artery walls and blood vessels to narrow and tighten. As a result, blood vessels relax, leading to a reduction in the blood pressure. Angiotensin II receptor blockers (ARBs), on the other hand work by blocking angiotensin from binding with the receptors, thus helping in the relaxation of the vessels since the chemical is not produced, and further resulting in reduced blood pressure ( Whelton et al, 2016) . Further, calcium channel blockers work by preventing some calcium from gaining entry into the cardiac muscles of the heart, leading to led forceful heartbeats and decreased blood pressure. The medicines also cause blood vessels to relax, and thus lower blood pressure. Finally, the Alpha-2agonists causes changes in the nerve impulses that lead to the tightening of the blood vessels. As a result, they allow for the relaxation of the blood vessels, and thus a reduction in blood pressure.
In addition to medications, hypertension may be prevented and managed using home remedies that mainly aim at controlling the factors that contribute to increases in blood pressure. These interventions include developing a healthy diet, increasing physical activity, attaining a healthy diet, managing stress, and maintaining a cleaner lifestyle. A healthy diet plays a crucial role in the management of hypertension, reducing blood pressure, and minimizing the risk of complications associated with hypertension, such as heart attack, stroke, and the heart disease. A healthy diet comprises of a balanced diet that includes such foods as whole grains, vegetables, fruits, and lean proteins, such as fish.
On the other hand, increasing physical activity helps in attaining an ideal weight, as well as helping one to minimize stress, strengthening the cardiovascular system, and lowering blood pressure naturally. One can realize the benefits of physical activity by engaging in at least 150 minutes of physical activity each week ( Whelton et al, 2016) . Moreover, attaining a healthy weight especially for individuals with obesity or those that are overweight, which can be achieved through a healthy diet or a heart-healthy diet, helps in lowering blood pressure and therefore preventing or minimizing the effects of hypertension. Stress management through such ways as massage, deep breathing, meditation, tai chi or yoga, and muscle relaxation, as well as getting adequate sleep plays a key role in reducing blood pressure ( Lackland, 2014) . Finally, adhering to a cleaner lifestyle by quitting such harmful substances as tobacco and alcohol can help in managing hypertension since the substances are associated with increasing blood pressure. For individuals already diagnosed with high blood pressure, some of the dietary recommendations that can be provided include taking more of a plant-based diet and less meat. This includes consuming more whole grains, leafy greens, vegetables and fruits. In place of red meat, one may opt for such lean proteins as poultry and fish. Further, one should reduce sodium intake to range between 1500 milligrams and 2300 milligrams a day, and minimize the intake of sugary beverages and foods, including sweets and sodas.
Based on the above literature, there are many interventions that can be used in the prevention and management of hypertension. However, exercise and diet have been identified as the most effective strategies for managing hypertension, particularly among the African American population. The Dietary Approaches to Stop Hypertension, abbreviated as DASH, have shown efficiency in reducing blood pressure in the group, even without reductions in sodium intake or weight loss ( Flynn et al., 2013) .
However, despite the fact that DASH plays a crucial in the prevention and management of hypertension, African Americans fail to benefit from the intervention since the large proportion fail to adhere to the diet in the long-term, especially if they lack support. To a great extent, the failure to observe the diet is closely linked to the poor access to care as well as socioeconomic disadvantage that affects the African American population. Moreover, perceptions among the African Americans regarding hypertension also affect their adherence and compliance to the recommended therapy.
Section 4: Conclusions
The high prevalence of hypertension and related illnesses remains a key challenge among African Americans, particularly with both control and treatment lagging behind in the population. Given the limited access to healthcare due to economic challenges, it is essential to raise awareness on hypertension to facilitate prevention in the high risk group through such interventions as diet and physical activity. In addition, it is crucial for the population to be informed about the available resources that they can access to gain more knowledge on the disease and some of the viable strategies that can use to manage and prevent hypertension. Some of the reliable online resources that the population can access include WebMed, healthline.com, and the mayoclinic.org.
In this context, a BSN degree is essential in the management of hypertension among the African-Americans since effective management of the population requires health care practitioners to adopt approaches that recognize the socioeconomic, physiological, epidemiological, and cultural differences in the American population. The health practitioners are, therefore, required to effectively assess the blood pressure and cardiovascular risk, establish the amount by which the blood pressure should be reduced, identify the appropriate drugs according to the unique patients’ profile, and select a dose that matches the dose-response curve for the population ( Lackland, 2014) . The nurses should also consider such factors as the educational background, lifestyle, and the socioeconomic background of the patient in selecting appropriate medication or interventions. Largely, the degree would enable one to effectively educate patients on the treatment, disease, expectations, and the required lifestyle changes to facilitate better management of the disease.
References
Barnidge, E. K., Baker, E. A., Schootman, M., Motton, F., Sawicki, M., & Rose, F. (2015). The effect of education plus access on perceived fruit and vegetable consumption in a rural African American community intervention. Health education research , 30 (5), 773-785.
Flynn, S. J., Ameling, J. M., Hill-Briggs, F., Wolff, J. L., Bone, L. R., Levine, D. M., ... & Ephraim, P. L. (2013). Facilitators and barriers to hypertension self-management in urban African Americans: perspectives of patients and family members. Patient preference and adherence , 7 , 741.
Lackland, D. T. (2014). Racial differences in hypertension: implications for high blood pressure management. The American journal of the medical sciences , 348 (2), 135-138.
Lackland, D. T. (2014). Racial differences in hypertension: implications for high blood pressure management. The American journal of the medical sciences , 348 (2), 135-138.
Luque, J. S., Ross, L., & Gwede, C. K. (2014). Qualitative systematic review of barber-administered health education, promotion, screening and outreach programs in African-American communities. Journal of Community Health , 39 (1), 181-190.
Lynch, E. B., Liebman, R., Ventrelle, J., Avery, E. F., & Richardson, D. (2014). Peer reviewed: A self-management intervention for African Americans with comorbid diabetes and hypertension: A pilot randomized controlled trial. Preventing chronic disease , 11 .
Muntner, P., Abdalla, M., Correa, A., Griswold, M., Hall, J. E., Jones, D. W., ... & Tucker, K. L. (2017). Hypertension in Blacks: unanswered questions and future directions for the JHS (Jackson Heart Study). Hypertension , 69 (5), 761-769.
Weber, M. A., Schiffrin, E. L., White, W. B., Mann, S., Lindholm, L. H., Kenerson, J. G., ... & Cohen, D. L. (2014). Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension. The journal of clinical hypertension , 16 (1), 14-26.
Whelton, P. K., Einhorn, P. T., Muntner, P., Appel, L. J., Cushman, W. C., Diez Roux, A. V., ... & Arnett, D. K. (2016). Research needs to improve hypertension treatment and control in African Americans. Hypertension , 68 (5), 1066-1072.
Zoellner, J., Connell, C., Madson, M. B., Thomson, J. L., Landry, A. S., Molaison, E. F., ... & Yadrick, K. (2014). HUB city steps: a 6-month lifestyle intervention improves blood pressure among a primarily African-American community. Journal of the Academy of Nutrition and Dietetics , 114 (4), 603-612.
