Awareness and Management of Hypertension

Introduction
Health disparities refer to avoidable dissimilarities existing in the occurrence of violence, disease and injury or in the opportunities for enjoying peak health which is faced by minority and social disadvantaged ethnic and racial populations and communities. Health differences are present across every age group, even in the older adults. Even though general health and life expectancy have both gotten better of recent, the Centres for Disease Control and Prevention knows that not every senior adult is enjoying these benefits equally as a result of factors like race, economic status and gender. The CDC realises that this issue is slowly becoming a huge concern and it is integrating it into our duties (Centers for Disease Control and Prevention, 2015).
Hypertension, commonly called High Blood Pressure, refers to a medical condition where blood flows in its vessels with a higher-than-normal force. When the heart beats, it drives blood through the arteries to other body parts. When the pumped blood presses harder on the arterial wall, blood pressure increases. A human’s blood pressure varies throughout the day. It is mostly higher after an exercise session, when you get up in the morning or when under stress. Hypertension can overwork the heart, rupture blood vessels or raise the danger of stroke, heart attack, kidney problems as well as death (Pcori, 2013).
Identify Statistics
The hypertension therapy regimens employed by adult African Americans within the Jackson Heart Study were analysed during the first two medical examinations (2415 persons at Exam I, 2000–2004; 2577 at Exam II, 2005–08). The blood pressure (BP) reading was lower than 140/90 mm Hg for 66% and 70% at Exam I and II respectively; JNC7 BP treatment objectives were achieved for 56% and 61% at Exam I and II respectively. People living with CKD or diabetes have lower likelihood of having BP at the target. Similarly men have lower likelihood in comparison with women. The most regularly used anti-hypertensive drugs are thiazide diuretics and the people taking these have higher tendencies of having their BP regulated than those who are not. Thiazide use was much less in men compared to women. Though calcium channel blockers are normally considered as effective single therapy for the African Americans, people using this therapy have reduced likelihood of being at the target BP in comparison to people on thiazide single therapy (Harman et al., 2013).
Current Literature
The popularity of hypertension among African Americans is one of the world’s highest and as this population have high likelihood of poorly controlling this condition, they commonly suffer target-organ damage. Among the several American Americans living with hypertension who suffer heart failure, their hypertension is found to be poorly controlled. Nonetheless, even with risk factor adjustments and even blood pressure regulation, African Americans are still at high risk of heart problems especially heart failure (Sharma, Colvin-Adams & Yancy, 2014).
Hypertension is very important to African Americans as it needs intensive examination and aggressive therapy. Anti-hypertension drugs needs to be prescribed in time and there is a reduced possibility of reducing the effectiveness of therapy with drug combinations as most hypertensive persons require above one. A significant debate is raging on the proper blood pressure levels for identifying hypertension as well as the peak target BPs among African Americans. The report submitted by the Joint National Committee in 2014 suggests 140/90 mm Hg as the hypertension therapy target for every patient excluding older adults, in whose case, 150/90 mm Hg is suitable. It also suggests the same targets for all African Americans. Former recommendations made by this committee include the use of thiazide diuretics as the first anti-hypertension therapy for African Americans. The recent recommendations were thiazide diuretics or calcium channel blockers. However, for those suffering from left ventricular systolic malfunction, hypertension therapy should contain drugs which lowers the possibility of death in the case of heart failure i.e., nitrates, angiotensin-converting enzyme (ACE) inhibitors, aldosterone receptor antagonists and beta-blockers (Sharma, Colvin-Adams & Yancy, 2014).
The racial differences seen in hypertension and its related ailments have been identified and one of them is the higher mortality risk of African Americans in comparison to the white Americans. These increased risks of higher BP have a vivid effect on the life expectancy of African-American people which is considerably lower than that of Caucasian Americans. The risks of stroke mortality are twice greater in African Americans. Risks of end-stage kidney problems are five times in African Americans. Furthermore, the age at which problems like stroke surface is significantly earlier in African Americans. For instance, an African American man 45 years old living in the Southeast possesses the same stroke risk of a white man 55 years old and another white man 65 years old who are living in the Southeast and the Midwest respectively. Though HBP is a general problem, HBP is more common in the African American population. This higher prevalence and risk causes considerable population attributable risks. The specific population attributable risk for 30-year mortality and hypertension for white males was 23.8% against 45.2% for black males and for white females, 18.3% against 39.5% among black females (Lackland, 2014).
Interventions
Team-based hypertension therapy is described as a “healthcare systems-level and organizational intervention which employs a team from several disciplines for enhancing hypertension therapy quality.” 28 Teams include the hypertensive person, the person’s major healthcare practitioner as well as other medical personnel like pharmacists, nurses, community healthcare workers and social workers. Every member of the team is enjoined to apply their skills and expertise in improving hypertension therapy via the performance of duties like information provision, patient follow up, helping in the management of patient medications and ensuring patients follow their treatment routines like medication use, exercise sessions, blood pressure checks and reduction of sodium consumption.
Team-based therapy is backed by a solid evidence base. It is also backed by the Community Preventive Services Task Force and the CDC as an efficient method of managing blood pressure. The CDC director, Dr. Thomas Frieden claimed that application of this model all over the country will help enhance blood pressure management for the Americans (68 million in number) living with HBP. However, irrespective of the huge potential team-based care has in lowering strokes and heart attacks, huge research gaps still exist concerning the effectiveness this therapy model has in enhancing results within populations with high tendencies of experiencing dissimilarities. Particularly, there is little or no evidence concerning the relative effectiveness of teams with different compositions and/or teams with different duties for its members on hypertension control (Pcori, 2013).
Available evidence indicates that the interventions which are likely to enhance positive hypertension self-management lifestyles among African Americans include those which are aimed at several levels like the patients and their immediate and expanded social circles. Furthermore, a previous study in which community health workers (CHWs) provided encouragement and assistance to patients (e.g. teaching patient’s family members on how to make sure he/she keeps to appointments) so as to foster self-management lifestyles among patients proved that this brought about considerable progress as regards blood pressure management (Ephraim et al., 2014).
Culturally based patient interventions which directly address the obstacles against hypertension self-management in African American populations and channels the strengths possessed by their patients and also their immediate and expanded social circles for enhancing self-management lifestyles are required. We theorize that interventions built to back urban African American hypertension patients’ self-management via concurrently making use of patient, household and society strengths will enhance their hypertension control (Ephraim et al., 2014).
Policies
Lowering out-of-pocket costs necessitates policy modifications and programs which increases the affordability of cardiovascular disease prevention services. These services include behavioural support and counselling as well as medications. Wider treatment coverage as well as the reduction or outright elimination of out-of-pocket expenses for patients can lower costs. From the evidence available from previous studies, in order to measure the efficacy of ROPC, it is recommended for medication by the Community Preventive Services Task Force. It is equally recommended that it should be used together with other relevant interventions like team-based care and it should be employed alongside with patient education and medication counselling (Ferdinand, 2015). 
Value-dependent insurance design programs are based on the theory that connections between adherence to medication regimes and favourable healthcare outcomes portray a cause-and-effect relationship which can be recreated via interventions which are aimed at adherence to medication. This model defines cost sharing based on a service or medication’s clinical worth rather than its acquisition value. Combined payments can be fixed lower for treatments seen as more effective in comparison to other medications within the same group or instead cost sharing could be reduced for specific populations which have the highest tendencies to gain from better treatment access. A reflective pre-post data evaluation on VBID within a huge insurer database produced results which showed better adherence, reduced healthcare costs and improved disease management. Limited economic evaluations suggest VBID programs are quite cost neutral (Ferdinand, 2015). 
System interventions and population-based policies regarding hypertension deterrence and management are possibly the most relevant and important feature of hypertension packages employed by local and state public health authorities. Naturally, several parts of hypertension deterrence are similar to existing local and state public health authority programs like active living, obesity prevention and healthy eating. Due to this, population methods regarding hypertension needs to be incorporated into the present efforts instead of creating them as standalone, separate programs. Similarly, these present programs might require expansion and adjustment. For instance, the high frequency of hypertension among older populations as well as specific population subgroups like the African Americans should cause local and state public health authorities to evaluate and, if required, adjust these programs so as to ensure that they are appropriate as well as accessible to higher-risk and older populations (Institute of Medicine, 2010). 







References
Centers for Disease Control and Prevention. (2015, September 01). Adolescent and School Health. Retrieved August 02, 2017, from https://www.cdc.gov/healthyyouth/disparities/
Ephraim, P. L., Hill-Briggs, F., Roter, D., Bone, L., Wolff, J., Lewis-Boyer, L., … Boulware, L. E. (2014). Improving Urban African Americans’ Blood Pressure Control through Multi-level Interventions in the Achieving Blood Pressure Control Together (ACT) Study: A Randomized Clinical Trial. Contemporary Clinical Trials, 38(2), 370–382. http://doi.org/10.1016/j.cct.2014.06.009
Ferdinand, K. C. (2015). Hypertension in High Risk African Americans Current Concepts, Evidence-based Therapeutics and Future Considerations. New York, NY: Springer New York.
Harman, J., Walker, E. R., Charbonneau, V., Akylbekova, E. L., Nelson, C., & Wyatt, S. B. (2013). Treatment of hypertension among African Americans: the Jackson Heart Study. Journal of Clinical Hypertension (Greenwich, Conn.), 15(6), 367–374. http://doi.org/10.1111/jch.12088
Institute of Medicine (U.S.). (2010). A population-based policy and systems change approach to prevent and control hypertension. Washington, DC: National Academies Press.
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. http://doi.org/10.1097/MAJ.0000000000000308
Sharma, A., Colvin-Adams, M., & Yancy, C. W. (2014). Heart failure in African Americans: disparities can be overcome. Cleve Clin J Med, 81(5), 301-311.
Pcori. (2013, December 4). Clinical Interventions to Address Hypertension Disparities Workgroup: Topic Briefs. Retrieved August 2, 2017, from https://www.pcori.org/assets/2013/12/PCORI-Hypertension-Workgroup-Topic-Briefs-120413.pdf