Telemonitoring Blood Pressure Control in African Americans

Introduction

Ethnicity and race are sometimes linked to the body's response to hypertension, since blood pressure levels can vary with salt intake and other factors that differ across ethnic groups. Among African Americans, high levels of blood pressure, also known as hypertension, are commonly observed. Non-Hispanic Black adults experience hypertension more frequently than non-Hispanic Whites (54 percent and 46 percent, respectively) (Centers for Disease Control and Prevention, 2020). The reasons for these elevated rates can be linked to ethnicity, as environmental factors, eating habits, weight, and other health risk factors all contribute to hypertension. This paper reviews previous research articles to provide background literature and theory on this identified clinical problem.

Background and Significance

African Americans have the highest rates of hypertension among all racial groups in the United States. Research indicates that hypertension is more likely to develop among Black Americans: forty-three percent of African Americans have high blood pressure compared to 28 percent of non-Hispanic Whites in the hypertensive population (Skolarus et al., 2018). Prevention is of paramount importance, as untreated hypertension may lead to cardiovascular disease and death. Middle-aged African Americans show higher rates of this disease compared to middle-aged Whites, and racial disparities continue to leave hypertension uncontrolled in this community.

Several factors contribute to this disparity during the middle years of life, including employment demands, the pressure of providing care to families in a racially unequal society, and the burden on young families navigating complex social environments. A cardiovascular risk factor emerges when psychosocial, socio-economic, and other patient-level factors interfere with self-management of blood pressure and adherence to medication (Barton et al., 2018). Another risk factor is the failure to treat hypertension promptly when detected. Medical appointments related to hypertension increase over time, and maintaining regular face-to-face meetings with healthcare providers becomes increasingly difficult.

There is a clear need for continuous monitoring to keep patients on track and support lifestyle modifications that help control blood pressure. Dietary approaches aimed at reducing sodium intake and increasing physical activity are recommended. Stress is a significant risk factor for hypertensive African Americans, and being overweight further exacerbates this chronic condition. Medication adherence is pivotal, and mHealth approaches using technology and mobile applications are becoming more common. Although still in early stages of adoption, these tools can simplify blood pressure monitoring and provide a low-cost, effective method for encouraging adherence among African Americans across diverse geographical locations (Buis et al., 2017).

Mobile-based blood pressure monitoring devices allow patients to track their own readings and transmit data to remote providers through dedicated applications. Patients require education to use these tools effectively, and smartphones — now widely owned — are the primary platform. Older patients require special attention, as adapting to new technology and changing longstanding lifestyle and behavioral patterns presents unique challenges. African Americans utilize emergency department services for hypertension management more than any other racial group, making technological interventions increasingly necessary (Buis et al., 2019).

Assessment of the Phenomenon

The current state of hypertension management among African Americans requires change. Key examples include the urgent need for technological intervention, given that African Americans experience higher rates of this disease than all other racial groups in America. Older patients in particular need education on how to use smartphone applications to communicate daily blood pressure readings and medication schedules with their healthcare providers. Follow-up visits should be scheduled to enable weekly or monthly tracking for disease control. When a patient is away from home and experiences adverse blood pressure changes, timely contact with a nurse or physician via video call or text message can be critical. Telecommunication tools thus play an important role in early detection and accurate control of hypertension.

Gaps in the existing evidence highlight the educational needs of patients — especially older adults — and the importance of increasing acceptance of telemonitoring in the African American community. The reviewed studies do not comprehensively address how to shift perceptions toward telemonitoring, nor how to make it a more recognized priority. Further research is needed that specifically investigates how older members of this community respond to new technologies and whether they are willing to adopt interventions that support medication adherence. Future studies should be inclusive of the older population to address these questions.