Poor medication adherence may contribute to low hypertension control rates. In 2005, 295 hypertensive patients who reported taking antihypertensive medication were administered a telephone questionnaire including an 8‐item scale assessing medication adherence. Overall, 35.6%,36.0%, and 28.4% of patients were determined to have good, medium, and poor medication adherence, respectively. After multivariable adjustment, adults younger than 50 years and 51 to 60 years were 1.39 (95% confidence interval [CI], 0.56–3.42) and 1.53 (95% CI, 0.64–3.66),respectively, times more likely to be less adherent when compared with their counterparts who were older than 60 years. Black adults and men were 4.30 (95% CI, 1.06–17.5) and 2.45 (95% CI, 1.04–5.78) times more likely to be less adherent, respectively. Additionally, caring for dependents, an initial diagnosis of hypertension within 10 years, being uncomfortable about asking the doctor questions, and wanting to spend more time with the doctor if possible were associated with poor medication adherence. The current study identified a set of risk factors for poor antihypertensive medication adherence in the urban setting.
Main results of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial were published in December 2002. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, published in May 2003, recommended thiazide-type diuretics as initial pharmacological treatment alone or in combination with another drug in most patients with hypertension. To assess changes from before to after these publications, we compared antihypertensive medication prescriptions filled by patients who initiated pharmacological antihypertensive treatment in a large managed care organization during 3 time periods: (1) July 1, 2001, to June 30, 2002 (before these publications; n=1354); (2) July 1, 2003, to June 30, 2004 (to assess short-term changes; n=1542); and (3) July 1, 2004, to June 30, 2005 (to assess extended changes; n=1865). The percentage of patients initiating antihypertensive treatment with a thiazide-type diuretic increased from 30.6% to 39.4% (P<0.001) between 2001-2002 and 2003-2004, and the increase was maintained at 36.5% in 2004-2005 (P<0.001 compared with 2001-2002 and P=0.33 compared with 2003-2004). Among patients without diabetes mellitus, renal disease, a history of myocardial infarction, or heart failure, the percentage initiating pharmacological antihypertensive treatment with a thiazide-type diuretic increased from 33.1% in 2001-2002 to 43.4% in 2003-2004 (P<0.001) and remained increased (41.0%) in 2004-2005 (P<0.001 and P=0.23 compared with 2001-2002 and 2003-2004, respectively). Despite a sustained increase in the use of thiazide-type diuretics, this study indicates that an opportunity exists to increase adherence to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines.
Purpose Poor hypertension knowledge may contribute to low rates of blood pressure control. The purpose of this study was to determine levels and correlates of hypertension knowledge among an urban, black population. Methods Study participants with established hypertension (n = 263) were administered a telephone survey, designed for low-literacy populations. Hypertension knowledge was assessed through a validated 10-item questionnaire on which respondents received 1 point for a correct response for a total possible score of 10. Results The majority of participants were female (80.2%), 75% reported incomes less than $1,000/month, 60% had at least a high school education, and 75% of respondents were reported always being comfortable asking their doctors questions. Overall, 40% of participants correctly answered 9 or 10 questions. Items with the lowest percentage of correct responses included knowing that a blood pressure of 130/80 is normal (58.9% correct), hypertension lasts a lifetime (59.3%), hypertension does not cause cancer (40.3%), and renal failure is a complication of hypertension (77.6%). Compared with their counterparts with a high hypertension knowledge score (9 or 10 questions correct), the odds ratio of a low hypertension knowledge score ( Conclusions Overall knowledge of high blood pressure was good in this population. However, deficits exist in specific content areas and certain subgroups. Effectively targeting hypertension education content to specific audiences and topical areas may improve hypertension knowledge for black patients receiving care in urban public hospitals.
We conducted a meta-analysis of 25 randomized controlled trials published in English-language journals before February 2004, to assess the effect of dietary fiber intake on blood pressure (BP).Using a standardized protocol, information on study design, sample size, participant characteristics, duration of follow-up and change in mean BP, was abstracted. The data from each study were pooled using a random effects model to provide an overall estimate of dietary fiber intake on BP.Dietary fiber intake was the only significant intervention difference between the active and control groups.Overall, dietary fiber intake was associated with a significant -1.65 mmHg [95% confidence interval (CI), -2.70 to -0.61] reduction in diastolic BP (DBP) and a non-significant -1.15 mmHg (95% CI, -2.68 to 0.39) reduction in systolic BP (SBP). A significant reduction in both SBP and DBP was observed in trials conducted among patients with hypertension (SBP -5.95 mmHg, 95% CI, -9.50 to -2.40; DBP -4.20 mmHg, 95% CI, -6.55 to -1.85) and in trials with a duration of intervention > or = 8 weeks (SBP -3.12 mmHg, 95% CI, -5.68 to -0.56; DBP -2.57 mmHg, 95% CI, -4.01 to -1.14).Our results indicate that increased intake of dietary fiber may reduce BP in patients with hypertension and suggests a smaller, non-conclusive, reduction in normotensives. An intervention period of at least 8 weeks may be necessary to achieve the maximum reduction in BP. Our findings warrant conduct of additional clinical trials with a larger sample size and longer period of intervention to examine the effect of dietary fiber intake on BP.
Knowledge of hypertension risks and consequences can equip patients with the motivation and skills necessary to reduce their blood pressure. However, this knowledge is thought to be limited in indigent, minority populations.
Methods
Between January and August 2005, a trained interviewer administered a telephone questionnaire to 296 patients identified from an urban public hospital primary care clinic. Blood pressure knowledge was assessed through a validated 10-item/10-point questionnaire and included items measuring patient understanding of the prognosis, treatment, and adverse outcomes of hypertension.
Results
Overall, 12% (n = 34) of patients answered all 10 questions correctly. Only 8% (n = 23) answered less than half of the questions correctly. Among participants, 98% (n = 290) and 95% (n = 281) of patients knew that high blood pressure was associated with heart attacks and stroke, but only 76% (n = 226) knew it caused kidney disease. Only 42% (n = 124) of respondents knew that high blood pressure did not cause cancer; 8% (n = 24) responded they thought hypertension did cause cancer and 50% (n = 148) were uncertain. A logistic regression model was performed adjusting for age, race, gender, and including time since hypertension diagnosis, comfort asking their doctor questions, having dependents, income level, cigarette smoking, cohabitation status, and education. The odds ratios (95% confidence interval (CI)) of having limited blood pressure knowledge (score # 7 versus $ 9) were 2.4 (1.1-5.0) for patients > 60 compared to # 50 years, 5.2 (1.7-15.7) and 3.0 (1.4-6.3) for patients who were first diagnosed with hypertension < 1 year and 1-5 years ago, respectively, compared to > 10 years ago, and 2.3 (1.2-4.3) for patients with less than a high school education compared to completion of high school.
Conclusions
Knowledge of high blood pressure in these patients receiving care in an urban public health system is good, except in specific areas, such as its relationship to chronic kidney disease. Older patients and those with less formal education are most at risk for insufficient hypertension knowledge. Targeting hypertension education content to select areas and audiences may improve efficiency and effectiveness of hypertension education in urban, minority populations.
