title: 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.
authors.affiliation: North Carolina Translational Research and Clinical Sciences Institute, Chapel Hill, NC 27599, USA. gjdave@email.unc.edu
authors.forename: Gaurav J
authors.initials: GJ
authors.lastname: Dave
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Bibeau
authors.forename: Mark R
authors.initials: MR
authors.lastname: Schulz
authors.forename: Robert E
authors.initials: RE
authors.lastname: Aronson
authors.forename: Louise L
authors.initials: LL
authors.lastname: Ivanov
authors.forename: Adina
authors.initials: A
authors.lastname: Black
authors.forename: Lapronda
authors.initials: L
authors.lastname: Spann
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000367:Age Factors; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000187:drug effects; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000208:ethnology / Q000517:prevention & control; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009657:North Carolina; D016017:Odds Ratio; D020521:Stroke / Q000175:diagnosis* / Q000208:ethnology / Q000517:prevention & control; D011795:Surveys and Questionnaires; D014280:Triglycerides / Q000097:blood; D044465:White People; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents; D001786:Blood Glucose; D014280:Triglycerides
references.citation: Hypertension. 2008 Apr;51(4):1149-55
references.pmid: 18259013
references.citation: Med Care. 1979 Mar;17(3):285-92
references.pmid: 763006
references.citation: Circulation. 1997 Jul 1;96(1):308-15
references.pmid: 9236450
references.citation: Arch Intern Med. 2007 Dec 10;167(22):2431-6
references.pmid: 18071164
references.citation: Circulation. 2009 Jan 27;119(3):480-6
references.pmid: 19171871
references.citation: Med J Aust. 2006 Nov 20;185(10):549-57
references.pmid: 17115967
references.citation: Am J Hypertens. 2008 Jan;21(1):85-91
references.pmid: 18091749
references.citation: Hypertension. 2001 Oct;38(4):809-14
references.pmid: 11641291
references.citation: Natl Vital Stat Rep. 2009 Apr 17;57(14):1-134
references.pmid: 19788058
references.citation: Br Med J (Clin Res Ed). 1983 Jul 9;287(6385):88-93
references.pmid: 6407715
references.citation: Am J Health Behav. 2006 Nov-Dec;30(6):636-50
references.pmid: 17096621
references.citation: Vasc Health Risk Manag. 2008;4(1):157-66
references.pmid: 18629350
references.citation: Aust N Z J Public Health. 2010 Aug;34(4):394-400
references.pmid: 20649780
references.citation: J Am Coll Cardiol. 2011 May 17;57(20):2037-114
references.pmid: 21524875
references.citation: Ethn Dis. 2007 Winter;17(1):29-34
references.pmid: 17274206
references.citation: J Am Coll Cardiol. 2012 Oct 16;60(16):1503-11
references.pmid: 22999729
references.citation: N Engl J Med. 1998 Dec 31;339(27):1957-63
references.pmid: 9869666
references.citation: Hypertension. 2011 Jan;57(1):39-47
references.pmid: 21135358
references.citation: Am Heart J. 1991 Feb;121(2 Pt 2):664-9
references.pmid: 1989402
references.citation: J Clin Hypertens (Greenwich). 2008 Aug;10(8):644-6
references.pmid: 18772648
references.citation: Appl Nurs Res. 2003 Nov;16(4):266-77
references.pmid: 14608560
references.citation: Circulation. 2005 Sep 13;112(11):1651-62
references.pmid: 16157784
references.citation: Circulation. 2012 Apr 3;125(13):1594-6
references.pmid: 22379111
references.citation: Circulation. 2012 Oct 23;126(17):2105-14
references.pmid: 23091084
references.citation: J Gen Intern Med. 2008 Mar;23(3):323-8
references.pmid: 18196349
references.citation: Med Clin North Am. 2009 May;93(3):753-69
references.pmid: 19427503
references.citation: N Engl J Med. 2001 Aug 16;345(7):479-86
references.pmid: 11519501
references.citation: Implement Sci. 2011 Sep 01;6:100
references.pmid: 21884616
references.citation: Hypertension. 2003 Dec;42(6):1206-52
references.pmid: 14656957
references.citation: Curr Opin Cardiol. 2005 Jul;20(4):296-300
references.pmid: 15956826
references.citation: Circulation. 2010 Sep 21;122(12):1141-3
references.pmid: 20823382
references.citation: Ethn Dis. 2004 Winter;14(1):3-12
references.pmid: 15002917
references.citation: Hypertension. 2000 May;35(5):1021-4
references.pmid: 10818056
references.citation: Circulation. 2001 Mar 6;103(9):1245-9
references.pmid: 11238268
references.citation: Annu Rev Public Health. 2006;27:465-90
references.pmid: 16533126
references.citation: Cleve Clin J Med. 2002 Oct;69(10):793-9
references.pmid: 12371802
references.citation: Geriatrics. 2007 Jun;62(6):following 8; author reply following 8
references.pmid: 17582894
references.citation: J Clin Hypertens (Greenwich). 2000 Oct;2(5):324-330
references.pmid: 11416669
references.citation: J Gen Intern Med. 2009 Nov;24 Suppl 3:521-7
references.pmid: 19842001
references.citation: J Hypertens. 2011 Aug;29(8):1633-40
references.pmid: 21720274
references.citation: J Clin Hypertens (Greenwich). 2008 Dec;10(12):922-9
references.pmid: 19120718
references.citation: Circ Cardiovasc Qual Outcomes. 2008 Sep;1(1):46-53
references.pmid: 20031787
references.citation: Pharmacoepidemiol Drug Saf. 2009 Aug;18(8):672-81
references.pmid: 19479901
references.citation: Circ Cardiovasc Qual Outcomes. 2010 May;3(3):228-35
references.pmid: 20371760
references.citation: Acta Biomed. 2011 Dec;82(3):223-9
references.pmid: 22783719
references.citation: Hypertension. 2011 Jun;57(6):1076-80
references.pmid: 21502568
references.citation: J Clin Hypertens (Greenwich). 2013 Apr;15(4):254-63
references.pmid: 23551725
references.citation: J Clin Hypertens (Greenwich). 2002 Nov-Dec;4(6):393-404
references.pmid: 12461301
references.citation: J Cardiovasc Dis Res. 2010 Oct;1(4):196-202
references.pmid: 21264184
references.citation: Hypertension. 1995 Jul;26(1):60-9
references.pmid: 7607734
references.citation: Am J Hypertens. 2008 Jan;21(1):3-4
references.pmid: 18091733