Margaret Scisney-Matlock

Strategies for Implementing and Sustaining Therapeutic Lifestyle Changes as Part of Hypertension Management in African Americans

Abstract 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 individuals 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.

The Interaction of Age and Cognitive Representations in Predicting Blood Pressure

The purpose of this study was to investigate the interaction of age and cognitive representations of hypertension in predicting blood pressure. A model of illness self-regulation was used as the theoretical framework for the study. Secondary analysis of data collected from 224 hypertensive adult outpatients was conducted to assess five constructs of illness. ANOVA results indicated that older adults reported fewer hypertension-related symptoms than younger-and middle-aged adults, and that younger adults reported fewer health behaviors to control hypertension than did middle-aged and older adults. Results of hierarchical multiple regression models indicated that after adjusting for effects of demographic factors, no single cognitive representation construct was a significant predictor of blood pressure. The interactions of age and three cognitive representation constructs were, however, significant predictors of blood pressure. For younger adults, increases in the perceived Consequences, Control, and Timeline for hypertension were predictive of decreases in hypertension, although for older adults increased perceptions of control were associated with increased blood pressure.

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

BackgroundThe 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. MethodsBlood 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). ResultsBland–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 womens 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). ConclusionThese 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.

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.

Measuring behavior: Electronic devices in nursing studies

T HIS ARTICLE provides information about a variety of electronic measuring devices that should help increase the efficiency and usefulness of clinical nursing research. The devices reviewed include two-way beepers, medication dispensers, and monitors for sleep, activity, and heart rate and have been used in clinical studies for conditions such as hypertension, tuberculosis (TB), dementia, narcolepsy, exercise during pregnancy, and family planning. Although easy to use and representative of the state of the art in clinical research, electronic devices tend to be costly, and technical problems can require either specialized expertise or communication with the manufacturer or distributor. The advantages and disadvantages of using these devices in clinical research are presented. The purpose of this article is to add to existing information (e.g., Fahrenberg & Myrtek, 1996; Frank-Stromborg & Olsen, 1997) about data gathering techniques that directly measure behaviors of importance to nurses in research and clinical practice. The six devices reviewed were chosen to cover the most relevant classifications proposed by Jacox, Pillar, and Redman (1990): drugs, devices, and behaviors that are in the domains of prevention/ promotion, assessment/diagnosis, and interventions/ therapeutics. All met the following criteria: (1) behaviors measured are within nursings domain; (2) behaviors measured span several areas of specialization and scope of practice; (3) behaviors measured are important to client/patient outcomes; (4) use of the device can promote an integration of behavioral and biomedical information; and (5) instructions for use are easy to follow.

Therapeutic Lifestyle Changes to Decrease Unhealthy Eating Patterns and Improve Blood Pressure in African Americans

Data are limited for effective therapeutic lifestyle modifications or therapeutic lifestyle changes (TLC) interventions targeting minorities for promoting healthy eating behaviors and improving high blood pressure. Unhealthy eating habits or adverse lifestyle behaviors are directly related to high blood pressure. The purpose of this chapter is to address a critical gap in hypertension research on how to provide knowledge to sustain effective non-pharmacological treatment or TLC to and modify unhealthy eating and unhealthy eating. Specifically the beneficial effects of Dietary Approaches to Stop Hypertension (DASH) diet are highlighted, with a description of the theory-driven conceptual framework anchored by cognitive social and self-regulation model theories. These approaches identify how cognitive representations or culturally relevant perceptions (beliefs, attitudes, and intensions for behavior) affect the knowledge to set goals and guide decisions for motivation and self-confidence to accomplish long-term lifestyle behavioral changes.