Migration and cognitive representations of hypertension in african immigrant women.

The purpose of this study was to use the Self-Regulation Model on African immigrant women, to determine the association of migration and residence in the United States with cognitive representations and dietary behavior, and also to explore migration stress and blood pressure (BP) in them. Participants included a convenience sample of 91 Nigerian immigrant women (NIW) and 38 African American women (AAW). Data collection instruments were the Acculturative Stress Scale and the Women's and Men's Hypertension Experiences and Emerging Lifestyle Survey of 2008-2009. Descriptive t test and ANOVA statistics were used to analyze study variables comparing groups and NIW duration of residency in the United States. Knowledge of Hypertension and Cognitive Representation of Hypertension were significantly increased in the NIW by years of residency. Migration stress had no significant relationship with BP level. A longitudinal study initiated on immigrants' arrival in the United States is recommended to understand the trajectory of chronic illnesses such as hypertension.

Management of high blood pressure in Blacks: an update of the International Society on Hypertension in Blacks consensus statement.

Since the first International Society on Hypertension in Blacks consensus statement on the "Management of High Blood Pressure in African American" in 2003, data from additional clinical trials have become available. We reviewed hypertension and cardiovascular disease prevention and treatment guidelines, pharmacological hypertension clinical end point trials, and blood pressure-lowering trials in blacks. Selected trials without significant black representation were considered. In this update, blacks with hypertension are divided into 2 risk strata, primary prevention, where elevated blood pressure without target organ damage, preclinical cardiovascular disease, or overt cardiovascular disease for whom blood pressure consistently <135/85 mm Hg is recommended, and secondary prevention, where elevated blood pressure with target organ damage, preclinical cardiovascular disease, and/or a history of cardiovascular disease, for whom blood pressure consistently <130/80 mm Hg is recommended. If blood pressure is ≤10 mm Hg above target levels, monotherapy with a diuretic or calcium channel blocker is preferred. When blood pressure is >15/10 mm Hg above target, 2-drug therapy is recommended, with either a calcium channel blocker plus a renin-angiotensin system blocker or, alternatively, in edematous and/or volume-overload states, with a thiazide diuretic plus a renin-angiotensin system blocker. Effective multidrug therapeutic combinations through 4 drugs are described. Comprehensive lifestyle modifications should be initiated in blacks when blood pressure is ≥115/75 mm Hg. The updated International Society on Hypertension in Blacks consensus statement on hypertension management in blacks lowers the minimum target blood pressure level for the lowest-risk blacks, emphasizes effective multidrug regimens, and de-emphasizes monotherapy.

Strategies for implementing and sustaining therapeutic lifestyle changes as part of hypertension management in African Americans.

African Americans with high blood pressure (BP) can benefit greatly from therapeutic lifestyle changes (TLC) such as diet modification, physical activity, and weight management. However, they and their health care providers face many barriers in modifying health behaviors. A multidisciplinary panel synthesized the scientific data on TLC in African Americans for efficacy in improving BP control, barriers to behavioral change, and strategies to overcome those barriers. Therapeutic lifestyle change interventions should emphasize patient self-management, supported by providers, family, and the community. Interventions should be tailored to an individual's cultural heritage, beliefs, and behavioral norms. Simultaneously targeting multiple factors that impede BP control will maximize the likelihood of success. The panel cited limited progress with integrating the Dietary Approaches to Stop Hypertension (DASH) eating plan into the African American diet as an example of the need for more strategically developed interventions. Culturally sensitive instruments to assess impact will help guide improved provision of TLC in special populations. The challenge of improving BP control in African Americans and delivery of hypertension care requires changes at the health system and public policy levels. At the patient level, culturally sensitive interventions that apply the strategies described and optimize community involvement will advance TLC in African Americans with high BP.

Reliability and reproducibility of clinic and home blood pressure measurements in hypertensive women according to age and ethnicity.

BACKGROUND: The purposes of this study were to establish the reproducibility and reliability of clinic and home blood pressure readings and to determine whether correlations differed according to age and ethnicity. METHODS: Blood pressure readings taken in a clinical setting and at home from 161 hypertensive women who were either younger or older (including 91 White American and 61 African-American) were compared with 24-h ambulatory blood pressure monitoring (ABPM) readings (considered the gold standard of blood pressure measurement). RESULTS: Bland-Altman statistical method showed good levels of agreement between clinic blood pressures measured 30 days apart, and blood pressures measured at home in the morning over a 30-day program, when compared with mean 24-h ABPM readings. On examining individual Bland-Altman plots for younger and older women, White American and African-American women's blood pressures were well correlated for home measures and 24-h ABPM readings. The correlation between daytime systolic home blood pressure readings and systolic 24-h ABPM readings was much stronger for White American women (r=0.75) than for African-American women (r=0.57). There were also correlation differences in mean systolic blood pressure between home blood pressure readings and 24-h ABPM readings according to age (r=0.66 for younger and r=0.72 for older). CONCLUSION: These results support current research findings that home blood pressure measurements are reliable when compared with 24-h ABPM readings both in African-American and White women.

Development and evaluation of DASH diet tailored messages for hypertension treatment.

For this study, the Manage Associated Perceptions (MAP) of Dietary Behavior Study, researchers developed, evaluated, and tested messages tailored to improve compliance with the Dietary Approaches to Stop Hypertension (DASH) diet by gradually instilling healthy Cognitive Representations of the DASH Diet (CRDDs). The sample consisted of women from diverse backgrounds (N = 53), randomly assigned to two experimental groups (n = 13 and n = 14) and to two control groups (n = 12 and n = 14). The experimental groups performed a version of the intervention for 30 days. Data about dietary compliance and CRDDs were collected at 30, 60, and 90 days. Compared to control group members, experimental group members demonstrated greater improvements in CRDD scores and were significantly more compliant with the diet. Another significant finding was that older women were more compliant.

Comparison of quality-of-hypertension-care indicators for groups treated by physician versus groups treated by physician-nurse team.

PURPOSE: To determine whether the type of health care provider (i.e., physician versus physician-nurse team) affected the quality of hypertension care given to two groups of randomly selected adult women. DATA SOURCES: Three indicators measured the quality of hypertension care: blood pressure control level, knowledge of hypertension, and discussion about blood pressure medications with the health care provider(s). Blood pressure readings were taken with a 24-hr ambulatory blood pressure monitor, and demographic data from survey results taken at orientation and researcher-collected data on posttreatment knowledge of hypertension and cognitive representations of hypertension were gathered. Chi-square and t tests were used to analyze the data. CONCLUSIONS: The group whose care was managed by a physician-nurse team demonstrated lower means for 24-hr systolic blood pressure and diastolic blood pressure (systolic: M = 132, SD = 14.9; diastolic: M = 75, SD = 11.3) than the group whose care was managed only by one or more physicians (systolic: M = 136, SD = 13.4; diastolic: M = 79, SD = 11.24). Also, the group whose care was managed by a physician-nurse team revealed significantly higher scores for discussion of blood pressure medication than the group whose care was managed only by one or more physicians. There were no group differences for knowledge of hypertension. IMPLICATIONS FOR PRACTICE: Nurses qualified to assist with meeting the needs of hypertension clients in primary care settings can positively affect clients' knowledge about blood pressure medication and--perhaps as a result of this knowledge--how well the clients control their blood pressure.