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.
ResearchHypothesis 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.
ResearchHypothesis 2 (H2) The percentage of genetic variants identified in African-Americans
is positively correlated with blood pressure in West Africans.
ResearchHypothesis 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.

ResearchHypothesis (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.
Genetics
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.
Income
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.
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 ResearchStudies 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
Genetics
Prevention Report
Prevention Report
Income
Prevention Report
US Census Bureau Report
Attitudes towards visiting a
physician
Survey
Survey
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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