There Is a Very High Incidence of Hypertension, Research Paper Example

Introduction

This critical research analysis pertaining to the very high incidences of hypertension among African Americans will embrace a comprehensive review of seven relevant studies drawn from relevant peer-reviewed journals addressing the subject. Further, conclusions regarding convergent and divergent findings will be discussed exploring features of the problem, which remain obscure. In concluding, recommendations relating new approaches to screening, criteria and management ought to be upgraded distinctively into understanding this phenomenon among the prevailing population.

Comprehensive review of relevant Studies

Introduction

Studies pertaining to incidences of African American hypertensive phenomenon have been drawn from several research projects. Some differentiate between men and women while others group the genders and speak about this condition from a collective perspective. For example, one such study developed assumptions pertaining to prevalence of hypertensive complications among African American women. These researchers contended that African American women were at higher risk of complication arising from the disease. Studies varied immensely in their methodologies to arrive at the peculiar incidences discovered.

Studies selected from journals

Discussions on the incidences of hypertension among African Americans varied in context of the occurrences according to authors’ perspective of prevalence and the major features affecting the emergence. For example, studies covered evaluations pertaining to, Multilevel Associations of Neighborhood Poverty, Crime, and Satisfaction with Blood Pressure in African–American Adults (Coulon, Alia & Horn, 2015) and Prevalence, Determinants, and Clinical Significance of Masked Hypertension in a Population-Based Sample of African Americans (Diaz,  Veerabhadrappa  & Brown, 2014) through a Jackson heart study. Others explored the Aldosterone-to-Renin Ratio and the Relationship between Urinary Salt Excretion and Blood Pressure in a Community of African Ancestry (Majane, Paiker & Norton, 2011).

Further studies discovered through the Jackson Heart Study that Socioeconomic Position Is Positively Associated with Blood Pressure Dipping among African-American Adults (Hickson, Roux & Wyatt, 2011). Due to these factors relating prevalence and incidence of hypertension among African Americans, researchers were forced to study strategies for implementing and sustaining therapeutic lifestyle changes as part of hypertension management in African Americans (Scisney-Matlock, Bosworth, Giger & Strickland, 2009) in an effort to contain the escalating incidences among this vulnerable group. This concern regarding the incidences of hypertension led researchers into investigating provider communication effects medication adherence in hypertensive African Americans ( Schoenthaler, Chaplin & Allegrante, 2009).

Recurring incidences of hypertension among African Americans have forced researches into questioning  the issue of Reports of Racial Discrimination, Trust in Physicians, and Medications Adherence among Inner-City African Americans with hypertension ( Cuffee,  Hargraves &  Rosal, 2013). An investigation into the Prevalence Rate of Hypertension Self-care Activities among African Americans (Warren-Findlow &  Seymour, 2011) provided clarifications to the preceding researchers’ suspicions. While ‘Family Adaptability and Cohesion and High Blood Pressure among Urban African American women’ ( Brittain,  Taylor, & Yi Wu, 2010) gave more insights into the incidence profile.

 Analysis of methodologies

The methodologies applied by researchers in establishing a relationship between African Americans and hypertensions ranged from synthesis of scientific data to retrieval of data through scientific instrumentation and scaling measurements( Cuffee et.al, 2013). Other types of methodologies included cross-sectional studies; interviews as instruments after adapting the survey technique. There were some that utilized monitoring of patients’ blood pressure for a given period as an observational methodology whereas there were researchers who choose to more intense research methodologies such as the cross-sectional which were dominant among studies retrieved for this research analysis (Majane et.al, 2011)(Hickson et.al, 2011) (Diaz et.al, 2014) (Coulon et.al, 2015)( Schoenthaler et. al, 2009).

According to scientific research practice methodologies reflect the strength of evidence produced from the study. From these researchers’ perspective especially those applying the cross sectional approach, the methodologies selected were the most appropriates ones for the specific topic being investigated. For example, a cross-sectional research project is often undertaken in medical research even though the origin has been in psychology science. The major advantage above surveys is that it offers scope for data analysis on specific topics such as the very high incidence of hypertension among African Americans analysis (Majane et.al, 2011) (Hickson et.al, 2011) (Diaz et.al, 2014) (Coulon et.al, 2015)( Schoenthaler et. al, 2009).

Based on the researchers’ concern or interest regarding very high incidences/prevalence of hypertension, a sample was selected from a population of African Americans whose profile met the inclusion criteria for that particular area of interest. For instance studies relating the socio –economic and cultural implications of the prevalence/incidence would recruit samples from a relevant population of African Americans with socio-economic and cultural dispositions towards frequency of hypertension diagnosis (Majane et.al, 2011) (Hickson et.al, 2011) (Diaz et.al, 2014) (Coulon et.al, 2015)( Schoenthaler et. al, 2009).

Importantly, cross-sectional studies allow researchers to compare populations. Again, when investigating a particular variable pertaining to culture and socio-economic implications of the hypertension occurrence among African this type of observational investigation will utilize a subset of the population that does not reflect the inclusion criteria while the intervention group undertakes the treatment measurements. This aspect of a cross-sectional research method offers validity and reliability to the findings (Majane et.al, 2011) (Hickson et.al, 2011) (Diaz et.al, 2014) (Coulon et.al, 2015)( Schoenthaler et. al, 2009). Consequently, researchers who adapt the cross-sectional approach are at an advantage above those utilizing surveys through interviews or questionnaires to gather data for their study.

It must be clarified, however, that in medical research as the ones undertaken by these researchers, among the various projects listed in the introductory pages of this document, the cross-sectional approach does not encompass case controls, which is another research intervention. In healthcare cross-sectional studies describe an area of interest identifying the odds while also explaining absolute and relative risks along with outlining prevalence. This was an identifiable feature in the methodology undertaken by researchers Majane et.al, Hickson et.al, Diaz et.al, Coulon et.al and Schoenthaler et.al.

In concluding this section of the research analysis, survey method adapted by researchers Brittain, Taylor,  Yi Wu(2010 )  Schoenthaler,  Chaplin & Allegrante (2009) Cuffee,   Hargraves,  &  Rosal (2013) and Warren-Findlowd &  Seymour (2011) even though they could have used a more advanced method applicable to medical research simplicity on many occasions is just as effective. While surveys may cover a wide cross- section of the population once the researcher could establish internal and external validity during the research practice a very high level of evidence as cross-sectional method can be established.

Data retrieved from systemic reviews exploring randomized controlled trials produce the highest level of evidence in medical research. No systemic reviews were used among the studies selected for this critical analysis pertaining to the very high incidence of hypertension among African Americans. It follows then that an inevitable limitation of this analysis lies in the ability to produce level 1 empirical evidence from the studies evaluated.

 Analysis of findings/results

The actual findings pertaining to whether there is a very high incidence of hypertension among African Americans while communicated in much literature evidence supporting this phenomenon from empirical studies is obscure.  There are many suspicions regarding whether this is another strategy of marginaling African Americans as a people and ruin their health perception status; subsequently forcing them to become incapable of functioning as valuable social beings. This perspective constitutes the analysis of findings of this research review.

Specific findings from ‘Reports of Racial Discrimination, Trust in Physicians, and Medications Adherence among Inner-City African Americans with hypertension ( Cuffee et.al. 2013) revealed using secondary data from TRUST project that African Americans living in Birmingham, Alabama, that African Americans were more likely to be diagnosed with hypertension than any other race (Cuffee et.al, 2013).

Besides, the morbidity and mortality rates were highest among the identified population. More importantly, African Americans were more likely to suffer serious clinical consequences because it was further diagnosed that their blood pressure was uncontrolled by the conventional methods of hypertension criteria delivered by the healthcare system.‘Psychological and social factors, such as health literacy, cultural beliefs, and attitudes toward health care and the health care system, may be critically important determinants of hypertension disparities,’ ( Cuffee et.al, 2013, p 10).

Researchers also found that racial discrimination is also a powerful force determining diagnosis and treatment of hypertension concluding that the risk of discrimination increases incidences of uncontrolled hypertension as well as non-compliance with treatment measures outlined by healthcare providers (Cuffee et.al, 2013). This feature of the very high incidence hypertension phenomenon was supported by other studies when researchers challenged the communication system used by healthcare providers when discussing the condition with an African American in comparison to other ethnic groups. Fifty-one percent (51%) of African American patients sampled in the study that revealed provider communication effects medication adherence in hypertensive African Americans (Schoenthaler. al, 2009) said that their interaction was non collaborative.

While Cuffee (2013) and counterparts did mention socio-economic cultural influence on hypertension diagnosis among African Americans, unlike other researchers she did not use those factors as the main determinants for hypertension diagnosis and compliance with treatment as  Hickson (2011 and colleagues  proposition pertaining to ‘Socioeconomic Position Is Positively Associated with Blood Pressure Dipping among African-American Adults’ (Hickson et.al, 2011).

In addressing the incidences with regards to cormobities among African Americans diagnosed with hypertension, treatment discrepancies were exposed. Healthcare protocols have been established to diagnose and treat hypertension from an African American perspective since they have become a distinct population suffering from the condition. This in itself has been considered discriminatory ( Brittain et.al, 2010 ) (Coulon, 2015) (Diaz et.al,2014)( Majane et.al, 2011) (Scisney-Matlock et,al,2009)( Warren-Findlow et.al, 2011).

Conclusions about what is known from the convergent and divergent findings

 Conclusions, which can be drawn from this research regarding any phenomenon in the society relating health status of African Americans, are that research projects must be fully scrutinized by organizations representing African American rights to be accepted as authentic. They must pass internal and external validity tests. Adjacent studies conducted with Africans in other parts of the world comparing socio-economic status and diet, reveal that there is no high incidence of hypertension in their populations (Majane et.al, 2011).

Exposure concerning the Tuskegee study leaves much concerns regarding research involving African Americans as subjects. How accurate are the findings? Are they predesigned to provide adherence to political ideologies? Is there a hidden motive behind the ones communicated to participants and the public? A matter of concern relates to continuously studies showing African Americans generally sustaining a very low health status within the society. As a façade their health condition is blamed on socio-economic status, lack of health insurance and culture. Are these findings authentic?

What is still not conclusively known?

 What is being communicated through research regarding African Americans’  hypertension incidence ratios in relation to Hispanics, Caucasian and Native Americans is that there is a very high prevalence rate. The condition is also uncontrolled. It is believed that even when medications are free they do not take them due to their serious side effects. So the socio-economic variable has been discounted (Cuffee et.al, 2013).

What is not known relates to how African Americans respond to hypertensive medications as against other ethnic groups. They have been known to have a consistently high incidence of uncontrolled high blood despite application of empirically proven medication regimes applicable to them exclusively (Diaz et.al, 2014). Could it be that in an absence of empirical evidence providing mean blood pressure values for classifying hypertension among African Americans exclusively, they have been misdiagnosed as being hypertensive when they are truly not? Also, could it be that the medication regimes they are forced to comply with are responsible for the morbidities emerging from what is considered the disease? These issues are yet to be clarified from empirical evidence, which now distinguish every African American as a potential case of hypertension without even conducting all the appropriate investigations.

Conclusion

Hence, recommendations for future research must be aimed at establishing a mean blood pressure reading/value exclusively for African and not adopting means of other ethnic groups in the society. If studies could be provided to offer medication protocols for this population, then it this ought to be preceded by honest intense investigation into whether the 140/90 millimeters of mercury is a realistic  value for African Americans.

References

Brittain, K.  Taylor, J., & Yi Wu, C. (2010 ). Family Adaptability and Cohesion and High Blood Pressure among Urban African American womenJ Nurse Pract. 6(10): 786–793.

Coulon, S. Alia., & Horn M. (2015). Multilevel Associations of Neighborhood Poverty, Crime, and Satisfaction With Blood Pressure in African-American Adults Am J Hypertens ,82; 18-24

Cuffee, Y.  Hargraves, L., &  Rosal, M. (2013). Reported Racial Discrimination, Trust in Physicians, and Medication Adherence among Inner-City African Americans With Hypertension. Am J Public Health. 103(11): e55–e62.

Diaz, K. Veerabhadrappa, P., & Brown, M. (2014). Prevalence, Determinants, and Clinical Significance of Masked Hypertension in a Population-Based Sample of African Americans: The Jackson Heart Study Am J Hypertens, 28 (7); 900 -908

Hickson, D. Roux, A., & Wyatt, S. (2011) Socioeconomic Position Is Positively Associated With Blood Pressure Dipping Among African-American Adults: The Jackson Heart Study Am J Hypertens (2011) 24 (9): 1015-1021

Majane, O. Paiker, J.,& Norton,G. (2011). Aldosterone-to-Renin Ratio and the Relationship Between Urinary Salt Excretion and Blood Pressure in a Community of African Ancestry Am J Hypertens (2011) 24 (8): 951-957

Schoenthaler, A.  Chaplin, W., & Allegrante, J. (2009). Provider Communication effects Medication adherence in hypertensive African Americans. International Journal of Communication in Healthcare,75(2);185-191

Scisney-Matlock , M. Bosworth, H. Giger J., & Strickland, O.(2009). Strategies for Implementing and sustaining therapeutic lifestyle changes as part of hypertension Management in African Americans. Postgrad Med.121(3):147–159

Warren-Findlow, J., &  Seymour, R. (2011). Prevalence Rates of Hypertension Self-care Activities among African Americans. J Natl Med Assoc.103(6): 503–512.