The implementation of an exercise program to improve blood pressure and weight control in African American patients with hypertension in the primary care setting

Purpose: In recent years, hypertension, known as a "silent killer," has increased in the African American population. Approximately 45% of individuals diagnosed with hypertension receive adequate blood pressure control (Centers for Disease Control and Prevention [CDC], 2020). If left untreated or inadequately treated, hypertension can significantly increase the risk of mortality associated with cardiovascular, neurovascular, and renal diseases. Though several modalities have been studied and employed in the fight against hypertension, a vast array of evidence has brought to the forefront the role of exercise as a first-line treatment for hypertension. The purpose of this study was to investigate the impact of exercise on high blood pressure and weight control in African Americans with hypertension in the primary care setting. Method: The exercise program entailed performing an aerobic exercise such as walking or moving more for at least 150 minutes weekly for eight weeks. The exercise intervention also included education about lifestyle modification strategies such as diet and health promotion behaviors based on Nola Pender's Health Promotion Model. The goal of participants in this exercise program was to exercise (walk) or move more to help improve their blood pressure and weight and identify any facilitating factors or barriers. The DNP project took place at an outpatient primary care office in East Orange, New Jersey. Results: The exercise program was completed with a convenience sample of five participants, although ten participants were recruited. The outcomes measured utilizing SPSS statistical data technology indicated that there was a statistically significant reduction in systolic blood pressure pre-intervention (M=159, SD=12.86) and post-intervention (M=142.6, SD=7.20), t(4)=3.69, p=0.02. The reduction in the diastolic blood pressure was not statistically significant; pre-intervention (M=78.8, SD=15.78) and post-intervention ((M=73.6, SD=8.65), t(4)=1.42, p=0.23. Also, there was a statistically significant reduction in weight; pre-intervention (M=171.4, SD=55.1) and post-intervention (M=166.2, SD=54.3), t(4)=6.50, p=0.003. Discussion: Several limitations to this exercise program intervention significantly impacted the results; however, a program such as this one which indicated statistically significant results, should be replicated with a larger sample, especially with the emergence of the COVID-19 pandemic. The COVID-19 pandemic has demonstrated the magnitude of the impact of hypertension in African Americans since they were more severely affected with COVID-19 than other races. Bearing this knowledge in mind, it has become increasingly important to deploy life-saving strategies such as regular exercise for African Americans in the battle against this "silent killer." Implications: Primary care practices should be required by healthcare governing bodies to have an exercise program in place as part of their management and treatment plan for hypertension. Continuous education about exercise and its impact, especially those tailored to small groups at a time, should be ongoing. Electronic blood pressure machines to improve home self-monitoring should be covered by private and public health insurance companies. An exercise program will reduce the financial burden on society and have long-term benefits such as minimizing the morbidity and mortality associated with hypertension.DNPIncludes bibliographical reference