title: Blood pressure level and hypertension awareness and control differ by marital status, sex, and ethnicity: a population-based study.
abstract: BACKGROUND
  Population-based studies about factors associated with blood pressure (BP) levels and hypertension awareness and control are lacking in Israel. We aimed to identify covariables of BP level (across the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) categories) and hypertension awareness and control.
  
  
  METHODS
  Participants (n = 763; aged 25-74 years) were randomly selected from the population registry and stratified by sex, age, and ethnicity (Arab or Jewish). Sociodemographic, lifestyle, chronic morbidity, drug therapy, and measured anthropometric and BP data were collected. Hypertension was defined as physician diagnosis, antihypertension drug therapy, or systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg.
  
  
  RESULTS
  Standardized hypertension prevalence was 32.5%. Age and body mass index were positively associated with being in a higher JNC-7 category. In multivariable analysis, the association between gender and JNC-7 category depended upon marital status. Of those with hypertension (n = 315), 66.0% were aware of their status, and 26.0% exhibited adequate BP control. Using "aware-and-controlled" as the outcome reference category, the odds ratio (OR) of being aware and uncontrolled was 1.9 (95% confidence interval (CI) = 1.3-2.9) for 10-year age increment. The OR of being unaware and uncontrolled was 5.6 (95% CI = 2.0-15.8) for Arabs vs. Jews, 5.6 (95% CI = 1.4-22.3) for single/divorced vs. married participants, 3.9 (95% CI = 1.7-9.2) for those with <3 visits to the family physician per year, and 0.1 (95% CI = 0.02-0.4) for those with self-reported cardiovascular disease.
  
  
  CONCLUSIONS
  Sociodemographic factors and primary healthcare service utilization are associated with hypertension awareness and control. Specially focused outreach may be needed to improve hypertension awareness among Arabs, certain subgroups not traditionally considered to be at high risk, and those who have less contact with the healthcare system.
authors.affiliation: Cardiovascular Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel; kathleena@gertner.health.gov.il.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Abu-Saad
authors.affiliation: Cardiovascular Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel;
authors.forename: Angela
authors.initials: A
authors.lastname: Chetrit
authors.affiliation: Zinman College for Physical Education and Sports, Wingate Institute, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel;
authors.forename: Sigal
authors.initials: S
authors.lastname: Eilat-Adar
authors.affiliation: Clalit Health Services, Shomron Administration, Hadera, Israel;
authors.forename: Gershon
authors.initials: G
authors.lastname: Alpert
authors.affiliation: Clalit Health Services, Shomron Administration, Hadera, Israel;
authors.forename: Ahmed
authors.initials: A
authors.lastname: Atamna
authors.affiliation: Institute of Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel;
authors.forename: Michal
authors.initials: M
authors.lastname: Gillon-Keren
authors.affiliation: Sackler Faculty of Medicine, Tel-Aviv University, Israel; Internal Medicine Department C, Soraski Medical Center, Tel Aviv, Israel;
authors.forename: Ori
authors.initials: O
authors.lastname: Rogowski
authors.affiliation: Computer and Information Unit, Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel.
authors.forename: Arnona
authors.initials: A
authors.lastname: Ziv
authors.affiliation: Cardiovascular Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel;
authors.forename: Ofra
authors.initials: O
authors.lastname: Kalter-Leibovici
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination / Q000379:methods*; D005006:Ethnicity; D005260:Female; D006801:Humans; D006973:Hypertension / Q000208:ethnology* / Q000503:physiopathology; D007557:Israel / Q000453:epidemiology; D008019:Life Style; D008297:Male; D017533:Marital Status / Q000208:ethnology*; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012737:Sex Factors; D012959:Socioeconomic Factors
keywords: Israel; blood pressure; blood pressure level; ethnicity; hypertension; hypertension awareness; hypertension control; marital status; sex.