Hypertension increases risk of cardiovascular diseases, including heart disease and stroke, which are leading causes of death in the United States.1 New guidelines by the American College of Cardiology (ACC) and American Heart Association (AHA) now classify approximately 103.3 million adults in the United States as hypertensive (about 30 million more than in previous guidelines).2 Effective blood pressure management has been shown to decrease the incidence of stroke, heart attack, and heart failure.3 Early detection and quicker control of blood pressure has also been shown to be cost-effective, as it may prevent or delay the onset of costly CVD or renal disease.4
Lifestyle modification is an accessible and effective first-line therapy for hypertension.5 However, adopting changes in diet and physical activity to achieve weight reduction has been shown to be more challenging in ethnic minorities in the United States, particularly African Americans.6
A similar gap also exists among patients at the Berkeley Free Clinic. Despite focusing its practice around providing education to patients, allowing them to ask questions, and helping them to set a plan with steps that are feasible to them, the clinic still sees that return clients from minorities are less likely to have maintained lifestyle changes compared to non-Hispanic whites. I'd like to explore the challenges that the clinic might be experiencing in supporting these clients, as well as the circumstances preventing these clients from sustaining lifestyle changes.
1. Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), Underlying Cause of Death 1999-2016 on CDC WONDER Online Database, released 2017. Data are compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program.
2. Muntner P, Carey RM, Gidding S, Jones DW, Taler SJ, Wright JT Jr, Whelton PK. Potential US Population Impact of the 2017 ACC/AHA High Blood Pressure Guideline. 2018 Jan 9;137(2):109-118. doi: 10.1161/CIRCULATIONAHA.117.032582. Epub 2017 Nov 13
3. Fryar CD, Ostchega Y, Hales CM, Zhang G, Kruszon-Moran D. Hypertension prevalence and control among adults: United States, 2015–2016. NCHS data brief, no 289. Hyattsville, MD: National Center for Health Statistics. 2017.
4. Elliott, W.J. (2003). The economic impact of hypertension. J. Clin. Hypertens. 5, 3–13
5. Artinian NT, Fletcher GF, Mozaffarian D, et al. Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults: a scientific statement from the American Heart Association. Circulation. 2010; 122:406-41.
6. Flack JM, Sica DA, Bakris G, et al. Management of high blood pressure in blacks: an update of the International Society on Hypertension in Blacks consensus statement. Hypertension. 2010; 56:780-800.