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2

Health Issue: High Blood Pressure

Anisleidy Alvarez

Florida National University

Health Promotion & Role Development in Adv. Nursing Practice

Dr. Nora Hernandez-Pupo

November 18, 2025

Health Issue: High Blood Pressure

Hypertension is a severe global public health concern, especially in low- and middle-income nations, and has a profound impact on cardiovascular outcomes (Goorani et al., 2024). Hypertension affects nearly 47.7 percent of adults in the United States, and differences in the incidence and management of this condition can be observed across racial, ethnic, and socioeconomic groups (Fryar et al., 2024). As an example, hypertension rates are higher in non-Hispanic Black people (48.8) than in non-Hispanic White people (37.6) and Hispanics (27.9) (Sells et al., 2023). High blood pressure is a significant predisposing factor to heart failure, stroke, and kidney failure. Although these are very alarming statistics, a significant number of people are unaware of their condition, and control rates are low. The proposal seeks to control hypertension that has not been managed through community-based screening, self-monitoring and taking medicine, and connection with primary care. The targeted, quantitative change is a 15% relative improvement in the percentage of enrolled individuals who control their blood pressure (<130/80 mm Hg) in six months, confirmed through clinic-validated home measurements and chart recordings.

Vulnerable Population: Hypertension in Underserved Communities

The target population of the proposed health promotion program is the vulnerable population that consists of low-income and minority groups, especially non-Hispanic Blacks and Hispanics, who have a disproportionately high hypertension burden. Such populations are at risk of poor nutrition, lack of access to healthcare, stress, and education on the risks of hypertension. Studies have revealed that these groups have increased hypertension rates and less chance of appropriate care or treatment (Sells et al., 2023). Social determinants of health such as poverty, insurance and low levels of education, pose a high risk of developing hypertension and the poor control of hypertension. Also, the complications of hypertension management are exacerbated by the stigma of chronic illnesses among particular populations. Meticulous health interventions focusing on these aspects will be important in curbing the prevalence of hypertension among these susceptible groups and the availability of preventive health services and treatment to everyone.

Literature Review

Persell et al. (2020) detail one rigorous intervention in their randomized clinical trial comparing a smartphone coaching app and home blood pressure monitor to a tracking app and monitor in adults with uncontrolled hypertension. After six months, the systolic blood pressure of the coaching-app group decreased on average by 8.3 mm Hg (compared to the baseline) and the tracking-app group dropped on average by 6.8 mm Hg, but the adjusted between-group difference was not statistically significant (Persell et al., 2021). Notably, individuals who adopted the coaching app had increased self-efficacy in the management of their blood pressure. The strengths of the study are its randomized design, use of mobile technology and home monitoring in over six months, and measurement of physiological and behavioral outcomes. The limitations, however, include the small effect size and the likelihood that the sample size was not sufficiently large to identify smaller, but clinically significant differences.

Likewise, an investigative randomized controlled trial by Beger et al. (2025) evaluated the impact of the “Manoa’ digital blood pressure coach app in the primary care environment (non-hospital). The app was used with patients in the intervention arm, and it integrates guideline-based home BP with personalized coaching on lifestyle changes, whereas control patients were provided with standard care. The intervention group reported more office systolic blood pressure reduction than the control group over a period of 90–150 days, and it can be concluded that digital coaching plus structured home monitoring can make a significant contribution to the management of hypertension in clinical practice. The authors concluded that the app was more effective than standard care when it comes to BP control. One of its strengths is the real-world design, as it indicates how such an intervention could be used in ordinary clinical practice. Nevertheless, the comparatively brief follow-up hinders inferences regarding long-term effectiveness and sustained behavior change - and, as with most app-based interventions, there could be digital access or usability obstacles that do not allow all patients to get the full benefit.

Evaluation of Evidence

All these works present a strong argument in favor of the potential of digital health interventions to manage hypertension, especially when home blood pressure monitoring is used alongside behavioral coaching. According to the Persell et al. trial, a coaching application can enhance patient self-confidence in the management of their own blood pressure, although the reduction in measured blood pressure may have been modest. The pragmatic trial provides real-world validation to prove the fact that such an app can be applied to primary care, and it can be integrated into guideline-based monitoring. Mobile interventions have several advantages such as scalability, low marginal cost, and extensive reach.

Conversely, there exist obvious limitations. The effect sizes are low which casts doubts on clinical significance. The long-term sustainability is not easy to evaluate due to the relatively short periods. Furthermore, digital interventions are already biased towards patients who have access to smartphones and are digitally literate, which may exclude other subpopulations that may be the most vulnerable. Lastly, results can be related to self-reported behavior, which may be biased.

Health Promotion Model: Health Belief Model (HBM)

The Health Belief Model (HBM) is chosen as the theoretical framework due to its constructs, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy, which are aligned with the hypertension prevention and control activities (Alyafei & Carr, 2024). A large number of hypertensive adults are asymptomatic and thus they underestimate the risk of the disease and its severity in case of uncontrolled illness; this risk will be made salient and concrete through HBM-based education as it will reveal risk trends based on home monitoring and clarify the tangible benefits of control, such as decreased risks of stroke and heart diseases. The program will contain cues to action that will be automated alerts, community screening activities, and community health worker outreach, whereas interventions to reduce perceived barriers will focus on cost, transportation and health literacy.

The HBM focus on self-efficacy also contributes to intervention elements in which practical skills are developed: training on home BP measurement that is proven, medication management, diet and activity goal-setting, and peer-support sessions to enhance confidence. The program has a combination of individual-level HBM tactics and structural enablers, such as providing home monitors, community health worker navigation, telehealth escalation pathways and connection to low-cost medication support, which meets the behavioral determinants and social constraints. This theoretically based, multilevel design is aligned with the best evidence available and is likely to enhance engagement and measurable blood pressure control in the vulnerable population targeted. The program will focus on enhancing hypertension control by 15 percent among program participants in six months. The intention-to-treat analysis and blood pressure results that are proven by clinics will also be used to evaluate the results rigorously.

References

Alyafei, A., & Carr, R. E. (2024). The Health Belief Model of Behavior Change. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK606120/

Beger, C., Rüegger, D., Lenz, A., Wagner, S., Schmidt-Ott, K. M., Volland, D., & Limbourg, F. P. (2025). Effect of a digital blood pressure coach on hypertension management in primary care practices—a pragmatic, randomised controlled trial. Frontiers in Digital Health, 7. https://doi.org/10.3389/fdgth.2025.1516600

Fryar, C. D., Kit, B., Carroll, M. D., & Afful, J. (2024, October 23). Hypertension Prevalence, Awareness, Treatment, and Control Among Adults Age 18 and Older: United States, August 2021–August 2023. Cdc.gov. https://stacks.cdc.gov/view/cdc/164016

Goorani, S., Zangene, S., & Imig, J. D. (2024). Hypertension: A Continuing Public Healthcare Issue. International Journal of Molecular Sciences, 26(1), 123–123. https://doi.org/10.3390/ijms26010123

Persell, S. D., Peprah, Y. A., Lipiszko, D., Lee, J. Y., Li, J. J., Ciolino, J. D., Karmali, K. N., & Sato, H. (2020). Effect of Home Blood Pressure Monitoring via a Smartphone Hypertension Coaching Application or Tracking Application on Adults With Uncontrolled Hypertension: A Randomized Clinical Trial. JAMA Network Open, 3(3), e200255–e200255. https://doi.org/10.1001/jamanetworkopen.2020.0255

Sells, M., Blum, E., Perry, G. S., Eke, P. I., & Presley-Cantrell, L. (2023). Excess Burden of Poverty and Hypertension, by Race and Ethnicity, on the Prevalence of Cardiovascular Disease. Preventing Chronic Disease, 20(20). https://doi.org/10.5888/pcd20.230065

2

Health Issue: High Blood Pressure

Anisleidy Alvarez

Florida National University

Health Promotion & Role Development in Adv. Nursing Practice

Dr. Nora Hernandez-Pupo

November 18, 2025

Health Issue: High Blood Pressure

Hypertension is a severe global public health concern, especially in low- and middle-income nations, and has a profound impact on cardiovascular outcomes (Goorani et al., 2024). Hypertension affects nearly 47.7 percent of adults in the United States, and differences in the incidence and management of this condition can be observed across racial, ethnic, and socioeconomic groups (Fryar et al., 2024). As an example, hypertension rates are higher in non-Hispanic Black people (48.8) than in non-Hispanic White people (37.6) and Hispanics (27.9) (Sells et al., 2023). High blood pressure is a significant predisposing factor to heart failure, stroke, and kidney failure. Although these are very alarming statistics, a significant number of people are unaware of their condition, and control rates are low. The proposal seeks to control hypertension that has not been managed through community-based screening, self-monitoring and taking medicine, and connection with primary care. The targeted, quantitative change is a 15% relative improvement in the percentage of enrolled individuals who control their blood pressure (<130/80 mm Hg) in six months, confirmed through clinic-validated home measurements and chart recordings.

Vulnerable Population: Hypertension in Underserved Communities

The target population of the proposed health promotion program is the vulnerable population that consists of low-income and minority groups, especially non-Hispanic Blacks and Hispanics, who have a disproportionately high hypertension burden. Such populations are at risk of poor nutrition, lack of access to healthcare, stress, and education on the risks of hypertension. Studies have revealed that these groups have increased hypertension rates and less chance of appropriate care or treatment (Sells et al., 2023). Social determinants of health such as poverty, insurance and low levels of education, pose a high risk of developing hypertension and the poor control of hypertension. Also, the complications of hypertension management are exacerbated by the stigma of chronic illnesses among particular populations. Meticulous health interventions focusing on these aspects will be important in curbing the prevalence of hypertension among these susceptible groups and the availability of preventive health services and treatment to everyone.

Literature Review

Persell et al. (2020) detail one rigorous intervention in their randomized clinical trial comparing a smartphone coaching app and home blood pressure monitor to a tracking app and monitor in adults with uncontrolled hypertension. After six months, the systolic blood pressure of the coaching-app group decreased on average by 8.3 mm Hg (compared to the baseline) and the tracking-app group dropped on average by 6.8 mm Hg, but the adjusted between-group difference was not statistically significant (Persell et al., 2021). Notably, individuals who adopted the coaching app had increased self-efficacy in the management of their blood pressure. The strengths of the study are its randomized design, use of mobile technology and home monitoring in over six months, and measurement of physiological and behavioral outcomes. The limitations, however, include the small effect size and the likelihood that the sample size was not sufficiently large to identify smaller, but clinically significant differences.

Likewise, an investigative randomized controlled trial by Beger et al. (2025) evaluated the impact of the “Manoa’ digital blood pressure coach app in the primary care environment (non-hospital). The app was used with patients in the intervention arm, and it integrates guideline-based home BP with personalized coaching on lifestyle changes, whereas control patients were provided with standard care. The intervention group reported more office systolic blood pressure reduction than the control group over a period of 90–150 days, and it can be concluded that digital coaching plus structured home monitoring can make a significant contribution to the management of hypertension in clinical practice. The authors concluded that the app was more effective than standard care when it comes to BP control. One of its strengths is the real-world design, as it indicates how such an intervention could be used in ordinary clinical practice. Nevertheless, the comparatively brief follow-up hinders inferences regarding long-term effectiveness and sustained behavior change - and, as with most app-based interventions, there could be digital access or usability obstacles that do not allow all patients to get the full benefit.

Evaluation of Evidence

All these works present a strong argument in favor of the potential of digital health interventions to manage hypertension, especially when home blood pressure monitoring is used alongside behavioral coaching. According to the Persell et al. trial, a coaching application can enhance patient self-confidence in the management of their own blood pressure, although the reduction in measured blood pressure may have been modest. The pragmatic trial provides real-world validation to prove the fact that such an app can be applied to primary care, and it can be integrated into guideline-based monitoring. Mobile interventions have several advantages such as scalability, low marginal cost, and extensive reach.

Conversely, there exist obvious limitations. The effect sizes are low which casts doubts on clinical significance. The long-term sustainability is not easy to evaluate due to the relatively short periods. Furthermore, digital interventions are already biased towards patients who have access to smartphones and are digitally literate, which may exclude other subpopulations that may be the most vulnerable. Lastly, results can be related to self-reported behavior, which may be biased.

Health Promotion Model: Health Belief Model (HBM)

The Health Belief Model (HBM) is chosen as the theoretical framework due to its constructs, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy, which are aligned with the hypertension prevention and control activities (Alyafei & Carr, 2024). A large number of hypertensive adults are asymptomatic and thus they underestimate the risk of the disease and its severity in case of uncontrolled illness; this risk will be made salient and concrete through HBM-based education as it will reveal risk trends based on home monitoring and clarify the tangible benefits of control, such as decreased risks of stroke and heart diseases. The program will contain cues to action that will be automated alerts, community screening activities, and community health worker outreach, whereas interventions to reduce perceived barriers will focus on cost, transportation and health literacy.

The HBM focus on self-efficacy also contributes to intervention elements in which practical skills are developed: training on home BP measurement that is proven, medication management, diet and activity goal-setting, and peer-support sessions to enhance confidence. The program has a combination of individual-level HBM tactics and structural enablers, such as providing home monitors, community health worker navigation, telehealth escalation pathways and connection to low-cost medication support, which meets the behavioral determinants and social constraints. This theoretically based, multilevel design is aligned with the best evidence available and is likely to enhance engagement and measurable blood pressure control in the vulnerable population targeted. The program will focus on enhancing hypertension control by 15 percent among program participants in six months. The intention-to-treat analysis and blood pressure results that are proven by clinics will also be used to evaluate the results rigorously.

References

Alyafei, A., & Carr, R. E. (2024). The Health Belief Model of Behavior Change. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK606120/

Beger, C., Rüegger, D., Lenz, A., Wagner, S., Schmidt-Ott, K. M., Volland, D., & Limbourg, F. P. (2025). Effect of a digital blood pressure coach on hypertension management in primary care practices—a pragmatic, randomised controlled trial. Frontiers in Digital Health, 7. https://doi.org/10.3389/fdgth.2025.1516600

Fryar, C. D., Kit, B., Carroll, M. D., & Afful, J. (2024, October 23). Hypertension Prevalence, Awareness, Treatment, and Control Among Adults Age 18 and Older: United States, August 2021–August 2023. Cdc.gov. https://stacks.cdc.gov/view/cdc/164016

Goorani, S., Zangene, S., & Imig, J. D. (2024). Hypertension: A Continuing Public Healthcare Issue. International Journal of Molecular Sciences, 26(1), 123–123. https://doi.org/10.3390/ijms26010123

Persell, S. D., Peprah, Y. A., Lipiszko, D., Lee, J. Y., Li, J. J., Ciolino, J. D., Karmali, K. N., & Sato, H. (2020). Effect of Home Blood Pressure Monitoring via a Smartphone Hypertension Coaching Application or Tracking Application on Adults With Uncontrolled Hypertension: A Randomized Clinical Trial. JAMA Network Open, 3(3), e200255–e200255. https://doi.org/10.1001/jamanetworkopen.2020.0255

Sells, M., Blum, E., Perry, G. S., Eke, P. I., & Presley-Cantrell, L. (2023). Excess Burden of Poverty and Hypertension, by Race and Ethnicity, on the Prevalence of Cardiovascular Disease. Preventing Chronic Disease, 20(20). https://doi.org/10.5888/pcd20.230065