Documented lifestyle education among young adults with incident hypertension.
BACKGROUND
Only 38% of young adults with hypertension have controlled blood pressure. Lifestyle education is a critical initial step for hypertension control. Previous studies have not assessed the type and frequency of lifestyle education in young adults with incident hypertension.


OBJECTIVE
The purpose of this study was to determine patient, provider, and visit predictors of documented lifestyle education among young adults with incident hypertension.


METHODS
We conducted a retrospective analysis of manually abstracted electronic health record data.


METHODS
A random selection of adults 18-39 years old (n = 500), managed by a large academic practice from 2008 to 2011 and who met JNC 7 clinical criteria for incident hypertension, participated in the study.


METHODS
The primary outcome was the presence of any documented lifestyle education during one year after meeting criteria for incident hypertension. Abstracted topics included documented patient education for exercise, tobacco cessation, alcohol use, stress management/stress reduction, Dietary Approaches to Stop Hypertension (DASH) diet, and weight loss. Clinic visits were categorized based upon a modified established taxonomy to characterize patients' patterns of outpatient service. We excluded patients with previous hypertension diagnoses, previous antihypertensive medications, or pregnancy. Logistic regression was used to identify predictors of documented education.


RESULTS
Overall, 55% (n = 275) of patients had documented lifestyle education within one year of incident hypertension. Exercise was the most frequent topic (64%). Young adult males had significantly decreased odds of receiving documented education. Patients with a previous diagnosis of hyperlipidemia or a family history of hypertension or coronary artery disease had increased odds of documented education. Among visit types, chronic disease visits predicted documented lifestyle education, but not acute or other/preventive visits.


CONCLUSIONS
Among young adults with incident hypertension, only 55% had documented lifestyle education within one year. Knowledge of patient, provider, and visit predictors of education can help better target the development of interventions to improve young adult health education and hypertension control.
Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA, Hm2@medicine.wisc.edu.
Heather M
HM
Johnson
Andrea G
AG
Olson
Jamie N
JN
LaMantia
Amy J H
AJ
Kind
Nancy
N
Pandhi
Eneida A
EA
Mendonça
Mark
M
Craven
Maureen A
MA
Smith
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001795:Blood Pressure Determination / Q000379:methods; D015331:Cohort Studies; D016001:Confidence Intervals; D004032:Diet; D057286:Electronic Health Records; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000628:therapy*; D008019:Life Style; D008297:Male; D016017:Odds Ratio; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016896:Treatment Outcome; D055815:Young Adult
D000959:Antihypertensive Agents