November 9, 1998
Environmental stressors contribute significantly to hypertension in young, urban African-American males, but high blood pressure can be dramatically decreased with the intervention of health care providers, researchers at Johns Hopkins University School of Nursing report.
Preliminary results of a two-year study of 309 African-American males ages 18 to 54 show that the absence of high blood pressure treatment and factors such as unemployment, poverty, substance abuse, and lack of health insurance increase environmental stress and raise blood pressure. Efforts of a Hopkins intervention team resulted in blood pressure control rates of almost 50 percent and a decrease of 75 percent in emergency room visits.
Results of the study will be presented at 1:30 p.m., Nov. 9, at the American Heart Association's 71st annual Scientific Sessions in Dallas.
"Young, African-American males suffer some of the lowest rates of hypertension awareness, treatment and control," says Mary C. Roary, M.P.H., project director at Hopkins' Center for Nursing Research and an author of the study. "Environmental factors such as lack of health insurance, unemployment and other stressful living conditions exacerbate hypertension and put this population at even greater risk. The good news is that innovative and comprehensive approaches to the management and treatment of hypertension can have a significant impact on controlling high blood pressure.
"Use of an intervention team kept the men from having to use a hospital emergency department as their means of primary care," says Roary. "When health care providers recognized environmental stressors and addressed them, blood pressure was controlled."
The Hopkins intervention team comprises a nurse practitioner, a physician and a community health worker. Participants in the study are given treatment including free medication, regular hypertension monitoring, employment referrals, transportation, home visits by a nurse practitioner, nutrition and risk-behavior classes, and counseling. After a 12-month follow-up, blood pressure control rates for the men increased by 44 percent. In addition, the number of visits the men made to emergency departments decreased from 145 to 35 during the time the intervention team was in place.
The men in the study were seen in a variety of settings including a hospital clinic, private homes and community centers. Of the 309 men, 72 percent were unemployed, 72 percent had an annual income of under $10,000, 51 percent had no health insurance, 49 percent had no regular source of medical care, 64 percent had past incarceration, 62 percent had a history of alcohol abuse, 50 percent had a history of regular drug use, 39 percent did not complete the 12th grade, 30 percent felt unable to control important things in their lives, 28 percent had no one to speak to about personal concerns and, on a six-month follow-up, 34 percent reported the recent loss of someone close to them.
In a related study, Hopkins researchers also found that young black males with hypertension are at significant risk for renal impairment. Early identification of renal impairment can serve as a guide for high blood pressure treatment.
Other Hopkins study authors are Martha N. Hill, Ph.D.; Sue Hall; Miyong Kim; and Gabriela C. Romeri, of the School of Nursing; Lee R. Bone, M.P.H., of the School of Public Health; and David M. Levine, M.D., of the School of Medicine.