anthony keel research proposal 17 may 2013

Running head: HIGH BLOOD PRESSURE AND HYPERTENSION 1

High Blood Pressure and Hypertension in the African American Community

Why is Blood Pressure/Hypertension more prevalent in the African-American community

than any other race of people?

By

Anthony J. Keel

Troy University

Research Methods in Public Administration

HIGH BLOOD PRESSURE AND HYPERTENSION 2

Abstract

This study provides an outcome towards a directional methodology which exams the five causes

of hypertension and high blood pressure in African Americans. The results point out the

proportion of African Americans with high blood pressure.

Keywords: high blood pressure, hypertension, African American


Statement of the Problem

In general, African Americans suffer from high blood pressure and hypertension at a rate

greater than their percentage in the U.S. general population. African Americans make up 13% of

the population and practically twice that many die from heart disease each year (NAACP.org,

2009-2013) Fiscella and Holt (2008) gives compounding evidence through their studies that

demonstrate that 8,000 African Americans die annually from heart disease and stroke from

uncontrolled systolic blood pressure. (Fiscella & Kathleen Holt, 2008)

(Wexler, Elton, Pleister, & Feldman, 2009) illustrates that hypertension (as defined by systolic

blood pressure/diastolic blood pressure [SBP/DBP] greater than 140/90 mmHg) is particularly

common among blacks in the United States (US), with an age-adjusted prevalence higher than

for any other major race or ethnic group Recently published data from the National Health and

Nutrition Examination Survey (NHANES), covering the 20-year period of 1988 to 2008, support

significant increases over time in the proportions of blacks with hypertension, with rates of

hypertension (regardless of treatment status) as well as treated hypertension significantly higher

than those for both whites and Hispanics. More and more Black or African American adults

have this serious condition. Today, about 4 out of 10 Black or African American adults in the US

have high blood pressure. That’s one of the highest rates in the world. (Braun, 2010) Among

African Americans, more women than men have the condition of hypertension. 43% African

American men compared to 45.7% African American women. (Prevention C. f., 2011)

Cardiologist Elijah Saunders put the problem of hypertension in more simplistic terms, noting

that "On average, one African-American die from high blood pressure every hour in this

country," "Hypertension among African-Americans, particularly older African-Americans, is so


common that when someone doesn't have high blood pressure, they are the rare exception and

not the rule.” (Center, 2012)

(Ferdinand; Welch, 2007) reinforce how significant the problem really is by demonstrating

that African-Americans have one of the highest rates of hypertension worldwide—much higher

than other populations of African origin. Compared with white Americans, hypertension is not

only more prevalent in this population, it is also observed at an earlier age, has greater severity,

and is accompanied by a disproportionate level of target organ damage (1.8-fold higher rate of

stroke, 4.2-fold higher rate of end- stage renal disease, 1.7-fold higher rate of heart failure, 1.5-

fold higher rate of coronary heart disease mortality). (Ferdinand K. C., 2007)

Blacks also are known to develop hypertension at an earlier age than whites. In a large US

survey of children aged 8–17 years, SBP levels were noted to be 2.9 mmHg and 1.6. (Ferdinand

& Townsend, 2012) Taylor (2002) reports that a study of a nationally representative sample

revealed that between 1999 to 2002, age-adjusted high BP increased among children of African

American (4.2%), Hispanic (4.6%), and Caucasian (3.3%) ancestry (Din-Dzietham, Liu, Bielo,

& Shasma, 2007) (Taylor, 2002).

The Office of Minority states that, Although African American adults are 40% more likely to

have high blood pressure; they are 10% less likely than their non-Hispanic White counterparts to

have their blood pressure under control. In 2009, African Americans were 30% more likely to

die from heart disease, as compared to non-Hispanic white men. African American women are

1.6 times as likely as non-Hispanic whites to have high blood pressure. (Services, 2012).


The U.S. Department of Health and Human Services Centers for Disease Control and

Prevention collected data that was collapsed into three-time spans on the basis of data

availability: 1988–1994, 1999–2002, and 2003–2006. In all periods, a larger percentage of

African American men had elevated blood pressure than did white or Mexican-American men.

However, compared with the 1988–1994 period, the percentage of men in each race or ethnicity

group with elevated blood pressure had declined by the 2003–2006 period. The percentage of

African American women with elevated blood pressure fluctuated over the three periods, but by

the 2003–2006 period was smaller than that of African American men. (U.S. Department of

Health and Human Services Centers for Disease Control and Prevention (Prevention, 2010)

According to the Heart Association 2013 Statistical Fact Sheet, high blood pressure was listed

on death certificates as the primary cause of death of 61,762 Americans in 2009. High blood

pressure was also listed as a primary or contributing cause of death in about 348,102 of the more

than 2.4 million U.S. deaths in 2009. In that same year, the high blood pressure mortality rate

stood at 27,668 male deaths (44.8% of deaths from high blood pressure). 20,286 white males

6,574 black males 34,094 female deaths (55.2% of deaths from high blood pressure). 26,201

white females equal 6,951 black females. From 1999 to 2009 the death rate from high blood

pressure increased 17.1 percent, and the actual number of deaths rose 43.6 percent. The 2009

overall death rate from high blood pressure was 18.5 per 100,000. Death rates were: 17.0 for

white males. 14.4 for white females. 51.6 for black males. 38.3 for black females. There were a

total of 488,000 people diagnosed with high blood pressure and were discharged from short-stay

hospitals in 2010. Discharges included people both living and dead: 216,000 males. 272,000


females. High blood pressure’s direct health care cost is almost $131 billion

annually. (American Heart Association, 2013) These scholars all determined

that African Americans suffer a great burden and affliction when it comes to

hypertension.

Statement of Purpose

The purpose of this study is to identify the issues that contribute to the high rate of high blood

pressure and hypertension in the African American community. The study analyzes the

association between high blood and hypertension and the following independent variables: (1)

The types of food that are consumed by African Americans, (2) the genetics, (3) Income and

(4) Attitudes towards visiting a physician. The major thesis of this research is that African

Americans’ attitudes and lifestyle contribute adversely to their overall health issues of

hypertension and is exceedingly higher than any other group of people.

Consequence of the Problem

The disproportionate risk to African Americans with hypertension brings an abundance of,

repercussions. According to the Mayo Clinic, high blood pressure can damage the cells of your

arteries' inner lining. That starts a series of events that make artery walls thick and rigid, that

starts a serious disease called arteriosclerosis (ahr-teer-e-o-skluh-RO-sis), or better known as

hardening of the arteries. Arteriosclerosis is started by the fats from your diet that enter your

bloodstream and passes through the damaged cells. These changes can affect arteries throughout

your body, blocking blood flow to your heart, kidneys, brain, arms and legs. The damage can

cause countless problems, including chest pain (angina), heart attack, heart failure, kidney


failure, stroke, blocked arteries in your legs or arms (peripheral arterial disease), eye damage,

and aneurysms several consequences are associated with the problem of high blood

pressure/hypertension. (Staff, 2011) Researcher Dr. Charles Decarli argues that the brain was

affected earlier than medical researcher had once believed. He noted that through his research

there were people that showed signs of brain damage due to hypertension. Some of the people

were only 40 years old. This was the youngest group in which brain injury had been detected.

This research moved the impact of hypertension on the brain forward by at least 20 years. (Valeo,

2012)

Likewise, (Ferdinand and Townsend, 2012) research reinforces the results of hypertension. What

they found was that specifically in blacks, hypertension is a primary cause and an independent

risk factor for more severe cardiovascular and renal conditions, including stroke, left ventricular

hypertrophy (LVH) leading to heart failure, and renal disease (including end-stage renal disease

requiring dialysis). In the recent Coronary Artery Risk Development in Young Adults (CARDIA)

study], a long- term, multicenter, US study that enrolled young adults (aged 18–30 years at

baseline), the cumulative incidence of systolic heart failure during 20 years of follow-up was

greater among blacks (1.1% in black women and 0.9% in black men) than among whites (0.08%

in white women and 0% in white men; P00.001 for blacks versus whites) and was directly

related to the increased burden of hypertension. Specifically, 75% of blacks who developed

systolic heart failure had hypertension during the first 10 years of the study versus only 12% of

blacks without hypertension (P< 0.001). (Ferdinand & Townsend, 2012)

The Harvard School of Medicine identified one of the biggest problems with high blood

pressure is that many people who have it don't feel it. The absence of immediate symptoms

makes it easy to ignore, or stop drug treatment when side effects appear. One group of these side


effects—sexual problems—are the main reason people stop taking drugs that lower blood

pressure. Sex-related side effects have been ascribed to virtually all classes of drugs used to

control blood pressure (School, 2004) .

Statement of Relevance

This research is vitally important to the African American community because African

Americans make up 13% of the US population and yet, nearly twice that many die from heart

disease (heart disease being a complication from hypertension) each year (NAACP.org, 2009-

2013). It can also be noted that this research is extremely important to the medical field

because more African Americans are seeing their doctors for hypertension. Researchers Cherry;

Hing; Woodwel and Rechsteiner (2008) noted that, since 1996, the percentage of visits by adults

18 years and over with chronic diabetes increased 40%, and during the same time period, visits

increased for chronic hypertension (28%). (Cherry, Hing, & Rechtsteiner, 2006) Doctors have a

vested interest in their patients so this study is very relevant to them and how they treat their

patients. The major concern with doctors is that they lack the familiarity with African American

hypertension and treating it aggressively. In a national survey that consisted of 500 primary care

practitioners, recommendations of the sixth report of the Joint National Committee on

Prevention, Detection, Evaluation, and Treatment of High Blood Pressure were not followed

when beginning treatment for African Americans, older patients, and those with one or more

medical condition including renal disease. Additionally, physicians often lack appropriate

aggressiveness in the use of antihypertensive medications, especially in patients with isolated

systolic hypertension. Finally, there is proof that physicians are not suggesting lifestyle

adjustments to patients despite the proven value of these approaches. The poor adherence to

evidence-based treatment guidelines may reflect physicians’ lack of awareness of the guidelines,


disagreement with their content, lack of expectation that adherence to recommendations will

achieve the desired effect, clinical uncertainty, lack of support systems at the practice level, or

lack of motivation to change previous practice. (Ogedegbe, 2009) The doctor's justification of

their treatment of African American hypertension can be found in the in the Kelton Research

survey that was conducted online within the U.S. between January 29 and March 6, 2009. Just

one percent of doctors surveyed believed that their African American patients managed their

high blood pressure and kept it under control extremely well. Almost four in ten (38 percent)

believe that their patients don’t manage their condition very well. Nearly nine out of 10 doctors

(88 percent) acknowledge that patients follow the doctor’s advice only sometimes, at best. (My

Pressure Points, 2009) Possibly the most important physician-level obstacle to blood pressure

control is the lack of faithfulness to treatment guidelines.

Review of the Literature

The research on hypertension of African Americans has illustrated a significant number of

concepts. For instance, hypertension-related diseases such as coronary heart disease, heart

failure, renal dysfunction, and stroke, makes the African American population have a greater

problem than the general population. (John M. Flack MD, 2007). Moreover, because of this

fact, African Americans must change their lifestyle and attitudes towards hypertension. African

Americans with high blood pressure (BP) can significantly take advantage of therapeutic lifestyle

changes (TLC) such as diet alteration, physical activity, and weight management. ( (Scisney-

Matlock M, 2009)


Previous Research Studies

There has been an abundance of studies in the area of hypertension across every group of

society, but the African American community is of greater concern. Although hypertension and

cardiovascular problems are more prevalent in the African American Community, there is a

theory behind controlling this condition. In an article named Effects of regular exercise on

blood pressure and left ventricular hypertrophy in African-American men with severe

hypertension, the authors Kokkinos; Narayan; Puneet; Pittaras; Andreas; Aldo; Domenic and

Vasilios published their research in 1995 in the New England Journal of Medicine. What they

confirmed was that consistent exercise lowers blood pressure in patients with mild to moderate

hypertension; however, those patients with severe hypertension at the time had not been studied.

To obtain a result, the researcher examined the effects of moderately intense exercise on blood

pressure and left ventricular hypertrophy in African-American men with severe hypertension.

(Kokkinos, et al., 1995)

According to an article titled The Effects of Race and Occupation on Hypertension

Mortality by Howard and Holman. The article was published in the1970 Milbank Memorial

Fund Quarterly. The main purpose was to examine the effects of occupation and socioeconomic

status on race differences in hypertension mortality. “Regardless of occupation and class, non-

whites were found to have a higher mortality from hypertension than whites. This suggests the

relevance of a genetic or racial discrimination hypothesis, although the associated disorder

hypothesis may also be applicable. Future research should be designed to test these theories. The


magnitude of the race difference in hypertension mortality (as indexed by the non- white/white

death rate ratio) decreases with age. Various explanations for this trend are offered. For both

races, laborers have the largest mortality from hypertension. In this case, socioeconomic

considerations seem most relevant as explanations. Nonwhites show more variability in mortality

over the various occupations and classes than do whites. Several possible interpretations of this

difference are suggested taking into account genetic predisposition and environmental stress”.

(Howard, 1970)

In his research Racial differences in blood pressure levels of adolescents, that was published

in 1981 in the AM J Public Health Journal, W.L. Reed goes beyond the prevalent hypertension of

the adult Black adult, this researcher looks at the blood pressure levels of White youths and

Black youths. Through this research finding, it is discovered that White youth’s blood pressure

levels equaled or exceeded black youths. “In fact, the blood pressure levels of White youths

equal or exceed that of Black youths. This race effect still exists when age, sex, weight, and

socioeconomic status are controlled.” (Reed, 1981)

The researchers Shea; Misra; Ehrlich and Francis, 1992) took another approach to analyzing

hypertension within the African American community. According to their article that was

published in the American Journal of Public Health in 1992, titled Correlates of no adherence

to hypertension treatment in an inner-city minority population, adherence to treatment is the

main cause in attaining blood pressure control among the inner-city minority population. A total

of 202 were questioned as part of a case-control study of severe, uncontrolled hypertension

conducted in two New York City hospitals in 1989-91. “All subjects were African American or

Hispanic. Self-reported no adherence to drug treatment for hypertension was measured using a

five-item scale, and the sample was dichotomized as more (n = 87) or less (n = 115) adherent.


Multiple logistic regression analysis was used to adjust for demographic and other covariates.

RESULTS. No adherence was associated with having blood pressure checked in an emergency

room (adjusted odds ratio [OR] = 7.9; 95% confidence interval [CI] = 1.75, 35.77; P < .01), lack

of a primary care physician (adjusted OR = 2.9; 95% CI = 1.37, 6.02; P < .01), current smoking

(adjusted OR = 2.4; 95% CI = 1.10, 5.22; P = .03), and younger age (adjusted OR = 1.03, 95%

CI = 1.00, 1.06; P = .03). CONCLUSIONS. Changing the locus of care for hypertension from

emergency rooms to primary care physicians may improve adherence to hypertension treatment

in minority populations.” (Shea, Misra, Ehrlich, & Francis, 1992)

Researchers Sprafka, J Michael; Folsom, Aaron R; Burke, Gregory L; Edlavitch, Stanley A,

published a research article in the American Journal of Public Health in 1988. Their research

can be found in the article Prevalence of Cardiovascular Disease Risk Factors in Blacks and

Whites: The Minnesota Heart Survey. This research explains how a two cross-sectional

survey was conducted in 1985 and 1986 which measured the prevalence of coronary heart

disease risk factors in Black and Whites. The participants were interviewed at home with a

follow-up visit at the survey center. The rate of participation was 78 percent and 90 percent for

the participants who were interviewed at home and 65 percent and 68 percent for those

participants that were surveyed at the survey center. Factors such as age and education were

adjusted. The systolic and diastolic blood pressure was 3 to 4 mmHg higher in Blacks 44 percent

versus 28 percent in white participants. Among men, a greater number of Blacks than Whites

were cigarette smokers, 44 percent Black versus 30 percent White. Still, White smokers smoked

additional cigarettes per day, 26 White versus 17 Black. “Similar differences were noted for

women, although the prevalence and quantity of cigarette consumption were less than men. The

excess prevalence of these CHD risk factors in Blacks, especially among women, may explain


their elevated CHD and stroke mortality rates in the Twin Cities.” (Sprafka, Folsom, Burke, &

Edlavitch, 1988)

Rationale for Hypotheses

The collected works mentioned, delivered proposals as to probable causes of

hypertension being more prevalent in the African American community. Yet, the premise behind

this research is that the lifestyle and attitudes of African Americans are negatively related to

hypertension.

H1. Types of food that are consumed by African Americans

Wexler; Elton; Pleister and Feldman produced a very informative study in The Journal of the

National Medical Association which was published in 2009. The study is titled, Barriers to

Blood Pressure Control as Reported by African American Patients. The study pointed out

that the focus group participants identified that there were “crucial family health challenges,”

that hypertension “runs in families” and that customary cultural food selection and the way that

food was prepared in numerous African American households were not healthy as they ought to

be. Numerous African Americans continue to consume traditional African American diet, which

consists of substantial quantities of gravy, salt, and fat. Several participants believed that

adhering to a traditional diet was a constant health problem and a challenge for African

Americans.

H2. Genetics

In the in the African American community, genetics plays a major role in hypertension.

Genetic variants identified in African-Americans are associated with blood pressure in West

Africans. The West African people are of specific importance since it is the ancestral population

of many African-Americans. (Health, 2009)


H3. Income

African Americans, who are categorized as low income, face additional challenges when it

comes to hypertension. Because of their lack of resources for a healthy lifestyle and chronic

stress from social factors such as higher unemployment and living in a disadvantaged

neighborhood surrounded by noise, violence, and poverty are also factors. (System)

H4. Attitudes towards visiting a physician

Although African Americans recognized that they have the condition of hypertension, they lack

trust in their doctors. African Americans conveyed suspicions about their doctors’ reasons for

prescribing antihypertensive medications. Therefore, African American treats their blood

pressure based on how they were feeling, instead of following a prescribed medical routine.

(Rosalind M. Peters, African American Culture and Hypertension Prevention, 2006)

Preview of Hypotheses

The theories that were discussed earlier, now makes it more conceivable to present more

precise hypotheses that will be used in this study to test these theories.

Research Hypothesis 1 (H1) The percentage of African Americans that continue to consume

the traditional African American diet is positively correlated with constant health problems and is

a challenge for African Americans.

Research Hypothesis 2 (H2) The percentage of genetic variants identified in African-Americans

is positively correlated with blood pressure in West Africans.

Research Hypothesis 3 (H3). The percentage of African Americans who are categorized as low

income is positively correlated with African Americans facing additional challenges when the

condition of hypertension exist.


Research Hypothesis (H4) The percentage of African Americans that recognized that they have

the condition of hypertension is positively correlated lack trust in their doctors.

Figure 1. A theoretical model of the factors that influence African American hypertension

Independent Variables Dependent Variable

Environmental Variable

Types of food that are consumed

by African Americans (H1)

Income (H3)

Physiological Variable

Genetics (H2)

Psychological Variable

Attitudes towards visiting

physician (H4)

Prevalence of High Blood Pressure

and Hypertension in the African American

Community


Methodology

This research is a descriptive study and provides a snapshot of the factors that lead to the

prevalence of African American hypertension as of 2010. The year 2010 was selected because

this is the most current year that the Centers for Disease Control and Prevention (CDC)

published an informative, statistical summary that was exclusively for the African-American

community. Grimes and Schulz (2003) definition of a descriptive study is the representation of

the first scientific toe in the water in new areas of inquiry. A fundamental element of descriptive

reporting is a clear, specific, and measurable definition of the disease or condition in question.

Dependent Variable

Prevalence of High Blood Pressure and Hypertension in the African American

Community - The dependent variable is the prevalence of high blood pressure in the African

American community. In this research, this is measured as the percentage of African Americans

that are affected by hypertension as compared to the remaining U.S. population.

Independent Variables

Types of food that are consumed by African Americans (H1) Researchers hypothesize

that the variation in African American hypertension is more prevalent in the African American

community which is clearly clarified by the types of foods that are consumed by African

Americans. In this research, this is operationalized as the percent of African Americans in the

United States in 1996 that had a population of 31 million people of which 28% were reported to


have a poor-quality diet, compared to 16% of whites, and 14% of other racial groups. The

rationale is that hypertension and obesity have known links to poor diet and a lack of physical

activity. (diet.com, 2013) For that reason, African Americans have the power to control

hypertension as can be seen insufficient empirical evidence that supports the five areas of

lifestyle modification to decrease the risk of developing hypertension. These modifications

include weight control, increased physical activity, limited alcohol intake, no tobacco use, and

reduced dietary saturated fat and sodium (Rosalind M. Peters, US National Library of

Medicine National Institutes of Health, 2006)

Genetics ( H2 ) (Young; Chang; Kim; Chretien; Klag; Levine; Ruff; Wang;

Chakravarti, 2009) provides additional support that genetics, the sole physiological variable

can affect the prevalence of hypertension in the African American community. In this research

this variable is operationalized by the percentage of African Americans men and African

American women in the United States in 2011, that had a population of over 38 million people of

which 43% African American men and 45.7% African American women suffer from

hypertension, compared to 27.8% Mexican American men and 28.9% Mexican American women

and 33.9 White American men and 31.3% White American women. (Prevention C. f., 2011)

Income (H3) This research variable is operationalized by the percent of African Americans in

the United States in 2011 that had a population over 38 million of which 25.41% received an

annual income under $15,000, which was below the poverty line. (BlackDemographics.com,

2011)


Attitudes towards visiting a physician (H4) In this research this variable is operationalized by

a small sample of African Americans in the city of Chicago, IL in 2006 that had a population of

105. Unique factors contribute to trust and distrust in physicians among African-American

patients. (Elizabeth A Jacobs, 2006)

Table 1. How variables will be operationalized and measured

Variable How variable will be measured

Types of food that are consumed by African Americans

The percent of African Americans in the United States in 1996 that had a population of 31 million people of which 28% were reported to have a poor-quality diet, compared to 16% of whites, and 14% of other racial groups.

GeneticsThe percentage of African Americans men and African American women in the United States in 2011 that had a population of over 38 million people of which 43% African American men and 45.7% African American women suffer from hypertension, compared to 27.8% Mexican American men and 28.9% Mexican American women and 33.9 White American men and 31.3% White American women.

IncomeThe percent of African Americans in the United States in 2011 that had a population over 38 million of which 25.41% received an annual income under $15,000 which was below the poverty line.

Attitudes towards visiting a physician

The number of African Americans in Chicago, IL in 2006 that had a population of 105. Unique factors contribute to trust and distrust in physicians among African-American patients.

Data Collection Methods Used In previous Research Studies Previous researchers

(Holmes, Hossain, and Opara 2013; Williams; Lavizzo-Mour and Warren, 1994) employed the

National Health Interview Survey (NHIS) to a nationwide cross-section of the United States.

There is an article titled Nation Health Interview Survey (NHIS) by Lavrakas, in 2008. The

article was published in the Encyclopedia of Survey Research Methods. The National Health

Interview Survey provides a constant survey and special studies to secure accurate and current

statistical information on the amount, disruption and effects of illness and disability in the United


States. The NHIS is an annual survey that is administered to all civilians that are non-

institutionalized of the United States population.

Data Collection Methods Used for This Research - Data relating to the independent variables

will be taken from the from Centers for Disease Control and Prevention Report, US Census

Bureau Report and the National Health Interview Survey.

Table 2. Sources of data for variables

VARIABLE PRIMARY SOURCE SECONDARY SOURCE

Types of food that are consumed by African Americans

Centers for Disease Control and Prevention Report

National Health Interview Survey

GeneticsCenters for Disease Control and Prevention Report

Centers for Disease Control and Prevention Report

IncomeCenters for Disease Control and Prevention Report

US Census Bureau Report

Attitudes towards visiting a physician



Contributions to the Field of Public Administration

Contribution to the Literature

There have been numerous studies (i.e.; Fiscella & Holt, 2008; Ferdinand & Welch, 2007;

Din-Dzietham, Liu, Bielo, & Shasma, 2007; Taylor, 2002; Valeo, 2012 and Cherry, Hing &

Rechtsteiner, 2006) that have investigated why hypertension is so prevalent in the African

American community. Due to the various research undertakings, there is a considerable amount


of theories that support the prevalence of hypertension in American Americans. This dissertation

attempts to support the field of public administration by reinforcing studies in the literature

relating to the prevalence of hypertension in American Americans.

Contribution to Methodology

This research takes the methodology to another level. Earlier researchers (i.e., Kokkinos;

Narayan; Puneet; Pittaras; Andreas; Aldo; Domenic and Vasilios 1995; Sprafka, J Michael;

Folsom, Aaron R; Burke, Gregory L; Edlavitch, Stanley 1988) illustrated the how hypertension

made an impact on small samples populations. They did not look at a larger sample of African

Americans. This study takes a greater view of hypertension by taking a cross-sectional

nationwide view.

Contribution to Theory

This research furthermore attempts to offer an additional empirical test of the genetic variants

identified in African-Americans that are associated with blood pressure in West Africans. This

theory proposes that African Americans hypertension can be traced back to African ancestors.

Contribution to Practitioners in the Field of Public Administration

In conclusion, this research has real-world significance to the field of Public Administration

because it may help Administrators such as Congressmen and Senators implement additional

government policies to eradicate hypertension in the African American community.


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