Hypertensive Black South Africans Need Multi-level Approach

Black South Africans, a population greatly at risk for high blood pressure, need comprehensive, multi-level interventions addressing socioeconomic challenges, lifestyle behaviors, and health care delivery approaches to improve high blood pressure treatment and outcomes, according to a study conducted by researchers from Johns Hopkins University and the Medical Research Council of Tygerberg, South Africa.

High blood pressure (HBP) control is poor among Black South Africans and is frequently complicated by characteristics of age, unemployment, limited education, alcohol and tobacco use, and excessive weight. According to study results presented in a poster session at the American Heart Association 2005 Scientific Sessions in Dallas, TX, the Hopkins and South African researchers found that despite making regular visits to primary health care facilities for treatment and receiving HBP medications, the majority of the study participants continued to have uncontrolled blood pressure.

Two hundred and twenty women and 183 men who received public or private primary care services in three South African Cape Peninsula townships participated in the study.

The sample had spent the majority (67 percent on average) of their lives in an urban setting. Eighty-one percent had less than 10 years of schooling-and 61 percent were unemployed. All had a high prevalence of lifestyle risk factors, particularly alcohol and tobacco use and physical inactivity, and the majority were overweight or obese. While rates were somewhat lower among women, nearly one-third of the men reported regular tobacco and alcohol use, and more than one-half were at high risk for alcoholism. Thirty-eight percent of men and 15 percent of women were overweight and an overwhelming 36 percent of men and 78 percent of women were obese.

"These findings lead us to conclude that hypertension care for Black South Africans is inadequate," says lead investigator Cheryl Dennison, ANP, PhD, an assistant professor at the Johns Hopkins University (JHU) School of Nursing. She adds, "The data reinforces our view that hypertension must be approached at the policy, care setting, provider, and patient levels. We must consider a wider array of techniques and approaches in addition to pharmaceutical intervention, including significant policy-level changes that support additional changes at the provider and patient levels to improve blood pressure control and reduce cardiovascular morbidity and mortality,"

Dennison's co-investigators were Krisela Steyn, MD, MEd, Jean Fourie, RN, MS, Lulama Kepe, MS, Carl Lombard, PhD, and Martha N. Hill, RN, PhD, Dean of the JHU School of Nursing. Funding was provided by the National Institutes of Health and Novartis Pharmaceutical Company.