Predictors of Uncontrolled Hypertension in the Stroke Belt

Abstract

Inadequate control of high systolic blood pressure in older adults has been largely attributable to poor control of overall hypertension (HTN). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines emphasize the importance of controlling isolated systolic HTN in older adults. The study examined demographics, self‐reported health information, and clinical measures as predictors of uncontrolled HTN among individuals taking antihypertensive medications. The Community Initiative to Eliminate Stroke, a stroke risk factor screening and prevention project, collected data in two North Carolina counties. Statistical modeling of predictors included odds ratios (ORs) and logistic regression analyses. Of the 2663 participants, 43.5% and 22.8% had uncontrolled systolic and diastolic HTN, respectively. African Americans were more likely to have uncontrolled systolic (60%) or diastolic HTN (70.9%) compared with whites (40% and 29.1%, respectively). Participants 55 years and older were more likely to have uncontrolled systolic HTN compared with younger individuals. Regression analyses showed that race (OR, 1.239; P=.00), age (OR, 1.683; P=.00), and nonadherence with medications (OR, 2.593; P=.00) were significant predictors of uncontrolled systolic HTN. Future interventions should focus on improving management of isolated systolic HTN in older adults and African Americans to increase overall control of HTN.

Analysis of Gender Differences in Knowledge of Stroke Warning Signs

“…This is particularly concerning in light of a higher prevalence of certain stroke risk factors in this population, namely uncontrolled hypertension. 31 Black race has also been shown to be associated with longer prehospital delays 32 and higher mortality rates, 33 making this an especially vulnerable group.…”

Predictors of Uncontrolled Blood Pressure in Treated Hypertensive Individuals: First Population‐Based Study in Lebanon

“…Similar findings have been reported in other studies that investigated the predictors of uncontrolled AH and the relationship between SBP and DBP control and the risk of coronary heart disease. 22 The hemodynamic patterns of age-related changes in BP have been explored by Franklin and colleagues. 23 They attributed the continuous rise in SBP throughout life, coupled with an early rise and late fall (after the age of 50) in DBP, to large artery stiffness.…”

“…This is in agreement with most of the existing evidence. 22 The Combination Pill of Losartan Potassium and Hydrochlorothiazide for Improvement of Medication Compliance Trial (COMFORT) 29 demonstrated that patients with a relatively low adherence rate (<90%) showed significantly higher systolic and diastolic BP compared with those with a perfect adherence rate (100%) over a 6-month treatment period.…”

Engaging Gatekeeper-Stakeholders in Development of a Mobile Health Intervention to Improve Medication Adherence Among African American and Pacific Islander Elderly Patients With Hypertension

“…Estimates from the National Health Interview Survey in 2007 found that Native Hawaiians and Pacific Islanders had the second highest rates of any ethnic group in the United States at 29% [2-5]. Despite evidence that appropriate pharmacological treatment reduces morbidity and mortality across all populations [6-8], racial and ethnic minorities, including African Americans and Native Hawaiian and Pacific Islanders, often underutilize antihypertensive medications [9-11]. …”