title: Strategies for implementing and sustaining therapeutic lifestyle changes as part of hypertension management in African Americans.
abstract: African Americans with high blood pressure (BP) can benefit greatly from therapeutic lifestyle changes (TLC) such as diet modification, physical activity, and weight management. However, they and their health care providers face many barriers in modifying health behaviors. A multidisciplinary panel synthesized the scientific data on TLC in African Americans for efficacy in improving BP control, barriers to behavioral change, and strategies to overcome those barriers. Therapeutic lifestyle change interventions should emphasize patient self-management, supported by providers, family, and the community. Interventions should be tailored to an individual's cultural heritage, beliefs, and behavioral norms. Simultaneously targeting multiple factors that impede BP control will maximize the likelihood of success. The panel cited limited progress with integrating the Dietary Approaches to Stop Hypertension (DASH) eating plan into the African American diet as an example of the need for more strategically developed interventions. Culturally sensitive instruments to assess impact will help guide improved provision of TLC in special populations. The challenge of improving BP control in African Americans and delivery of hypertension care requires changes at the health system and public policy levels. At the patient level, culturally sensitive interventions that apply the strategies described and optimize community involvement will advance TLC in African Americans with high BP.
authors.affiliation: Division of Acute Critical and Long-Term Care Programs, School of Nursing, The University of Michigan, Ann Arbor, MI 48109-0482, USA. mscisney@umich.edu
authors.forename: Margaret
authors.initials: M
authors.lastname: Scisney-Matlock
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
authors.forename: Joyce Newman
authors.initials: JN
authors.lastname: Giger
authors.forename: Ora L
authors.initials: OL
authors.lastname: Strickland
authors.forename: R Van
authors.initials: RV
authors.lastname: Harrison
authors.forename: Dorothy
authors.initials: D
authors.lastname: Coverson
authors.forename: Nirav R
authors.initials: NR
authors.lastname: Shah
authors.forename: Cheryl R
authors.initials: CR
authors.lastname: Dennison
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Dunbar-Jacob
authors.forename: Loretta
authors.initials: L
authors.lastname: Jones
authors.forename: Gbenga
authors.initials: G
authors.lastname: Ogedegbe
authors.forename: Marian L
authors.initials: ML
authors.lastname: Batts-Turner
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Jamerson
mesh_terms: D001741:Black or African American; D001521:Behavior Therapy / Q000379:methods / Q000592:standards*; D006801:Humans; D006973:Hypertension / Q000208:ethnology / Q000523:psychology / Q000628:therapy; D008016:Life Change Events; D008019:Life Style / Q000208:ethnology*; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011379:Prognosis; D014481:United States / Q000453:epidemiology