title: Association of health literacy with elevated blood pressure: a cohort study of hospitalized patients.
abstract: BACKGROUND
  The clinical consequences of low health literacy are not fully understood.
  
  
  OBJECTIVE
  We evaluated the relationship between low health literacy and elevated blood pressure (BP) at hospital presentation.
  
  
  METHODS
  We conducted a cross-sectional evaluation of adult patients hospitalized at a university hospital between November 1, 2010 and April 30, 2012.
  
  
  METHODS
  Health literacy was assessed using the Brief Health Literacy Screen (BHLS). Low health literacy was defined as a BHLS score ≤9. BP was assessed using clinical measurements. The outcome was elevated BP (≥140/90 mm Hg; ≥130/80 mm Hg with diabetes or renal disease) or extremely elevated BP (>160/100 mm Hg) at hospital presentation. Multivariate logistic regression adjusted for age, sex, race, insurance, comorbidities, and antihypertensive medications; preplanned restricted analysis among patients with diagnosed hypertension was performed.
  
  
  RESULTS
  Of 46,263 hospitalizations, 23% had low health literacy, which occurred more often among patients who were older (61 vs. 54 y), less educated (28.4% vs. 11.2% had not completed high school), and more often admitted through the emergency department (54.3% vs. 48.1%) than those with BHLS>9. Elevated BP was more frequent among those with low health literacy [40.0% vs. 35.5%; adjusted odds ratio (aOR) 1.06; 95% confidence interval (CI), 1.01-1.12]. Low health literacy was associated with extremely elevated BP (aOR 1.08; 95% CI, 1.01-1.16) and elevated BP among those without diagnosed hypertension (aOR 1.09; 95% CI, 1.02-1.16).
  
  
  CONCLUSIONS
  More than ⅓ of patients had elevated BP at hospital presentation. Low health literacy was independently associated with elevated BP, particularly among patients without diagnosed hypertension.
authors.affiliation: *Department of Emergency Medicine, Vanderbilt University †Department of Medicine and the Vanderbilt Center for Health Services Research, Division of General Internal Medicine and Public Health ‡Vanderbilt Center for Health Services Research §School of Nursing, Vanderbilt University ∥Department of Medicine and Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), Division of General Internal Medicine and Public Health, Nashville VA Medical Center, Nashville, TN.
authors.forename: Candace D
authors.initials: CD
authors.lastname: McNaughton
authors.forename: Sunil
authors.initials: S
authors.lastname: Kripalani
authors.forename: Courtney
authors.initials: C
authors.lastname: Cawthon
authors.forename: Lorraine C
authors.initials: LC
authors.lastname: Mion
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Wallston
authors.forename: Christianne L
authors.initials: CL
authors.lastname: Roumie
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001794:Blood Pressure; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D057220:Health Literacy / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged