Protocol Screening for Prehypertension in African American Females
Introduction
Hypertension has been linked as the leading cause of death in African American women in the United States (Frederieke et al., 2017). “Over half (53.2%) of non-Hispanic African American women suffer from hypertension, compared to 42.8% among women of all racial groups and 38.8% among non-Hispanic white women” (Michael et al., 2019). With the prevalence of how this epidemic is in the African American population, teens of this race have an increased risk of developing hypertension in early adulthood. There are several types of hypertension that causes an increase in blood pressure; essentials, family history, diet, and exercise. Substantial emphasis should be placed on screening for prehypertension to decrease the risk of developing high blood pressure. If an existing protocol for detection were to be utilized, it is speculated that cardiovascular, stroke, chronic kidney disease, and hypertension will drastically improve in the areas of morbidities and mortality rates (Umar et al., 2019).
Problem & Significance
According to Ibekwe (2015), High blood pressure, or hypertension is a chronic medical condition in which the arteries are elevated by the blood pressure, causing the heart to work harder than usual to circulate blood throughout the blood vessels. Hypertension has been identified as having an elevated blood pressure equal or greater than 140/90 at more than two readings, and this is one of the most modifiable risk factors for cardiovascular diseases and death (Rodriguez-Inturbe, Pons,& Johnson, 2017). According to Larson et al. (2017), high blood pressure is a significant risk factor among young women of childbearing age. . Don't use plagiarised sources.Get your custom essay just from $11/page
According to the Department of public health in Georgia, (2020), the epidemiology of chronic diseases cost the state of Georgia 40 billion dollars a year. There are some lifestyle factors to consider in controlling chronic disease. Higher quality nutrition, eliminate tobacco use, and increase in physical activity, will allow Georgia to improve overall health and educational outcomes. Georgia has 18 public health partners for healthcare despite all the healthcare resources. Cardiovascular disease is the single leading cause of death in Georgia.
Target Population
The target population will be African American women, ages 15-24 of childbearing years. They will be women of Chatham County with a population of 300,000 on the East Coast of the United States. Post Partem in women is high in hypertension and sadly goes undiagnosed or treated (Larson et al.,.2017).
A gap in Delivery of Care
According to Yancu et al., (2018), although 1/3 of adults have hypertension, there are several reasons why screening for prehypertension remain below standard in African- Americans. It is the assumption that all young adults are generally healthy without recognizing early warning signs lurking beneath the surface with juveniles and adolescents. Young African- American’s are more overweight than any other race. It would be sensible to start with this generation of people to help curve this controllable global health concern. High blood pressure does lack the apparent signs and symptoms in early stages; however, this can be a consequence of many people going undiagnosed. All it would take is early recognition for creating healthy lifestyle modifications. Medications may be needed sooner to decrease chronic kidney disease, a significant end-stage, a complication in African- Americans. A body mass index is used frequently to calculate an overall person weight without regard to ethnicity or age. This is a significant gap in health care because African- Americans have increased body mass. Acknowledgement of their body mass index can help change the way they are treated. To better predict health risks, central adiposity would be a better indicator in measuring body fat.
Impact on Health Care
Nuttall (2015), asserts that a primary goal is that prehypertension can be a modifiable risk factor for cardiovascular disease, although it remains the number one cause of death in women. There should be measures to implement with direct interventions for rural women to decrease their blood pressure to optimal levels(Ferdinand, 2016). With healthy modifications of exercise, Dietary Approaches to Stop Hypertension, (DASH) eating plan, group meetings, and individual counsel settings will have an impact on change for the better. There will be a significant reduction in Cardiovascular disease, chronic kidney disease, and debilities related to strokes(Kokubo et al., 2019).
People will have more knowledge about lifestyle changes to control and prevent hypertension. This will dispute the pessimistic attitude towards the modification changes. Hypertension pre-screening will become more prevalent if there is cooperation from the insurance companies to increase awareness with health programs, reimbursement, and resources to pay for the underprivileged (Meiqari et al., 2019).
Stakeholders
According to Chan (2013), the main groups to initiate the screening for prehypertension are government, primary healthcare providers, OBGYN screenings, and hospitals. Patients and families should be advocates to help encourage them to improve they’re well being. The federal government and health insurance agencies can provide funding to assist people with getting their medications at a reasonable cost. Hypertension advocacy groups, nurses, social workers may be qualified to provide support with healthy eating and financial resources. This protocol embarkation will be appointed to the primary members listed above. The critical holders in decision making will be the nurse practitioners and the physicians at Curtis V. Cooper Women’s Health centre.
Type of Protocol
The protocol to be proposed is diseased based in prehypertension. This protocol will cogitate a primary screening tool which will be used globally within the community to all clinics and hospitals that manage the care of African- American women. The questionnaire screening will be administered during the initial visit of patients through hospitalization, primary care providers, scheduled immunizations for high school and college students. If prehypertension is suspected, the patient will have to provide their telephone number, address, and two emergency contacts. The hypertension screening tool will be selected from the WHO organization in the screening tool, and they will also learn guidelines on how to treat patients with low blood pressure.
Theoretical Framework
The theoretical framework that best mirrors the screening of prehypertension in African Americans is recognized as the Theory of Planned Behavior (TPB) model. Icek Ajzen (1985, 1987), is the nursing theorist responsible for this model. It relates to behaviour, which is influenced by three types of speculations: normative, behavioural, and control. To change the behavioural interventions, you must try to change the beliefs which guide the behavioural performance. Human behaviour is implicated in general attitudes and personality traits ( Ajzen, 1985,1987 ).
This theory relates to African American beliefs and attitudes concerning self-care behaviours with hypertension preventive care. They have binding ties for acceptable cultural practices with their lifestyles and social environment. The TPB theorize African-Americans attitude with perceived behavioral control, subjective norm; and perceived behavioral control that predicts actual health behaviors (Peters, Aroian, & Flack, 2006). There are critical antecedents’ intuitions of African- Americans attitudes toward behavior that visualize mentally, which reflects the conative, and cognitive beliefs regarding their behavior. The foundation of philosophy is antecedents’ behavioral beliefs, and the values held toward expected outcomes. Motivation to comply are antecedents to subjective norms which include normative beliefs. Normative theories are essential concerns for others approval or disapproval of a particular behavior. An expanded perspective of TPB is by identifying a cultural influence and their attitude toward health-related behavior (Peters, Aroian, & Flack, 2006).
The TPB has outlined how African Americans manage their hypertension with their personal beliefs. The main factor in using this theory is changing their attitude because it affects their cognition and connotation on how they feel about their blood pressure. The subjective norm is influenced by a person’s perception of their social expectations to adapt to a particular behavior, of healthy eating, and lifestyle changes, this will become the new normal for African Americans. Normative beliefs within the culture will help with the finding of their views in taking care of themselves. A reflection of a person’s feelings is perceived behavioral control as to how difficult or easy it will be to get them to perform the behavior in making this change gradually for improved health (Peters & Templin, 2010).
This theoretical framework will provide an effective mechanism of delivery that reassure positive behavior with African Americans and their health beliefs. The design of this theory requires an organization to rethink and bring into existence a new team of how to change their attitude. This Capstone protocol is an experimental design that will create a more proactive system in focusing on the total health of a person and not their signs and symptoms. In Primary care, this framework could help manage a patient’s thought on their level of care. Literature Review
A comprehensive literature review was conducted using an academic search of PubMed, CINAHL, Ovid, Google scholar, and South University Campus Library. They were researched to obtain knowledge of the state of the science related to recognizing prehypertension. For this literature review, peer-reviewed articles were selected, connecting prehypertension with hypertension and self-management behaviors in African Americans. The materials were pertinent to understanding prehypertension in women. The search words were African Americans, blacks, women, young women, hypertension, prehypertension. Cardiovascular disease and behaviors of self-care. The literature search resulted in 29,810 articles concerning hypertension. Many of the articles were duplicates, leaving 3,850 to review, 40 articles relevant from this pool of studies, and 17 items met the criteria. There were several Government websites used in addition to the above search engines to gather statistical data on the degree of hypertension. The literature review unveiled contributory factors to why African Americans are a harbinger for hypertension.
The foundation of all national recommendations is healthy lifestyle behaviors. Young African American women have a higher risk factor for developing hypertension and cardiovascular disease, even though there are extensive promotions for healthier lifestyles (Staffileno et al., 2017). Prehypertension is a precursor for hypertension, which has been recognized in more African American women. Prehypertension can be differentiated by a “systolic blood pressure of 120-139, and diastolic blood pressure of 80-89”, at rest. More young African American women go undetected when they are slightly elevated, and this puts them at risk for developing hypertension (Bond et al., 2016). Their risks can be reduced significantly through lifestyle modifications and the use of hypertensive medications (Arena et al., 2014).
According to Breyer et al., (2018), a Jackson heart study suggests African Americans have higher blood pressure levels from childhood and are more superior to hypertension across the lifespan. A central component for decreasing Cardiovascular disease among African Americans is prevention. The American Heart Association has a life simple of seven elements to healthy behaviors. The baseline data collection was gathered during clinical examinations and in-home interviews. It entailed: BMI, diet, physical activity, cigarette smoking, the three health factors involved were total cholesterol, fasting glucose, and blood pressure. The outcome was African Americans had three or less ideal life simple seven behaviors.
Barriers to Screening for Hypertension in African Americans
Although therapy for hypertension is readily available, there still is a compelling cause of morbidity and mortality in cardiovascular disease, chronic kidney disease and stroke in the United States. Despite improvements of treatment awareness African Americans suffer from hypertension-related mortality and morbidity from being poorly treated, poorly controlled and undiagnosed. The antecedents affecting blood pressure control are behavioral lifestyles, medication adherence, genetics, cognitive attitude, and knowledge (Muller, Pernell, Mensato & Cooper, 2015). In addition to hypertension control, behavioral lifestyle changes, which include physical activity and diet changes, will help reduce the impact of hypertension (Boehnie, Esenwa, &Elkind, 2017).
Disparity barriers in hypertension and self-management for African Americans exist in not accepting their diagnosis, but also lack of education concerning their symptoms, difficulty committing to their hypertension medications, lack of communication with their providers, and poor taking of medications as prescribed. African Americans behaviors toward controlling their hypertension are perceived by beliefs of the following (Flynn et al., 2013).
Barriers to Self-belief– African Americans have a strong religious faith in God which guides their behavior of medical beliefs. It is often heard by the ” God will take care of me; I am not claiming hypertension.” This attitude diminishes their behaviors in limiting stress, quitting smoking, reducing salt intake, and taking their medications (Flynn et al., 2013).
Lack of Money– Most African Americans live-in low-income housing and their blood pressure medications is a struggle due to the cost. Having other commodities, it becomes a challenge to manage.
Missing Clinic Appointments– After the majority of African American patients are treated by lowering their blood pressure, there is little follow-up in the continuity of care. Some of the issues are related to co-pays in; monitoring, transportation, and lack of rescheduling if the appointment is missed.
Lack of exercise– African Americans live more of a sedentary lifestyle in lack of exercise; they relate exercise to working at their jobs as physical activity. They also have a fear of loneliness by not having family support for motivation (Rimando, 2015).
Recognizing Prehypertension in African Americans
Although there is a warranted assumption that all young adults are generally healthy, the African American race and age are associated with the prevalence of pre-hypertension. They also have more comorbidities that link them to prehypertension such as; diabetes mellitus, elevated CRP, and microalbuminuria (Glasser et al ., 2011). Knowing African Americans are at risks of excess in blood pressure, it is imperative to evaluate and treat if needed as early as possible to prevent vascular damage. African Americans weight and body mass index play an essential factor in predisposing to prehypertension(Senthill & Krishndasa, 2015). They also have higher total triglycerides & cholesterol. BMI is a strong predictor for prehypertension and other risk factors. Majority of people with prehypertension have at least one cardiovascular disease. Lifestyle modifications are a crucial determinant of healthier lifestyles and physical health for prevention and blood pressure control(Badakhsh, 2015).
African American Cultivate Hypertension
More inadequate blood pressure control is demonstrated more in African Americans. The racial difference disparities are salt sensitivity, body mass, and uncontrolled blood pressure (Lackland,2014). It is time to act and recognize the warning signs to individuals that prehypertension is inevitable among this race of people. It must start from the paediatrician and continue into early adult primary care. Majority of African American children are at the 95% percentile for weight, height, BMI, and prediabetes. Women surpass men later in life in the incident of hypertension. There have been recommendations to treat hypertension with an angiotensin II blocker in prehypertension patients, and this will delay or prevent essential hypertension(Collier & Landram, 2012).
Integrating Primary Care and Hypertension
Despite a crucial key to hypertension control is detection, power, and treatment, it remains uncontrolled in African American patients. It must start from a change in behavior, which is a strong commitment to learn and adopt the necessary skills of a better lifestyle. Primary care providers are first in bringing awareness to recognize prehypertension and hypertension. Second, patients with signs and symptoms of hypertension must be treated accordingly, with lifestyle changes, medications, or a combination. Third, as the primary care provider, they must be followed up to make particular they are complying to the treatment and plan to control their blood pressure(Khatib et, al., 2014). Healthy people of 2020 have a goal in treating hypertension with medication to help lower blood pressure. There should be adequate training to help improve health care qualities with cultural competency, provider knowledge; and better attitudes related to health will increase patient satisfaction(Balfour, Rodriguez,& Ferdinand, 2015).
Initiating Prehypertension Screening in African Americans
African Americans have the leading cause of organ damage, cerebral vascular accident, cardiovascular disease, and chronic kidney disease in the United States, and it’s all attributed to hypertension. African Americans would benefit from prior therapy when they reach the prehypertension zone of elevated blood pressure(Williams et al., 2016). In 2014 the JNC 8 introduced a different guideline for African Americans with hypertension. The treatment is a calcium channel blocker or a diuretic for monotherapy. As for African Americans with proteinuria or chronic kidney disease, an ace inhibitor should be utilized for early interventions to prevent chronic kidney disease.
Best Practices for Screening for Prehypertension
The standard of practice used to guide this project stems from The American College of Cardiology. They were able to acknowledge vital points for blood pressure guidelines that entailed detection, evaluation, prevention, and management(Whelton, Carey, Aronow et al., 2017). As for screening, a general approach and follow-up are expected of providers to influence a standard for meticulous blood pressure measurements. These are the guidelines as followed from the JNC 7 report: When checking blood pressure, it is either elevated, normal, or Stage 1 or 2 hypertension this is a guiding factor to treat and prevent an increased blood pressure(Whelton, Carey, Aronow et al., (2017).A normal blood pressure is less than 120/80; as the blood pressure attempts to heighten to 120-129/ < 80; it becomes a sign elevation; stage 1 hypertension is 130-139 or 80-89 stage 2 hypertension is > or = 140 or > or equal to 90. This is based on two consecutive readings at two different times(Whelton, Carey, Aronow, et al., 2017).
In African American women, hypertension was the leading cause of death and disability in the United States in 2010. Cardiovascular disease is often not recognized when screening and treating hypertension. Other risk factors of cardiovascular disease are low fitness behaviors, excessive weight, diabetes mellitus, smoking, sleep apnea, and psychosocial stress. The secondary screening is related to drug resistance and target organ damage. Non-pharmacological treatment to help control blood pressure are sodium restriction, weight loss for overweight patients, heart-healthy diet/ DASH diet, a structured exercise program, and increased physical activity. A follow up should be assessed every 3-6 months in low-risk adults with stage 1 hypertension and managed by pharmacologic and non-pharmacological interventions. In stage 2, hypertension adults should be handled with two antihypertensive drugs and reevaluated in a month of the first diagnosis. Adults with extremely elevated blood pressure should have prompt treatment to adjust medications with careful monitoring(Whelton, Carey, Aronow, et al., 2017).
American College of Cardiology guided Capstone Protocol
This Capstone Protocol and The American College of Cardiology both believe every adult with hypertension should have a detailed, current, and clear evidence-based practice plan of care. This would establish self-management goals of treatment, management of comorbid conditions; following up promptly with the health care team, and complying with cardiovascular evidence-based guidelines. Promote lifestyle modifications, and there must be effective behavioral and motivational strategies for change to occur. Lifestyle interventions need to adapt to significant lifestyle promotions(Tabrizi et al., 2016).
Project Protocol Development Appendix
| Type of Protocol: Disease based protocol | ||
| Name of Protocol: Prehypertension in African American Women | ||
| Introduction: African – Americans have more prevalence of prehypertension, which is a significant risk factor of hypertension, cardiovascular disease, and chronic kidney disease. The JNC 7 adopted the term prehypertension to increase awareness of the accelerated incident of hypertension. These rates are rising in children and adolescents of African Americans. Recognizing a “systolic blood pressure between 120-139 and diastolic blood pressure between 80-89” is prehypertension( Booth et al., 2017), and treatment should be initiated immediately. Lifestyle modifications and antihypertensive medication use can reduce the risk factors for hypertension among people with this condition. Implementing therapeutic lifestyle modifications of diet, exercise, decrease alcohol and smoking will improve overall blood pressure. The goal of prehypertension is to manage the blood pressure to a normal range and prevent blood pressure-related cardiovascular events. Bringing awareness is essential to African- American women on cardiovascular risk and improving behaviors in culture, beliefs, and values concerning their blood pressure. They understand that this culture responds differently to medication for hypertension since they have been underrepresented in treating their blood pressures for years. This has resulted in a higher prevalence of comorbid diseases, with obesity, cardiovascular disease and chronic kidney disease. This why treatment is imperative, and this situation must be addressed. The JNC- 8 was the first to recognize race and different hypertension combinations for African Americans. | ||
| Definitions of disease or clinical process concerns: · Prehypertension, therapeutic lifestyle changes, pharmacological treatment all work concerning the protocol capstone project development. · Prehypertension has been defined as a significant global health risk. There have been blood pressure parameters to recognize early warning signs in the prevention of cardiovascular disease. · Hypertension is characterized in stages of prehypertension; stage 1 hypertension, and stage 2 hypertension. It is defined as systolic blood pressure > 140 and a diastolic blood pressure > 90 on two separate occasions. Hypertension has many risk factors including; congestive heart failure, stroke, coronary artery disease, and end-stage renal disease. · Therapeutic lifestyle changes are the most active lifestyle modification strategy for the prevention of hypertension. Weight loss is decreasing the body mass index this will lower systolic blood pressure by 5-20 mm Hg, consumption of a rich diet in vegetables and fruits, low-fat dairy products will reduce systolic blood pressure by 8 to 14mm Hg. · Dietary approaches to stop hypertension (DASH) plan practice a diet rich in vegetables, fruits, nuts, legumes, low saturated, fats, and low-fat nutritional products have a significant impact on lowering patients’ blood pressures. · Exercise, physical activity, decrease blood pressure. Counselling is a crucial key to early interventions of lifestyle modifications. · Medication management in African Americans is from 2 antihypertensive classes which are a diuretic or calcium channel blocker. | ||
| Key Points this protocol addresses: · Prehypertension first-line treatment is a healthy lifestyle, to reduce obesity, prediabetes, diabetes mellitus, dyslipidemia, sedentary lifestyles, salt intake, smoking, and excessive alcohol intake · Annual blood pressure screening for African American Women · Blood pressure log at all follow up visits · Providing resources and tools to check blood pressures · Education/diet recommendations on management | ||
| Screening: Describe if applicable Primary: Recognizing prehypertension in African American women Secondary: Once their blood pressure reaches the guidelines of elevation, essential resources will be introduced. · Counselling · Diet/DASH · Exercise and physical activity · Blood pressure log for monitoring · Follow up appointment monthly Tertiary: If there is an elevated blood pressure on two occasions above the standard guidelines, pharmacological medication will be initiated. | ||
| ||
| Treatment Initiation: (add pharmacologic treatment only if working with a provider) Non-pharmacologic treatment | ||
| Special Considerations: Changing African American lifestyles to decrease morbidity and mortality | ||
|
References
Albarwani, S., Al-Siyabi, S., & Tanira, M. O. (2014). Prehypertension: Underlying pathology and therapeutic options. World journal of cardiology, 6(8), 728–743. https://doi.org/10.4330/wjc.v6.i8.728 Booth JN 3rd, Li J, Zhang L, Chen L, Muntner P, Egan B. Trends in Prehypertension and Hypertension Risk Factors in US Adults: 1999-2012. Hypertension. 2017;70(2):275–284. doi:10.1161/HYPERTENSIONAHA.116.09004 Buis, L. R., Dawood, K., Kadri, R., Dawood, R., Richardson, C. R., Djuric, Z., Sen, A., Plegue, M., Hutton, D., Brody, A., McNaughton, C. D., Brook, R. D., & Levy, P. (2019). Improving Blood Pressure Among African Americans With Hypertension Using a Mobile Health Approach (the MI-BP App): Protocol for a Randomized Controlled Trial. JMIR research protocols, 8(1), e12601. https://doi.org/10.2196/12601
Brown, A.G.M., Hudson, L.B., Chui, K. et al. Improving heart health among Black/African American women using civic engagement: a pilot study. BMC Public Health 17, 112 (2017). https://doi.org/10.1186/s12889-016-3964-2 Muntner, P., Abdalla, M., Correa, A., Griswold, M., Hall, J. E., Jones, D. W., Mensah, G. A., Sims, M., Shimbo, D., Spruill, T. M., Tucker, K. L., & Appel, L. J. (2017). Hypertension in Blacks: Unanswered Questions and Future Directions for the JHS (Jackson Heart Study). Hypertension (Dallas, Tex. : 1979), 69(5), 761–769. https://doi.org/10.1161/HYPERTENSIONAHA.117.09061 Selassie A, Wagner CS, Laken ML, Ferguson ML, Ferdinand KC, Egan BM. Progression is accelerated from prehypertension to hypertension in blacks. Hypertension. 2011;58(4):579–587. doi:10.1161/HYPERTENSIONAHA.111.177410 Williams SK, Ravenell J, Seyedali S, Nayef S, Ogedegbe G. Hypertension Treatment in Blacks: Discussion of the U.S. Clinical Practice Guidelines. Prog Cardiovasc Dis. 2016;59(3):282–288. doi:10.1016/j.pcad.2016.09.004 | ||
| Flow Chart |
Reference
Albarwani, S., Al-Siyabi, S., & Tanira, M. O. (2014). Prehypertension: Underlying pathology and therapeutic options. World journal of cardiology, 6(8), 728–743. https://doi.org/10.4330/wjc.v6.i8.728
Ajzen, I.(1985,1987).Organizational behavior and human decision processes. Retrieved from google scholar. February 5, 2020.
Arena, S. K., Drouin, J. S., Thompson, K. A., Black, E., & Peterson, E. L. (2014). Prevalence of Pre-hypertension and Hypertension Blood Pressure Readings Among Individuals Managed by Physical Therapists in the Home Care Setting: A Descriptive Study. Cardiopulmonary Physical Therapy Journal (American Physical Therapy Association, Cardiopulmonary Section), 25(1), 18–22.
Badakhsh, M. H., Malek, M., Aghili, R., Ebrahim Valojerdi, A., & Khamseh, M. E. (2015). Prehypertension; patient awareness and associated cardiovascular risk factors in an urban population in Iran. Medical journal of the Islamic Republic of Iran, 29, 290.
Balfour, P. C., Jr, Rodriguez, C. J., & Ferdinand, K. C. (2015). The Role of Hypertension in Race-Ethnic Disparities in Cardiovascular Disease. Current cardiovascular risk reports, 9(4), 18. https://doi.org/10.1007/s12170-015-0446-5
Boehme, A. K., Esenwa, C., & Elkind, M. S. (2017). Stroke Risk Factors, Genetics, and Prevention. Circulation Research, 120(3), 472–495. https://doi.org/10.1161/CIRCRESAHA.116.308398
Bond, V., Curry, B. H., Adams, R. G., Obisesan, T., Pemminati, S., Gorantla, V. R., Kadur, K., & Millis, R. M. (2016). Cardiovascular Responses to an Isometric Handgrip Exercise in Females with Prehypertension. North American Journal of Medical Sciences, 8(6), 243
Booth JN 3rd, Li J, Zhang L, Chen L, Muntner P, Egan B. Trends in Prehypertension and Hypertension Risk Factors in US Adults: 1999-2012. Hypertension. 2017;70(2):275–284. doi:10.1161/HYPERTENSIONAHA.116.09004
Brewer, L. C., Redmond, N., Slusser, J. P., Scott, C. G., Chamberlain, A. M., Djousse, L., Patten, C. A., Roger, V. L., & Sims, M. (2018). Stress and Achievement of Cardiovascular Health Metrics: The American Heart Association Life’s Simple 7 in Blacks of the Jackson Heart Study. Journal of the American Heart Association, 7(11), e008855. https://doi.org/10.1161/JAHA.118.008855
Brown, A.G.M., Hudson, L.B., Chui, K. et al. Improving heart health among Black/African American women using civic engagement: a pilot study. BMC Public Health 17, 112 (2017). https://doi.org/10.1186/s12889-016-3964-2
Buis, L. R., Dawood, K., Kadri, R., Dawood, R., Richardson, C. R., Djuric, Z., Sen, A., Plegue, M., Hutton, D., Brody, A., McNaughton, C. D., Brook, R. D., & Levy, P. (2019). Improving Blood Pressure Among African Americans With Hypertension Using a Mobile Health Approach (the MI-BP App): Protocol for a Randomized Controlled Trial. JMIR research protocols, 8(1), e12601. https://doi.org/10.2196/12601
Chan, M.(2013).[A a global brief on hypertension]. Retrieved.February1,2020.https://ish-world.com/downloads/pdf/global_brief_hypertension.pdf
Collier, S. R., & Landram, M. J. (2012). Treatment of prehypertension: lifestyle and medication. Vascular health and risk management, 8, 613–619. https://doi.org/10.2147/VHRM.S29138
https://dph.georgia.gov/heart-disease-prevention. Accessed January 19, 2020.
Ferdinand K. C. (2016). Cardiovascular risk reduction in African Americans: Current concepts and controversies. Global cardiology science & practice, 2016(1), e201602. doi:10.21542/gcsp.2016.2
Flynn, S. J., Ameling, J. M., Hill-Briggs, F., Wolff, J. L., Bone, L. R., Levine, D. M., Roter, D. L., Lewis-Boyer, L., Fisher, A. R., Purnell, L., Ephraim, P. L., Barbers, J., Fitzpatrick, S. L., Albert, M. C., Cooper, L. A., Fagan, P. J., Martin, D., Ramamurthi, H. C., & Boulware, L. E. (2013). Facilitators and barriers to hypertension self-management in urban African Americans: perspectives of patients and family members. Patient preference and adherence, 7, 741–749. https://doi.org/10.2147/PPA.S46517
Frederieke S Diemer, Se-Sergio M Baldew, Yentl C Haan, Jet Q Aartman, Fares A Karamat, Lenny M W Nahar-van Venrooij, Gert A van Montfrans, Glenn P Oehlers, Lizzy M Brewster, Hypertension and Cardiovascular Risk Profile in a Middle-Income Setting: The HELISUR Study, American Journal of Hypertension, Volume 30, Issue 11, November 2017, Pages 1133–1140, https://doi.org/10.1093/ajh/hpx105
Fuchs, F.D., de Mello, R.B. & Fuchs, S.C. Preventing the Progression of Prehypertension to Hypertension: Role of Antihypertensives. Curr Hypertens Rep 17, 505 (2015). https://doi.org/10.1007/s11906-014-0505-1
Glasser, S. P., Judd, S., Basile, J., Lackland, D., Halanych, J., Cushman, M., Prineas, R., Howard, V., & Howard, G. (2011). Prehypertension, racial prevalence and its association with risk factors: Analysis of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. American journal of hypertension, 24(2), 194–199https://doi.org/10.1038/ajh.2010.204
Ibekwe, R. (2015). Modifiable Risk Factors of Hypertension and Socio-demographic Profile in Oghara, Delta State; Prevalence and Correlates. Annals of medical and health sciences research, 5(1), 71–77. https://doi.org/10.4103/2141-9248.149793
Jones, L. M., Wright, K. D., Wallace, M. K., & Veinot, T. (2018). “Take an opportunity whenever you get it”: Information Sharing Among African American Women With Hypertension. Journal of the Association for Information Science & Technology, 69(1), 168–171. https://doi-org.su.idm.oclc.org/10.1002/asi.23923
Khatib, R., Schwalm, J. D., Yusuf, S., Haynes, R. B., McKee, M., Khan, M., & Nieuwlaat, R. (2014). Patient and healthcare provider barriers to hypertension awareness, treatment, and follow up: a systematic review and meta-analysis of qualitative and quantitative studies. PloS one, 9(1), e84238. https://doi.org/10.1371/journal.pone.0084238
Kokubo, Y., Padmanabhan, S., Iwashima, Y., Yamagishi, K., & Goto, A. (2019). Gene and environmental interactions according to the components of lifestyle modifications in hypertension guidelines. Environmental health and preventive medicine, 24(1), 19. doi:10.1186/s12199-019-0771-2
Larson, E., Rabkin, M., Mbaruku, G., Mbatia, R., & Kruk, M. (2017). Missed Opportunities to Improve the Health of Postpartum Women: High Rates of Untreated Hypertension in Rural Tanzania. Maternal & Child Health Journal, 21(3), 407–413. https://doi-org.su.idm.oclc.org/10.1007/s10995-016-2229-0
Meiqari, L., Nguyen, T. P., Essink, D., Zweekhorst, M., Wright, P., & Scheele, F. (2019). Access to hypertension care and services in primary healthcare settings in Vietnam: a systematic narrative review of existing literature. Global health action, 12(1), 1610253. doi:10.1080/16549716.2019.1610253
Michaels, E. K., Reeves, A. N., Thomas, M. D., Price, M. M., Hasson, R. E., Chae, D. H., & Allen, A. M. (2019). Everyday Racial Discrimination and Hypertension among Midlife African American Women: Disentangling the Role of Active Coping Dispositions versus Active Coping Behaviors. International journal of environmental research and public health, 16(23), 4759. doi:10.3390/ijerph16234759
Muntner, P., Abdalla, M., Correa, A., Griswold, M., Hall, J. E., Jones, D. W., Mensah, G. A., Sims, M., Shimbo, D., Spruill, T. M., Tucker, K. L., & Appel, L. J. (2017). Hypertension in Blacks: Unanswered Questions and Future Directions for the JHS (Jackson Heart Study). Hypertension (Dallas, Tex. : 1979), 69(5), 761–769. https://doi.org/10.1161/HYPERTENSIONAHA.117.09061
Mueller, M., Purnell, T. S., Mensah, G. A., & Cooper, L. A. (2015). Reducing racial and ethnic disparities in hypertension prevention and control: what will it take to translate research into practice and policy? American journal of hypertension, 28(6), 699–716. https://doi.org/10.1093/ajh/hpu233
Muntner, P., Carey, R. M., Jamerson, K., Wright, J. T., Jr, & Whelton, P. K. (2019). Rationale for Ambulatory and Home Blood Pressure Monitoring Thresholds in the 2017 American College of Cardiology/American Heart Association Guideline. Hypertension (Dallas, Tex. : 1979), 73(1), 33–38. https://doi.org/10.1161/HYPERTENSIONAHA.118.11946
https://www.nhlbi.nih.gov/health-topics/dash-eating-plan
Nuttall F. Q. (2015). Body Mass Index: Obesity, BMI, and Health: A Critical Review. Nutrition today, 50(3), 117–128. doi:10.1097/NT.0000000000000092
Peters, R. M., Aroian, K. J., & Flack, J. M. (2006). African American culture and hypertension prevention. Western journal of nursing research, 28(7), 831–863. doi:10.1177/0193945906289332
Peters, R. M., & Templin, T. N. (2010). Theory of planned behavior, self-care motivation, and blood pressure self-care. Research and theory for nursing practice, 24(3), 172–186. doi:10.1891/1541-6577.24.3.172
Redmond, N., Booth III, J. N., Tanner, R. M., Diaz, K. M., Abdalla, M., Sims, M., Muntner, P., Shimbo, D., & Booth, J. N., 3rd. (2016). Prevalence of Masked Hypertension and Its Association with Subclinical Cardiovascular Disease in African Americans: Results From the Jackson Heart Study. Journal of the American Heart Association, 5(3), 1–8. https://doi-org.su.idm.oclc.org/10.1161/JAHA.115.002284
Rimando, M.(2015). Perceived barrier to and facilitators of hypertension management among underserved African Americans older adults.https://ethndis.org/edonline/index/php/ethndis/article/view57/73.Volume 25,no 3.
Rodriguez-Iturbe, B., Pons, H., & Johnson, R. J. (2017). Role of the Immune System in Hypertension. Physiological reviews, 97(3), 1127–1164. doi:10.1152/physrev.00031.2016
Selassie A, Wagner CS, Laken ML, Ferguson ML, Ferdinand KC, Egan BM. Progression is accelerated from prehypertension to hypertension in blacks. Hypertension. 2011;58(4):579–587. doi:10.1161/HYPERTENSIONAHA.111.177410
Senthil, S., & Krishndasa, S. N. (2015). Pre-Hypertension in Apparently Healthy Young Adults: Incidence and Influence of Haemoglobin Level. Journal of clinical and diagnostic research : JCDR, 9(11), CC10–CC12. https://doi.org/10.7860/JCDR/2015/14970.6847
Staffileno, Beth A. PhD, FAHA; Zschunke, Jessica BS; Weber, Mallery BS; Gross, Lauren E. BS; Fogg, Louis PhD; Tangney, Christy C. PhD, CNS, FACN .The Feasibility of Using Facebook, Craigslist, and Other Online Strategies to Recruit Young African American Women for a Web-Based Healthy Lifestyle Behavior Change Intervention. Journal of Cardiovascular Nursing. 32(4):365-371, July/August 2017. [ARTICLES: Technology] AN: <strong>00005082-201707000-00009</strong>.
Tabrizi, J. S., Sadeghi-Bazargani, H., Farahbakhsh, M., Nikniaz, L., & Nikniaz, Z. (2016). Prevalence and Associated Factors of Prehypertension and Hypertension in Iranian Population: The Lifestyle Promotion Project (LPP). PloS one, 11(10), e0165264. https://doi.org/10.1371/journal.pone.0165264
Umar, A. B., Koehler, T. J., Zhang, R., Gilbert, V., Farooq, M. U., Davis, A. T., … Gorelick, P. B. (2019). Stroke knowledge among middle and high school students. Journal of International Medical Research, 4230–4241. https://doi.org/10.1177/0300060519858887
Wall HK, Hannan JA, Wright JS. Patients with Undiagnosed Hypertension: Hiding in Plain Sight. JAMA. 2014;312(19):1973–1974. doi:10.1001/jam
a.2014.15388 Chan, M.(2013).[A global brief on hypertension]Retrieved.February1,2020.https://ish-world.com/downloads/pdf/global_brief_hypertension.pdf
Whelton PK, Carey RM, Aronow WS, et al (2017)ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018;71:e127-e248
Williams, S. K., Ravenell, J., Seyedali, S., Nayef, S., & Ogedegbe, G. (2016). Hypertension Treatment in Blacks: Discussion of the U.S. Clinical Practice Guidelines. Progress in cardiovascular diseases, 59(3), 282–288. https://doi.org/10.1016/j.pcad.2016.09.004
Yancu, Cecile N.; DeBono, Amber; Lee, Anna K.; McRae, Correll; and Witherspoon, Daphne (2018) “Prehypertensive Risk Among African-American Undergraduates: Do The Extra Pounds Really Matter?,” Journal of Health Disparities Research and Practice: Vol. 11 : Iss. 4 , Article 2.
Available at: https://digitalscholarship.unlv.edu/jhdrp/vol11/iss4/2