For African Americans with Hypertension (P), Does Telemonitoring Blood Pressure Education (I), Compared to Usual Care (C), Improve Blood Pressure Control (O), Within Three Months (T) Abstract

With the advent of technology, telemedicine has gained its popularity over the past few years. Various researches are now being conducted to see whether this emerging trend is effective in controlling diseases remotely. Patients need to be educated about technology, especially for the most common and most complicated chronic disease called hypertension. African Americans are believed to have higher rates of this disease, and data have been collected from numerous scholarly articles in this paper to support whether telemonitoring would be helpful for their hypertension control. A background and significance of the problem are mentioned, and then, an assessment of the phenomenon is provided. To highlight the societal perspective of the problem, details are added for further elaboration of the chosen clinical problem. Incidence and prevalence are explained for presenting a comprehensive understanding of the scholarly articles and the times when this problem was probed deeply.

Keywords: hypertension, African Americans, high blood pressure, telemonitoring, usual care, blood pressure control

For African Americans with Hypertension (P), Does Telemonitoring Blood Pressure Education (I), Compared to Usual Care (C), Improve Blood Pressure Control (O), Within Three Months (T)

Ethnicity or race is sometimes linked with the body reactions to hypertension since the levels of blood pressure response to the level of salt one ethnic person intakes and other similar factors too. Among African Americans, high levels of blood pressure, also known as hypertension, are observed. Non-Hispanic black adults experience hypertension more commonly than non-Hispanic Whites (54 percent and 46 percent, respectively) (Centers for Disease Control and Prevention, 2020). The reason for these high levels can be linked to ethnicity since there are environmental factors as well as eating habits, weights, and other health risk factors impacting hypertension. This paper would look into previous research articles providing background literature and theory on the current identified problem.

Background and Significance

African Americans are found to have the highest rates of blood pressure among all the other racial groups of the United States. It is stated that the blood pressure of Blacks in the American community is more likely to develop. Forty-three percent of African Americans are found to have high blood pressure compared to non-Hispanic Whites, which were 28 percent of the hypertensive population (Skolarus et al., 2018). Prevention is of paramount importance since if this disease is left untreated, it might lead to heart and cardiovascular diseases, leading to death. The middle ages of the same racial community are seen to have high rates of this disease compared to the middle ages of Whites. The racial disparities are seen for hypertension, and for this reason, hypertension remains uncontrolled.

Several factors that lead to such conditions at the middle ages of lives of African Americans, such as work, increasing demands to provide care to their families in racial disparity society, and young families who have to lead themselves in complex societal circles. A cardiovascular risk factor is observed when psychosocial, socio-economic, and other patient factors affect self-management of blood pressure rates and self-adherence to medication (Barton et al., 2018). Another risk factor is the inability to treat hypertension on time when it is detected. Medical appointments increase concerning hypertension, and the feasibility of maintaining face-to-face meetings with the health care providers becomes difficult.

There arises a definite need for these patients to be constantly monitored for keeping them on track so that their lifestyle changes can be made to control their blood pressures. The dietary approaches are set so that sodium intake is lessened, and physical activity is increased. Stress is a risk factor for hypertensive African Americans, and being overweight also leads to this chronic disease. Medication adherence is pivotal, and for that, mHealth approaches with the use of technology and mobile applications are becoming common. It is still in the introduction stage and needs to be made common for everyone with its ease of usage and user-friendly interfaces. Still, the option is there, so that blood pressure...

It is also a low-cost and effective method for encouraging adherence among African Americans and reaching various geographical locations (Buis et al., 2017).
Connectivity to technology in mobile usage and blood pressure monitoring devices would be better since patients would monitor their blood pressure on their win. Their data would be transmitted too far away locations with the help of those apps. Patients need education in this regard, and for that, patients need to have smartphones, which are quite common these days. Older patients need special attention since they might not be familiar with these methods as such, and to change their lifestyle and behavioral patterns would be a challenge. African Americans utilize emergency department services for hypertension control of all the racial groups, and technological interventions have become compulsory (Buis et al., 2019).

Assessment of the Phenomenon

The current state of the problem needs to be changed, and several examples have been mentioned in the previous section. The examples include the need for technological intervention for control of hypertension among African Americans who are more exposed to this disease than all the other racial groups in America. There is a need for education on technological use for older patients since they might have smartphones. Still, they might not be able to use applications on their mobiles so that their blood pressure data and schedules for taking medications daily are communicated with their health care providers. Follow-ups then need to be scheduled so that weekly or monthly tracking is set for the control of this disease. If the patient has gone to a distant location and he seems to be experiencing bad blood pressure conditions, he might feel the need to contact his nurse caregiver or the physician so that they can help on time. Timely detection of the problem is necessary for accurate control. In this case, telecommunication in the form...…data of control from the patients. For example, access to self-monitored blood glucose and clinic-based blood pressure not reflecting home B.P. monitoring can be the source of this uncertainty.

Another study was conducted in 2018 to assess the feasibility and acceptability of technological intervention for controlling hypertension among African Americans and the Church community. Eighty million adults, which are 30 percent of the American population, have hypertension. Hypertension is crucial in the middle years of life since midlife African Americans are more likely to have their hypertension controlled if they adhere to medications. Racial disparities were also clear since midlife African Americans were more prospective to this disease than midlife Whites.

The study conducted in 2019 was aimed at improving blood pressure among African Americans with the use of the mobile health approach, the MI-App. The study is still ongoing, and the expected results are likely to be in favor of the application of technological intervention for better control of hypertension. One hundred million Americans were mentioned to be suffering from hypertension, and only half of them receive blood pressure control with appropriate strategies. 15.9 percent of them continue to be ignorant of the problem. African Americans are again more likely to have higher rates of this chronic disease, which remains uncontrolled in later years if not treated early, triggering higher cardiovascular morbidity and mortality. Increased use of emergency departments by this ethnic population is witnessed, and this is because of a lack of access to primary care, less awareness of the disease and its preventive measures, and the inability to receive care and having less money for that.

The final chosen study conducted in 2020 was based on the economically disadvantaged community in Flint, majorly African Americans. Thirty percent of the U.S. adult population was affected by hypertension. Reasons for the prevalence of this problem in this community were non-adherence to the medication plan and following an improper lifestyle inducing increased hypertension. Health promotional messages were used to improve their diets, physical activities, medication adherence, and blood pressure monitoring.

Review of Health Care Costs of Problems

After a thorough review of the chosen studies, it has been deducted that with telemonitoring, the costs of health care for hypertension patients would be reduced. Text messaging is thought to be low-cost and an easy method for adoption when it comes to Telehealth. It allows lesser visits to the emergency departments, doctor visits, hospitalization costs, and the stay time within the hospital premises (Nguyen & Nguyen-Le, 2017). The direct costs were reported to be considerably lower than those of the usual care method, despite differences in the execution of the program, duration, and demographics. Even the research conducted by Skolarus et al. (2018) also mentioned that the text messaging telemedicine approach is appealing in its low costs.

Evidence of Support for APRN's Role in Solutions

The chosen research, which was conducted by Barton et al. (2018), revealed that two nurse-administered interventions were carried out to see the effectiveness of telemedicine in the control…