Abstract

Hypertension is a major problem both in the US and the world as a whole. Globally, over 9.4 million individual die, while 7.4% of the human population has disability-adjusted years of life because of the disease. Moreover, one billion people suffer from this health issue. Two-thirds of this population comes from middle-income countries. In the United States (US), more than 65 million people suffer from the high blood pressure with adults constituting the majority of this population. It is the primary risk factor for coronary heart diseases, chronic renal failure, heart failure, and cerebrovascular disease. However, disparities in the incidence and prevalence rates of the high blood pressure follow racial and ethnic lines. In the US, the non-Hispanic blacks represent 39.1% of people, who suffer from the disease; they are followed by non-Hispanic whites, who account for 28.5%, and the Hispanics with 27.8%. Some of the factors that cause these figures include ethnic variations in the socioeconomic status, including education, income, and poverty. Also, these populations have differences in smoking and alcohol intake rates, physical inactivity, overweight, and obesity, among many other issues. Many studies have investigated the variation of these factors in terms of hypertension and ethnicity, but many have failed to offer ways, via which these disparities can be bridged. This research examined the predisposing factors that could explain racial disparities in hypertension and subsequent measures that aimed at curbing this disease.

Keywords: hypertension, ethnicity, racial and ethnic disparities, socioeconomic factors

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Introduction

Hypertension is a major problem both in the United States (US) and the world as a whole. According to Opara (2010), the disease affects over 65 million people in the US alone, with adults being the most vulnerable group. This disease affects the entire cardiovascular system, which subsequently impacts other body parts. Hypertension is a serious condition that influences both the heart and blood vessels that, in turn, can lead to the heart failure, stroke, heart attack, end-stage renal disease, and vision problems among many other consequences (Robinson, 2012). This deadly disease shows substantial variations across different racial and ethnic groups. Balfour, Rodriguez, and Ferdinand (2015) explain that hypertension is an enormous contributor to various cardiovascular diseases, and it varies across racial-ethnic groups of the US population concerning the disease prevalence. Also, disparities exist in the longevity among hypertensive individuals that belong to different racial and ethnic groups.

Many reasons explain why racial disparities occur in the prevalence and longevity of hypertension among different ethnic groups in the US. In this regard, knowledge about the renin-angiotensin system (RAS) is instrumental. The secretion of renin is down-regulated once the kidney detects an increased secretion of sodium, which is something that increases sodium amounts in the circulation and results in hypertension (Dreisbach, 2014). Black people have a tendency of developing this disease at an early age because they have a lower renin activity, and the target organ damage differs in the blacks and whites. Dreisbach (2014) further states that the blacks have a worse response to the hypertension treatment with angiotensin converting enzyme (ACE) inhibitors than the whites do. Additionally, beta-blockers are less effective in the blacks. Such a thing may be a reason as to why the blacks have poor prognoses of the disease. Many other factors such as the socioeconomic status and access to healthcare services bring the disparities in this condition into a realm.

Disease Background

In the world, hypertension is the major risk factor for the global disease burden that accounts for more than 9.4 million deaths with an additional 7% of the population having disability-adjusted years of life (Busingye et al., 2014). It is the primary risk factor for coronary heart diseases, cerebrovascular disease, cardiac failure, and chronic renal failure. One billion people suffer from this devastating health condition with two-thirds residing in low and middle-income countries (Busingye et al., 2014). Such a statistics is an indicator of the high prevalence of hypertension in the poor populations, which sometimes are associated with racial and ethnic factors.

The prevalence of hypertension by race among the US citizen residents of 20 years old and above is disproportionate for different age groups. Holmes, Hossain, Ward, and Opara (2012) explain that the non-Hispanic blacks represent 39.1% of hypertension cases; they are followed by non-Hispanic whites (28.5%) and the Hispanics (27.8%). These figures show that the hypertension incidence, prevalence, and mortality rates vary by race and ethnicity. Currently, it is not fully understood whether these variations are caused by the race itself or by a set of multiple reasons that are associated with different races or risk factors for hypertension (Holmes et al., 2012). Such a trend shows the relationship between hypertension and ethnicity, which is a complicated issue.

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One of the previous studies found out that the black Americans have an increased risk of developing hypertension as compared to the non-Hispanic whites and Hispanics (Borrell, Menendez, & Joseph, 2011). In this study, authors stated that the Hispanics had higher levels of income as compared to their African American counterparts. Additionally, income and education levels seemed to have a close association since these people had higher levels of education that matched their high income as compared to the blacks. Lower levels of income are related to an increase in the prevalence of hypertension among the US populations. Since there is a racial and ethnic disparity in the income levels among the Americans, the variation in hypertension may be its direct result.

On the same line, the prevalence of hypertension among populations raises with an increase in the rates of smoking, alcohol intake, physical inactivity or sedentary lifestyles, and body mass index. According to Holmes et al.'s (2012) study, the non-Hispanic whites smoke more than the Hispanic whites and the black Americans do. The increase in the prevalence of hypertension may explain the reason as to why there is a disproportion in hypertension in the non-Hispanic whites. However, one expects the prevalence and incidence rate of hypertension in the blacks to be lower than those in the whites because their smoking rates are low. Nevertheless, the situation on the ground does not reflect the association. Smoking is a major risk factor for the development of hypertension because it leads to the constriction of blood vessels, which results in the subsequent increase in the peripheral vascular resistance. On the same line, leading a sedentary lifestyle that is full of physical inactivity is associated with the development of obesity, which is also a risk factor for many cardiovascular diseases that include hypertension (Balfour et al., 2015). Numerous studies have found out that there is a huge disparity in physical exercises among different racial and ethnic groups in the US (Holmes et al., 2012). Sedentary lifestyles with the lack of regular physical activities predispose individuals to the overweight and obesity. Both cause the development of cardiovascular disease conditions, including hypertension. All these indicators suggest that hypertension is caused by many etiologies, which seem to vary from one racial or ethnic group to another.

Problem Statement and Research Purpose

Racial disparities are visible in hypertension rates of Americans. African Americans are affected disproportionately because the incidence rate in this population is two times more than the one in Caucasians with the mortality being the highest among all racial and ethnic groups (Opara, 2010). Many factors explain the racial and ethnic disparities under this condition. They include variations in socioeconomic factors, including income, education, poverty, physical inactivity, alcohol intake, and smoking, as well as body mass index, which is a reflection of the weight status of a person. Many scholars have conducted extensive research studies in order to establish the disparity in hypertension in different racial groups (Kendrick, Nuccio, Leiferman, & Sauaia, 2015). However, a few have explored the ways, via which the disparity in hypertension can be bridged. This research proposes to investigate predisposing factors for the variations and develop measures for curbing the health challenge.

Research Objectives

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This study aims to

1. Determine the factors that cause racial and ethnic variations in hypertension in Americans

2. Design measures that can manage differences in hypertension among different racial and ethnic groups in the US.

Research Hypothesis

1. There are factors that influence the disparity in the hypertension prevalence among various ethnic groups in the US.

2. There are measures that can help manage hypertension and its disparity by race and ethnicity in the US.

Research Methods

This research will utilize data from secondary sources that will be reviewed with the view to addressing the study objectives. In determining the factors that influence the disparity in the prevalence of hypertension in different American ethnic groups, articles to be used will contain valuable information concerning factors that predispose individuals to hypertension and their relationship with ethnicity. Furthermore, articles will provide useful information about intervention strategies that can help prevent hypertension and bridge the gap in disease prevalence disparity in different ethnic groups in the US.

Appropriate articles will be taken from online sources. The search strategy will yield various scholarly sources from peer review journals via multiple online databases. The databases, through which the academic sources will be researched, include ProQuest, PubMed, Cochrane Library, CINAHL, and Google Scholar. The search queries will include hypertension related to ethnicity, ethnicity and hypertension," risk factors for hypertension, and ethnic disparities, among some other. The initial search results will be refined in order to include peer reviewed articles that were published within the last five years. Such a thing will help acquire the most recent and updated information, which will reflect the actual situation at the moment. The researcher will review abstracts of all articles that suit the study and then settle on studies that were conducted in the US, which reveal information that can help address the research objectives. At last, the information obtained will be presented in writing to either support the study hypotheses or refute them.

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