title: Hypertension management and lifestyle changes following screening for hypertension in an Asian low socioeconomic status community: a prospective study.
abstract: BACKGROUND
  This study investigated the effect of an access-enhanced intervention on hypertension screening and management, as well as on health behaviours among newly diagnosed hypertensives, in a multi-ethnic low socioeconomic status (SES) community. Factors associated with hypertension screening, treatment, and control in the community were also determined.
  
  
  METHODS
  The study involved all residents aged ≥40 years in 2 public rental housing precincts (low SES), between 2009 and 2011, who were followed-up prospectively for 1 year after a 6-month community-based intervention comprising a 3-month access-enhanced screening component and a 3-month follow-up (outreach) component. Blood pressure was measured at baseline and follow-up. Multivariate Cox regression determined predictors of hypertension management at follow-up.
  
  
  RESULTS
  The follow-up rate was 80.9% (467/577). At baseline, 60.4% (282/467) were hypertensive; 53.5% (151/282) were untreated; 54.2% (71/131) uncontrolled. One year later, postintervention, 51.6% (78/151) of untreated hypertensives were treated; combined with treated hypertensives previously uncontrolled, 53.0% (79/149) achieved control. Older age independently predicted treatment (adjusted relative risk, aRR = 1.98, CI, 1.08 to 3.65); majority ethnicity (aRR = 1.76, CI, 1.05 to 2.96), employment (aRR = 1.85, CI, 1.26 to 2.80) and newly treated hypertension (aRR=1.52, CI, 1.01 to 2.32) predicted control. A total of 52.4% (97/185) were irregularly screened at baseline; at follow-up 61.9% (60/97) were regularly screened. Cost and misperceptions were common barriers to screening and treatment. Newly diagnosed hypertensives were also less likely to go for additional cardiovascular screening (aRR = 0.54, CI, 0.29 to 0.99).
  
  
  CONCLUSIONS
  An access-enhanced intervention had some success in improving hypertension management within low SES communities; however, it was less successful in improving cardiovascular risk management, especially in encouraging lifestyle changes and additional cardiovascular screening amongst newly diagnosed hypertensives.
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore.
authors.forename: Liang En
authors.initials: LE
authors.lastname: Wee
authors.forename: Jolene
authors.initials: J
authors.lastname: Wong
authors.forename: Run Ting
authors.initials: RT
authors.lastname: Chin
authors.forename: Zhi Yong
authors.initials: ZY
authors.lastname: Lin
authors.forename: Daniel E Q
authors.initials: DE
authors.lastname: Goh
authors.forename: Kalpana
authors.initials: K
authors.lastname: Vijakumar
authors.forename: Kiat Yee
authors.initials: KY
authors.lastname: Vong
authors.forename: Wei Ling
authors.initials: WL
authors.lastname: Tay
authors.forename: Hui Ting
authors.initials: HT
authors.lastname: Lim
authors.forename: Gerald C H
authors.initials: GC
authors.lastname: Koh
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D044466:Asian People / Q000706:statistics & numerical data; D004039:Diet, Sodium-Restricted / Q000379:methods; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance / Q000208:ethnology / Q000706:statistics & numerical data*; D010352:Patient Dropouts / Q000706:statistics & numerical data; D011203:Poverty / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D040242:Risk Reduction Behavior; D012846:Singapore; D016540:Smoking Cessation / Q000379:methods; D012923:Social Class; D016896:Treatment Outcome; D061217:Weight Reduction Programs / Q000379:methods
chemical_list: D000959:Antihypertensive Agents