High blood pressure prevalence in African Americans

Statement of the Problem

High blood pressure (HBP) prevalence in African Americans in the US is among the world’s highest. Much of non-Hispanic African American men and women have high blood pressure. High blood pressure also occurs earlier in life and is typically more extreme for African Americans (Maraboto & Ferdianand, 2020).

Uncontrolled hypertension (HTN) in the USA is particularly prevalent and devastating among Black people who are more vulnerable than people from other racial / ethnic groups to the effects of this disease. Moreover, the findings of evidenced based data in this population are frequently underrepresented in cardiovascular clinical trials, restricting their ability to accurately apply them. In this analysis, we summarize and examine the information that is currently available regarding risk factors, manifestations, complications and HTN management in this often difficult to treat population. This practice change project seeks to better understand to what degree of increasing patient’s knowledge on the DASH diet is a best approach for treatment of patients with hypertension (Maraboto & Ferdianand, 2020)

Health organizations urge healthcare providers to participate in programs that help patients control high blood pressure (CDC, 2017). Lifestyle changes recommendations to treat HTN include weight management, exercise, and diet (Yang et al., 2015). Many patients do not adhere to the recommendations because of insufficient education. Educating patients about lifestyle modifications can have a significant impact on their beliefs about hypertension (Yang et al., 2015). Patel et al. (2016) indicated that lack of education was a common reason that patients did not adhere to diet education.

There are many barriers to the management of patients with hypertension, and one that is see daily by health care providers is lack of patient education. It was not known if or to what degree the implementation of a Dietary Approach to Stop Hypertension (DASH) intervention education program would impact the patients’ blood pressure when compared to no intervention among African American patients diagnosed with hypertension in an outpatient clinic in Washington, D.C.

Clinical Question

The primary objective of this practice change project is to determine if a diet approach that emphasizes rich fruits, vegetables, and low fat significantly reduces the development and increased the management of HTN among African Americans. The study also evaluates if lifestyle practices such as exercise and physical therapy significantly reduce the development and management of HTN among black Americans. The PICOT question is: Does the implementation of a Dietary Approach to Stop Hypertension education intervention for patient’s impact blood pressure readings for patients diagnosed with hypertension at an outpatient clinic in Washington, D.C. over a four-week period of time?

The following clinical question guides this quantitative project: 

CQ: To what degree does the implementation of a Dietary Approach to Stop Hypertension education intervention for patient’s impact blood pressure readings for patients diagnosed with hypertension at an outpatient clinic in Washington, D.C. over a four-week period?

The independent variable will be defined as the implementation of a Dietary Approach to Stop Hypertension education for approximately 30 African American adult patients with hypertension. The dependent variable will be defined as mean systolic and diastolic blood pressure before and after the intervention. The question leads to a search for the best evidence that can contribute to a decision about the patient’s care (Harmic, 2009). 

This DPI project will employ a pretest posttest design guided by the theoretical framework Pender’s health promotion model. All patients will be given a 20-minute educational overview on HTN and the effectiveness of the DASH diet. There will be a 5-question pre-posttest designed by DASH “Fruits and Vegetable” given to patients about the DASH diet.  Provider will then counsel and educate patients with hypertension about the DASH and patients’ blood pressures will be evaluated before and after the intervention of the DASH diet.  The DASH was created 20 years ago, and quantitative data demonstrates it consistently lowers BP across a diverse range of patients with HTN and prehypertension (Steinberg, Bennett, & Sevetkey, 2017). Barriers to patients incorporating the DASH diet into their hypertensive management could possibly be lack of provider knowledge and training, and patients lack awareness of the potential benefits of the DASH diet as a means of hypertension management.

Project Methodology Comment by Sharina Sigur: This section is underdeveloped.

A clinical practice change project will be designed and implemented to educate patients about a dietary approach to stop hypertension (DASH) diagnosed with hypertension. This project focuses on increasing patient knowledge and improving HTN management. Patients will be recruited from an outpatient clinic in Washington, D.C. The participants will consist of approximately 10 African American adults diagnosed with hypertension. A pre-posttest design will be utilized and guided by Nolan Pender health promotion model. 

Quantitative methods are most appropriate in the following circumstance: a) clearly defined study variables. b) large sample size available in a cost-effective manner, c) validated instrument available for data collection, and d) a desire to generalize study findings (Leedy, Ormrod, & Johnson, 2019). Quantitative data follow a linear sequence in obtaining answers to quantitative questions (Polit & Beck, 2017). Quantitative methodology is most appropriate for this DPI project, as the focus of quantitative data is to determine the relationship or trends between independent and dependent variables (Polit & Beck, 2017).

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