Afam Hypertension in African-Americans Culturally 'Literature Review' chapter

Excerpt from 'Literature Review' chapter :

2009). The interventions used in this research study proved to be ineffective, however, and it has been suggested that more culturally relevant study leading to the development of more highly-culturally-specific practices is needed in this regard (Pekmezi et al. 2009).

Certain studies have also demonstrated a reduced efficacy of certain blood-pressure regulating pharmaceuticals in the African-American community, with certain individuals responsive to one type of medication but not others (Lackland 2004). This is significant in the area of hypertension prevention in the African-American community for several reasons, not the least of which is the fact that it is evidence of certain mechanisms at work that are still not fully understood or even necessarily identified in the medical literature (Lackland 2004). In addition, this suggests that there are certain predispositions that both affect hypertension and interrupt the mechanisms of drugs proven efficacious in other communities, which could provide greater insight into why hypertension remains so prevalent amongst African-Americans (Lackland 2004).

This and similar advances in research have not been adequately pursued, however, in fact evidence from the beginning of the decade suggests that the fight against a higher prevalence of hypertension in the African-American community might already be on a losing streak (Glover et al. 2005). Through the course of the 1990s and into the first years of the new millennium, there was an increase in the prevalence of hypertension in the three major ethnic divisions studied (non-Hispanic whites, non-Hispanic blacks, and Hispanics), suggesting that preventative efforts have not been especially efficacious in any of these demographics (Glover et al. 2005). At the same time, there was an observed increase in the awareness of their condition by patients in all demographics but the increase of awareness in the non-Hispanic black community observed in this study was lower than that of the other groups, suggesting an educational and outreach disparity at work here, as well (Glover et al. 2005).

An even more demonstrable disparity exists in the recommended best practices for treating individuals with hypertension and the actual treatment that African-Americans receive for their diagnosed hypertension (Henderson et al. 2003). While beta-blockers have long been identified as especially effective and more often necessary in the African-American community when combating hypertension or preventing the worsening of the condition and attendant dangers, more than forty percent of patients in a long-term study of medical practices were not receiving medications in accordance with clearly established guidelines (Henderson et al. 2003). The reasons behind this remain unclear, but the results are resoundingly negative.

One of the most direct studies regarding the cultural issues involved in preventing hypertension in the African-American community focused far more on cultural influences than on medical interventions and means of overcoming cultural barriers. In many ways, this study suggests, the perception of a "closed" and "different" African-American culture held by many African-Americans is counterproductive to prevention strategies, as it reinforces health habits and attitudes from generation to generation and penalizes anyone who is perceived as acting "different" from the African-American cultural norm, in aspects such as eating healthier or exercising for the sake of heart health (Peters et al. 2006). While this study both conclusively and objectively identifies specific cultural barriers, it -- like other studies in the area -- fails to significantly develop successful intervention and prevention strategies, noting only the problems that are faced in this area (Peters et al. 2006).

Implications for Nursing Practice

There are certain implications of this literature review on current and ongoing nursing practice that are fairly clear and self-evident. Among these is the need for greater screening and awareness of hypertension in the African-American community, including early preventative counseling and advice by nurse practitioners with adolescents and young adults in an effort to stave off the development of hypertension. While specific strategies for medical prevention and intervention against hypertension the African-American community have yet to be developed, there is certainly a need for greater knowledge of this issue in the community.

There are other implications that are far less clear, however, and in fact a great many questions for nursing practice and for nursing and medical research are raised by this review. It is unclear, for instance, whether or not it is truly beneficial to truly push for standard blood pressure goals through accepted behavior and lifestyle modification, or if this might actually cause a certain negative and reactionary response that drives more individuals towards risky behaviors due to cultural imperatives to remain within certain bounds of traditional behaviors and values. Also unclear is whether there are truly significant enough differences in the progress and development of hypertension to warrant the continuing search for culturally relevant strategies of hypertension prevention amongst the African-American community. While this author certainly believes that such strategies should and could exist given proper empirical study, the published literature has yet to bear out this conclusion.


There have not yet been any clearly defined strategies for preventing hypertension amongst African-Americans or reducing the prevalence of the disorder in this community, other than the general recommendations that are made in regards to hypertension prevention for all individuals. Educational and awareness outreach programs have been identified as especially useful in all communities, and the more culturally relevant the educational materials the more effective they are likely to be, but this does not provide a medical answer to the problem. For this, more research is necessary.


Douglas, J., Bakris, G., Epstein, M., Ferdinand, K., Ferrario, C., Flack, J…. & Vidt, D. (2003). Management of High Blood Pressure in African-Americans: Consensus Statement of the Hypertension in African-Americans Working Group of the International Society on Hypertension in Blacks. Archives of Internal Medicine 163(5): 525-41.

Glover, M., Greenlund, K., Ayala, C. & Croft, J. (2005). Racial/Ethnic Disparities in Prevalence, Treatment, and Control of Hypertension -- United States, 1999-2002. JAMA 293(8): 923-5.

Harvard. (2003). High blood pressure isn't color-blind. Harvard heart letter 13(10):1.

He, J., Klag, M., Caballero, B., Appel, L., Charleston, J. & Whelton, P. (1999). Plasma insulin levels and incidence of hypertension in African-Americans and Whites. Archives of internal medicine 159(5): 498-503.

Heartline. (1998). Hypertension initiative targets churchgoers. Nursing 28(6): 68.

Henderson, S., Bretsky, P., DeQuattro, V. & Henderson, B. (2003). Treatment of Hypertension in African-Americans and Latinos: The Effect of JNC VI on Urban Prescribing Practices. The journal of clinical hypertension 5(2): 107-12.

Lackland, T. (2004). Hypertension Control Among African-Americans: An Urgent Call for Action. Journal of clinical hypertension 6(6): 332-3.

Moulton, S. (2009). Hypertension in African-Americans and its related chronic diseases. Journal of Cultural Diversity 16(4): 165-70.

Pekmezi, D., Babera, B., Bodenlos, J., Jones, G. & Brantley, P. (2009). Promoting Physical Activity in Low Income African-Americans: Project LAPS. Journal of Health Disparities Research & Practice 3(2): 82-91.

Peters, R., Arolan, K. & Flack, J. (2006). African-American Culture and Hypertension Prevention. Western Journal of…

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