Its estimated that one in four American adults has high blood pressure,
yet nearly half are not in care, and only 27 percent have their blood pressures
under control. In the at-risk group of young urban black men, the effects
of high blood pressure can be more devastating as it tends to occur at
a younger age and be more severe.
Martha Hill, Ph.D., professor at the Johns Hopkins University School
of Nursing in Baltimore, M.D., spoke Oct. 9 and 10 to University of Nebraska
Medical Center and Nebraska Health System faculty and staff, and community
groups, about her research and its implications. Dr. Hill is an expert
in hypertension and is the 10th visiting nurse scholar for the UNMC College
of Nursing and Nebraska Health System.
The purpose of the visit, which is sponsored by UNMC and NHS, is to
highlight the research work of a nurse scientist who has had an impact
on the health of society and on public policy.
Her research is really important and relevant in clinical implications
for communities focused on diabetes and hypertension in vulnerable populations,
said Ada Lindsey, Ph.D., dean of the UNMC College of Nursing.
High blood pressure causes the heart to work harder, which increases
the risk of heart attacks, strokes, kidney failure, damage to the eyes,
congestive heart failure and arterosclerosis hardening of the arteries.
The risk for heart attack or stroke increases with obesity, smoking, high
blood cholesterol and diabetes, as well as with high blood pressure.
Dr. Hill spoke about the need of identifying and understanding the barriers
to high blood pressure care and control in young urban black men with high
blood pressure.
When Dr. Hill proposed to begin her research work in this area in 1992,
she was greeted with skepticism. Skeptics said her target audience would
be hard to reach, and not interested in their health or participating in
research studies.
It made me even more determined, she said. Barriers to high blood
pressure care and control have been reported in the literature for 30 years.
Few reports on barriers have focused on the young black man with high blood
pressure. These young men are the age, sex and race group with the highest
rates of early severe and complicated high blood pressure and the lowest
rates of awareness, treatment and control.
It is necessary to understand and address these barriers in order to
ultimately reduce the racial and ethnic disparities in high blood pressure
care and control. In an on-going study, she and her team recruited and
are following 309 underserved, inner-city, hypertensive black men between
the ages of 18 and 54.
Dr. Hills research indicates a majority of the men encountered a variety
of overwhelming obstacles to adequate blood pressure care and control,
including economic, social and lifestyle obstacles. Her research uncovered
a lack of knowledge about the seriousness of untreated high blood pressure;
lack of health insurance; lack of a physician or a valued patient-provider
relationship; and the high cost and complexity of treatment. Other barriers
included unemployment, use of alcohol or illicit drugs, and social isolation.
Through the study, researchers found education, individualized care,
home visits — as well as compassion, commitment and concern — increased
the number of men who took control of their high blood pressure. They found
39 percent of the men who had high blood pressure controlled their blood
pressure after two years.
Dr. Hill also discovered changes that need to be made in the way health
providers are trained, as well as how they deliver care.
We cant sit in clinics and expect everyone is going to come, Dr.
Hill said. If you dont move out of the clinics and connect with people
in the context of their livesyou will not be successful. Were looking
at it from our perspective.
We need to reframe our approach. It needs to be considerate, convenient
and customer-focused.
Many of the research participants Dr. Hill works with have little or
no experience with the health-care system.
Many men didnt know how to call and get an appointment or had no tolerance
waiting on hold. If you dont understand how the system works or have never
been a part of it, how can you benefit from it? Blood pressure can be controlled
in most people with comprehensive, continuous and culturally relevant health
care, as well as compliance with health providers treatment recommendations,
she said.
Dr. Hill said the team also dispelled myths. The bonding of our health
provider-patient relationship really helped refute the myth that this group
doesnt care about their health and wont participate in studies. They
are appreciative of the care they receive. They value the care and nurturing
they receive in the study and are concerned about their health.
Dr. Hill is director of the Center for Nursing Research at Johns Hopkins,
and also holds faculty appointments in the School of Medicine and School
of Hygiene and Public Health. She was the sixth woman and first non-physician
to serve as president of the American Heart Association.
She has published more than 100 papers and 34 abstracts, and contributed
to 15 books. She has served on numerous panels and boards, including the
World Health Organizations Patient Education Program. She currently is
working on three research projects funded by the National Institutes of
Health to improve care and control of hypertension and/or diabetes in urban
blacks.