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 individual's 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.

Management of High Blood Pressure in Blacks

“…Comprehensive lifestyle modifications should continue even with the initiation of antihypertensive drug therapy. 136 We also endorse use of comprehensive therapeutic lifestyle modification in all blacks with BP Ն115/75 mm Hg.…”

Improving Blood Pressure Control: Results of Home-based Post-acute Care Interventions

“…Second, evidence suggests considerable provider inertia in adjusting BP medications among patients with lower disease severity 19 . Third, patients themselves may be less adherent to medications and more reluctant to seek adjustment or adopt therapeutic lifestyle changes when BP values are perceived as within an "acceptable range" 20 . Our approach of examining the interventions' effectiveness by HTN severity, although initially unplanned, highlights the importance of targeting specific types of intervention to specific patient severity groups.…”

Cardiovascular Health Among an Underserved Population

“…Patient empowerment is one of the key components of introducing any type of therapeutic lifestyle change related to cardiovascular risk reduction. 20 Community engagement is necessary to address the current barriers that exist, and using the AHA 7 metrics of cardiovascular health provides quantifiable factors to measure improvement. Using a multifaceted approach can yield incremental success in improving cardiovascular health in vulnerable populations.…”