title: Low literacy is associated with uncontrolled blood pressure in primary care patients with hypertension and heart disease.
abstract: OBJECTIVE
  To evaluate the association between low literacy and uncontrolled blood pressure (BP) and their associations with medication adherence.
  
  
  METHODS
  Cross-sectional study of 423 urban, primary care patients with hypertension and coronary disease. The relationship between low literacy (Rapid Estimate of Adult Literacy in Medicine ≤ 44) and uncontrolled BP (≥140/90 mmHg, ≥130/80 mmHg for patients with diabetes) was evaluated by crude and adjusted logistic regression. Relationships with self-reported adherence and refill adherence were explored using adjusted linear and logistic regression.
  
  
  RESULTS
  Overall, 192 (45%) subjects had low literacy and 227 (52.9%) had uncontrolled BP. Adjusting for age, gender, race, employment, education, mental status, and self-reported adherence, low literacy was associated with uncontrolled BP (OR 1.75, 95% CI 1.06-2.87). Lower self-reported adherence was associated with uncontrolled BP; the relationship between refill adherence and uncontrolled BP was not statistically significant.
  
  
  CONCLUSIONS
  Low literacy is independently associated with uncontrolled BP.
  
  
  CONCLUSIONS
  Awareness of the relationships among patient literacy, BP control, and medication adherence may guide healthcare providers as they communicate with patients.
authors.affiliation: Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, USA. Electronic address: candace.mcnaughton@vanderbilt.edu.
authors.forename: Candace D
authors.initials: CD
authors.lastname: McNaughton
authors.affiliation: Division of General Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, USA.
authors.forename: Terry A
authors.initials: TA
authors.lastname: Jacobson
authors.affiliation: Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, USA; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, USA.
authors.forename: Sunil
authors.initials: S
authors.lastname: Kripalani
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D001795:Blood Pressure Determination; D003327:Coronary Disease / Q000188:drug therapy / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011320:Primary Health Care; D012959:Socioeconomic Factors
chemical_list: D000959:Antihypertensive Agents
keywords: Blood pressure control; Hypertension control; Literacy; Medication adherence