Hypertension in Adults.When Does it Stop?

JaNell Wylie
HLTH 634-D01
August 21, 2015

Introduction
According to the Centers for Disease Control and Prevention (CDC), one in three adults
living in the United States are living with high blood pressure (also known as
hypertension).1 Putting this into perspective one in three adults equals to around 70 million adults
living with this detrimental disease.1 Out of these individuals 43% of African American men and
45.7% of African American women have been diagnosed with hypertension.1 With this being said
about "two out of five African American adults that have been diagnosed with hypertension with
less than half of them having it under control."1 One could assume that there are several reasons
to why these individuals are not controlling their hypertension such as living a sedentary lifestyle
or eating an unhealthy diet. According to the American Heart Association, 63% of African
American men and 77% of African American women are overweight.2 Much of the African
American adult population has been diagnosed with hypertension due to their choices in food.
Many individuals chose unhealthy eating habits over eating healthy due to various reasons. One
reason there may be unhealthy eating habits among this community is because of culture. Many
African Americans eat soul food, which are foods that contain lots of sodium, sugar and fat such
as fried chicken, macaroni and cheese and yams. By educating this population on the importance
of not eating these foods daily it could help to lower the hypertension rate. These individuals
could also lower the rate of hypertension through exercising daily, maintaining a healthy body
weight, managing their stress levels, avoid smoking, limiting alcohol, and taking their
medications properly.2 The specific demographic area I would like to focus on is those
individuals who have a low social economic status. Some individuals do not have a choice of
what they eat due to things such as poverty or living in a food desert. African Americans
currently have the highest poverty rate compared to other ethnicities with a rate of 27.4%.3 A

food deserts is defined as a "urban neighborhood (typically poverty stricken) without ready
access to fresh, healthy, and affordable food."4 Instead of individuals living in these
neighborhoods shopping in grocery stores or farmers markets, they are usually shopping in
convenient stores or eating from fast food restaurants.4
Blood pressure is defined as the force of blood that is pushed against an individuals artery
walls. Having high blood pressure (hypertension), is when an individuals blood pressure stays
high for a long period of time.1 There are two numbers involved in a blood pressure reading,
which are systolic and diastolic. Systolic measures the pressure in blood vessels when the heart
beats and diastolic measures the pressure in blood vessels when the heart rests in between
beats.1 A normal blood pressure is considered to be 120/80mmHg or lower, while a high blood
pressure would be considered 140/90mmHg or higher.1 Many people are completely oblivious to
having high blood pressure because much of the time the disease does not display any signs or
symptoms.1 Hints the reason why doctors call it the silent killer.1 When individuals do display
signs or symptoms associated with high blood pressure they may experience headaches, blood
spots in eyes, facial flushing, or dizziness.2 If blood pressure is not controlled other detrimental
health conditions can arise such as heart disease, stroke, and kidney disease.2 Due to
hypertension being on the steady rise along with being a serious health disparity amongst the
African American community I have decided to plan a health communication intervention
around the disease in hopes to lower the rate among this community.
In order to combat the health disparity hypertension among the United States African
American adult population I will deploy a health communication intervention that will be held
nationwide at local YMCAs and community centers that will focus on diet and exercise. Within
this intervention, I will educate all African American participants who have been diagnosed with

hypertension on the disease itself, the importance of following a healthy diet specifically the
DASH diet and the importance of participating in physical activity daily for at least 60 minutes.
Registered dieticians, nutritionists, and health care professionals will help educate participants on
healthy eating habits and the DASH diet through hands on cooking demonstrations that will
teach them how to prepare and cook snacks and meals following the DASH diet guidelines. For
those individuals that do not have access to fresh fruits and vegetables due to living in low
socioeconomic areas and/or food deserts I will enlist the help of gardeners and/or farmers to
teach these individuals how to start and maintain their own community gardens. I will also enlist
the help of fitness instructors who work at the local YMCAs and community centers to teach
participants how to exercise properly within their own homes after the intervention is over.
Throughout the intervention these fitness instructors will lead group exercise classes in the
communities of which the intervention is taking place in at the local YMCAs and community
centers.
Within this literature review I will introduce the health issue at hand (hypertension) and
my intervention to combat this issue amongst the African American community. I will then
discuss several articles that discuss this health disparity and why it is important to create and
implement and intervention to lower the rate of hypertension. Lastly I will conclude this
literature review by summarizing each of the articles I have discussed previously and concluding
how my intervention could apply to the existing research on the topic.
Body of Evidence
During my research on the African American adult hypertensive population, I have found
several types of articles from qualitative studies, randomized trials, to interventions, and reviews.

The first study was focused around five focused groups (3 womens and 2 mens groups) with 34
participants in total ranging from 27 to 60 years old.5 This study consisted of a survey that
contained three different sets of questions, a behavioral belief section around hypertension
preventative behaviors, a normative belief section to develop a understanding on how family and
friends influenced preventative self-care behaviors, and a controls belief section to determine the
perception of the benefits and barriers one could have towards prevention strategies.5 It was
found that many individuals actions were based around the circle of culture which are the
boundaries that effect individuals decisions within their culture.5 Individuals identified several
preventative behaviors that could prevent hypertension such as poor eating habits, stress, obesity,
physical inactivity, smoking and alcohol.5 It was also found that all participants believed that
self care measures could prevent and control hypertension which could result in people feeling
better and living longer healthier lives.5 This study was also able to determine why individuals
lived stressful lives. Most stress came from participants socioeconomic status. If it was low, the
more stressed the participant would become, the more likelihood they would not eat healthy and
take care of themselves.5 Lastly this study found that there are several barriers that prevent
individuals from changing their behaviors to prevent hypertension such as participants saying
change is hard, habits are hard to break, and living stressful lives.5 There were also several
external barriers found such as commercials encouraging poor eating habits, lack of free
exercise facilities, high cost of eating healthy foods, and the lack of information provided to the
community about preventing hypertension.5 With this being said this article introduces the
reason why hypertension is a problem within the adult African American community.
The second study focused around determining the barriers of adopting healthy eating
habits through the DASH (Dietary Approaches to Stop Hypertension) diet to lower hypertension

in the African American communities with low socioeconomic statuses. This study was also
another qualitative study that was based around focus groups. There were 30 African American
participants that took place in these focus groups in Forsyth County, North Carolina.6 The first set
of focus groups focused on participants food habits, availability of foods in the community and
the feasibility of following a DASH pattern of eating.6 The second set of focus groups focused
on obtaining participants perceptions about existing DASH eating plan materials from the
National Heart, Lung, and Blood Institute (NHLBI).6 Within both focus groups there were
questions asked by a trained moderator.6 After the focus groups were completed it was found that
the main barriers focused around the food environment, economic concerns, cultural factors, and
family influences on dietary choices.6 With this being said the concerns about the food
environment were the availability, quality, and costs of fresh fruits and vegetables, and leaner
meat options.6 Economic concerns were the inability to consume fresh fruit before spoilage.6
Lastly the concerns among cultural and family influences on dietary choices were tension
between family members being willing to eat healthier food options, and having the lack of
familiarity with the DASH menu options.6 This study also discovered that there were 82
potential food outlets in the area codes where the focus groups populations came from and that
only 10 of the food outlets were grocery stores, 8 smaller grocery stores, 31 convenience stores,
4 butcher shops and 1 outlet store that sold food.6 With this being said it shows that food deserts
are very likely to exist in some locations of this study. Also between the first two studies, it
shows that there were many of the same barriers that prevented individuals from obtaining and
eating healthy foods to prevent hypertension.
The next study is a randomized trial study that is focused around demonstrating the
effectiveness of the DASH program in a African American population in a under resourced

community through the use of a pilot study.7 This study also took place in Forsyth, North
Carolina, but instead of the study just concentrating on neighborhoods with low income like the
previous study, researchers also used neighborhoods who had high blood pressure and used
fewer than 3 antihypertensive medications.7 With this being said there were 25 participants
recruited to participate in the study, which lasted 12 weeks.7 Within the 12 week study
participants went through a rigorous recruitment and screening process that included, readings of
blood pressure, height and weight, and a fasting blood draw.7 After the recruitment and screening
process participants were able to participate in the intervention based around the DASH program.
Participants participated in individual sessions were they were given binders with information to
help them with grocery shopping, budget management, and meal planning.7 These individual
sessions were also used to help participants regulate eating habits by setting goals and helping
them to secure social support they needed to meet their goals and maintain them.7 In group
sessions they took on a different aspect of learning how to select foods and prepare meals
according to the DASH diet, and practicing how to prepare a meal with the assistance of a
professional chef.7 With this being said researchers found that the intervention was not successful
as there was no significance difference in dietary behaviors from the baseline and follow up
survey.7 It was found that participants felt like they could make healthier food choices to lower
their sodium and fat consumption.7 Lastly there were no significant changes in participants
beginning and ending blood pressures. This study helps to introduce the reason why there is a
need for my intervention in the adult African American hypertensive community.
These next few studies are based off of prior interventions that will also express the need
for my intervention. The first intervention study focused around hypertension in young African
American men and hypertension. Within this study a planning team from the University of North

Carolina at Greensboro and North Carolina A&T State University partnered with the director of
one of the local YMCAs to develop and assess a hypertension education and lifestyle
intervention program.8 This study was unlike most considering that there was both a focus group
intervention to help determine if the study could be done on a bigger scale and also pilot study
that actually involved the normal steps to an intervention.8 For the purpose of the literature
review I will discuss the pilot study. Twenty-six men participated in this study which included, a
health screening (height, weight, blood pressure, and a blood draw to test cholesterol levels and
for diabetes) and a 6 week intervention program.8 The program consisted of pre and post
assessments on hypertension, group exercise sessions taught by African American instructors and
meetings on the DASH diet guidelines that included information on the diet, how to prepare and
cook foods following the guidelines, and cooking demonstrations.8 This study has yet to analyze
the results of the intervention. However they did learn that African American men are willing to
work with each other to improve their health.8 It was also found that young African American
men want to learn about their health and the issues that disproportionately affects them.8 This
being said this intervention opens the door for my intervention, as I would like to incorporate
physical activity and a healthy diet (DASH diet) into my program.
The next intervention is a quasi-experimental design study that took place in rural
Mississippi to assess the effectiveness of a 6 month intervention that was church based around
diet and physical activity.9 There were 8 churches that qualified to participate in this study.9 This
diet was comprised of elements from the original Body and Soul program that included things
like a 60 minute education session on how to increase consumptions of fruit and vegetables and
decreasing consumption of things with high fats, sugar, and sodium.9 This study also included
things such as physical activity and educational presentations on nutrition, chronic diseases, and

physical activity.9 Lastly this study included a baseline and follow up questionnaire on
demographic information, their physical activity levels, and body measures such as BMI.9 It was
found that individuals increased their fruit and vegetable intakes, along with their physical
activity levels.9 Even though this was not an intervention focused directly on hypertension but
instead on all chronic diseases that affect African Americans such as diabetes and high
cholesterol it showed how diet and exercise could help decrease these health problems within the
community.
The last study I will be discussing is a systematic review that is focused around reviewing
educational interventions that are based around physical activity and diet amongst the African
American population n the United States.10 This review is compromised of 19 different studies
that were focused on diet and physical activity.10 The data from these studies were obtained from
Medline, Cochrane, and Dare databases.10 During this review it was found that interventions
based around nutrition and physical activity reduced the risk for chronic diseases by succeeding
in improving clinically relevant outcome measures, including weight loss, decrease in waist
circumference, body fat percentage, decrease in blood pressure and blood glucose levels and
etc.10 This study differs from all other studies I have discussed but it proves that with diet and
exercise interventions can be successful.
Summary and Conclusions
After discussing several interventions based around lowering hypertension in the African
American community I can conclude that diet and physical activity is a successful way to lower
this health disparity within this population. When looking back at these studies there is much
room for future research considering that many of these studies did not prove the lowering or

difference in blood pressure from the start of the study in participants. I would like to
successfully lower African Americans blood pressure through the education of how to and eat
and maintain a healthy diet based on the DASH diet and through physical activity. Through
implementing a intervention for African Americans around diet and physical activity I hope to
decrease the rate of hypertension amongst this population.