Factors Associated With Hypertension Awareness, Treatment, and Control in Dallas County, Texas

Abstract

Background: Hypertension (HTN) control rates in the United States remain lower in black than white persons, particularly before 65 years of age. Potential sociocultural factors have not been sufficiently addressed.Methods: We analyzed data from structured interviews and blood pressure measurements in a population-based sample of 1514 hypertensive (1194 non-Hispanic black and 320 non-Hispanic white) subjects aged 18 to 64 years in Dallas County, Texas, from 2000 to 2002 to identify sociocultural factors associated with low rates of HTN control. We calculated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) using multivariate logistic regression.Results: Awareness, treatment, and control of HTN were negatively associated with a common perception of good health, with aORs (95% CIs) of 0.37 (0.27-0.50) for awareness, 0.47 (0.36-0.62) for treatment, and 0.66 (0.51-0.86) for control. They were positively associated with having a regular physician, with aORs (95% CIs) of 3.81 (2.86-5.07) forawareness,8.36(5.95-11.74)fortreatment,and5.23(3.30-8.29) for control. Among untreated hypertensive subjects, lack of perceived need for a regular physician was associated with perceived good health (aOR [95% CI], 2.2 [1.2-4.0]), male gender (aOR [95% CI], 2.4 [1.4-4.1]), and black race/ethnicity (aOR [95% CI], 2.1 [1.0-4.4]). The HTN outcomes were unrelated to perceived racism or lay beliefs about the causes, consequences, and treatment of HTN.Conclusions: Among young to middle-aged hypertensive subjects, a perception of good health and the lack of perceived need for a regular physician remain major factors associated with untreated and uncontrolled HTN at the community level-particularly among black men. These factors merit greater emphasis in professional education and public health programs on HTN.

Awareness, Treatment and Control of Hypertension Among Filipino Immigrants

“…29 In our sample, only 21.7 % of hypertensive individuals exhibited hypertension control, a rate nearly half that of hypertensive adults in NYC overall (47.1 %), as well as Hispanics and non-Hispanic Blacks (both 46.8 %), and Asians overall (39.9 %). 29 Similar to previous research in Filipino and other ethnic groups, older age was associated with a greater awareness of hypertension and treatment for hypertension, 18,27 having health insurance was associated with greater BP control, 15,27,30 lower self-rated health and comorbidities were associated with greater awareness of hypertension, 15,26 and smoking cigarettes was associated with not being on treatment for hypertension. 15 A family history of hypertension was significantly associated with awareness of hypertension, and longer time lived in the U.S. was associated with treatment for hypertension.…”

“…Insured individuals were two times more likely than uninsured individuals to have controlled hypertension [26][27][28] this is the first study to examine awareness, treatment, and control of hypertension among Filipino Americans. One previous study in NYC examined these outcomes and included an Asian group, but all Asian subgroups were aggregated due to small sample size.…”

“…29 Poor control among individuals on medication for hypertension is of particular concern; while 78 % of aware individuals were taking medication for hypertension, the rate of control (38.4 %) was lower than the rate previously seen among African Americans, Mexican Americans, and whites. [26][27][28] A qualitative study examining 27 uninsured hypertensive Filipino immigrants found that forgetfulness, time constraints, ethnic/cultural practices, stress, and medication side effects contributed to nonadherence and uncontrolled hypertension. 19 The rate of hypertension awareness (72.1 %) among Filipino Americans in this study was lower than the unadjusted rate for NYC overall (83.0 %), as well as other minority populations in NYC, including non-Hispanic Blacks (85.5 %), Hispanics (81.9 %), and Asians overall (78.3 %).…”

“…National Health and Nutrition Examination Survey (NHANES), National Health Interview Survey (NHIS), and the Veteran Affairs Medical Centers records). 26,29,32 The data for our study was drawn from a community-based sample of Filipino Americans at health screening events around the NY Metropolitan area. Measurements were taken directly by CHWs and licensed clinical nurses and reflect an exact measurement as opposed to self-reported diagnoses of hypertension.…”

Using Insights From Behavioral Economics and Social Psychology to Help Patients Manage Chronic Diseases

“…Of course, several factors may diminish intrinsic motivation to seek medical treatment (e.g., anecdotes from friends about bad experiences with health care, fatalistic religious beliefs, unrealistically positive views of one's health status, mistrust of providers). 47 Thus, interventions designed to promote more effective control of chronic disease should take into account their potential positive or negative impact on intrinsic motivation.…”