The context of hypertension in the South Asian migrant community In the UK hypertension contributes to a high mortality rate in the South Asian migrant community (Cappuccio, 1997). There is considerable data indicating that undiagnosed hypertension leads to more negative outcomes for this group. One example is that it leads to a high risk for chronic kidney disease (Major, Davies, Crasto, Gray, Webb & Khunti, 2015). Screening for hypertension does not take into account the indicators which are specific to the South Asian community (Jayawardana, Ranasinghe, Matthews & Katulanda, 2013). The result is a greater number of patients with South Asian ancestry with undiagnosed hypertension who fail to receive patient education on proactive lifestyle steps and who may develop other acute problems such as chronic kidney disease.

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The issue
When nurses are not aware of the risk for hypertension, they cannot appropriately guide patients to make choices. Chronic conditions such as hypertension have risen rapidly in South Asian countries and communities (Jayawardana, Ranasinghe, Sheriff, Matthews & Katulanda, 2013). Prevention is more efficient and effective in achieving best possible patient outcomes. A study by Jayawardana and colleagues (2013) in Sri Lanka noted the need for an anthropometric indices tool that was accurate when used with the South Asian population given the high number of hypertensive South Asian adults who are not identified through the use of current screening tools.

The impact of the problem on the quality of care and patient outcomes
Undiagnosed hypertension is correlated with negative outcomes that can include the development of chronic kidney disease, as shown in a study by Major and associates (2015). Further, preventative interventions such as patient education are not made available to persons who do not realize that they have or are at risk of having problems with hypertension. Because there are no accurate screening tools to identify hypertension in this subpopulation, nursing is not providing the needed care to ensure the best possible quality of care. Patient outcomes are negative in comparison with persons who have been diagnosed with hypertension and therefore proactively manage the condition.

Gravity of the issue and its significance to nursing
An understanding of the risk and protective factors that are correlated with hypertension for specific populations can assist nurses in determining whether hypertension is an issue or potential issue in a patient’s life. Nursing could then provide appropriate education regarding lifestyle behaviors and self-care can help to ensure that acute problems are less likely to occur. Unfortunately traditional approaches are not accurate in identifying hypertension in South Asian patients. One example is the use of atrial fibrillation in screening for the general population (O’Neill & Tayebjee, 2016). This is not however a relevant indicator for the South Asian community. South Asian populations are known to have extremely high rates of atrial fibrillation, but research has shown that in fact this population does not show correlation between hypertension and atrial fibrillation (O’Neill & Tayebjee, 2016).

The solution
This significant problem of undiagnosed hypertension in the South Asian community can be improved with a targeted intervention. This intervention would require a new screening tool for hypertension in the South Asian population. The ideal outcome is better management of hypertension and even prevention of hypertension in the South Asian patient population. This would result in fewer acute negative outcomes. Measurement of the success of such an intervention would occur in the long run through comparison of baseline rates of poor outcomes relating to hypertension with the population who has benefited from the screening tool. For the purpose of piloting this intervention in order to provide evidence of its benefit, the use of such a screening tool could be used over a shorter period of time such as 30-60 days. The outcome that would be therefore measured is the number of persons screened and found to be at risk or suffering from the condition, based on the more relevant indicators in the new screening tool.

Further research is needed in order to refine the factors which serve a protective function for South Asians with hypertension; however research has already identified some of the variables that may be useful. For example, research using a sample of over 4,000 subjects allowed researchers to determine that waist to height ratio was the strongest predictor of metabolic syndromes such as hypertension (Jayawardana et al., 2013). This could become a screening variable that indicated risk for the South Asian population. A study by Hwangbo, Kim, Chu, Yun and Yang (2013) found that sleep deprivation was positively associated with hypertension in the Korean population. Hours of sleep and subjective responses regarding whether persons feel they have gotten enough sleep are therefore potential screening questions for the South Asian population. Screening tools based on research can support simple processes which help to prevent hypertension or identify it earlier.

    References
  • Cappuccio, F. P. (1997). Ethnicity and cardiovascular risk: variations in people of African ancestry and South Asian origin. Journal of human hypertension, 11(9), 571-576.
  • Hwangbo, Y., Kim, W. J., Chu, M. K., Yun, C. H., & Yang, K. I. (2013). Association between weekend catch-up sleep duration and hypertension in Korean adults. Sleep medicine, 14(6), 549-554.
  • Jayawardana, R., Ranasinghe, P., Sheriff, M. H. R., Matthews, D. R., & Katulanda, P. (2013). Waist to height ratio: a better anthropometric marker of diabetes and cardio-metabolic risks in South Asian adults. Diabetes research and clinical practice, 99(3), 292-299.
  • Major, R. W., Davies, M. J., Crasto, W., Gray, L. J., Webb, D. R., & Khunti, K. (2015). Association between undiagnosed hypertension and microalbuminuria in South Asians without known diabetes. Journal of human hypertension, 29(3), 185-189.
  • O’Neill, J., & Tayebjee, M. H. (2016). Why are South Asians seemingly protected against the development of atrial fibrillation? A review of current evidence. Trends in Cardiovascular Medicine.