title: "They're younger… it's harder." Primary providers' perspectives on hypertension management in young adults: a multicenter qualitative study.
abstract: BACKGROUND
  Young adults (18-39 year-olds) have the lowest hypertension control rates among adults with hypertension in the United States. Unique barriers to hypertension management in young adults with primary care access compared to older adults have not been evaluated. Understanding these differences will inform the development of hypertension interventions tailored to young adults. The goals of this multicenter study were to explore primary care providers' perspectives on barriers to diagnosing, treating, and controlling hypertension among young adults with regular primary care.
  
  
  METHODS
  Primary care providers (physicians and advanced practice providers) actively managing young adults with uncontrolled hypertension were recruited by the Wisconsin Research & Education Network (WREN), a statewide practice-based research network. Semi-structured qualitative interviews were conducted in three diverse Midwestern clinical practices (academic, rural, and urban clinics) using a semi-structured interview guide, and content analysis was performed.
  
  
  RESULTS
  Primary care providers identified unique barriers across standard hypertension healthcare delivery practices for young adults. Altered self-identity, greater blood pressure variability, and unintended consequences of medication initiation were critical hypertension control barriers among young adults. Gender differences among young adults were also noted as barriers to hypertension follow-up and antihypertensive medication initiation.
  
  
  CONCLUSIONS
  Tailored interventions addressing the unique barriers of young adults are needed to improve population hypertension control. Augmenting traditional clinic structure to support the "health identity" of young adults and self-management skills are promising next steps to improve hypertension healthcare delivery.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, H4/512 CSC, MC 3248, 600 Highland Avenue, Madison, WI, 53792, USA. hm2@medicine.wisc.edu.|Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 210, Box 9445, Madison, WI, 53705, USA. hm2@medicine.wisc.edu.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Johnson
authors.affiliation: Department of Counselor Education and Counseling Psychology, Marquette University, Schroeder Health & Education Complex, 561 N 15th Street, Room 151A, Milwaukee, WI, 53233, USA.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Warner
authors.affiliation: Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 210, Box 9445, Madison, WI, 53705, USA.|Division of Rheumatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, 4132 MFCB, Mail Code 2281, 1685 Highland Avenue, Madison, WI, 53705, USA.
authors.forename: Christie M
authors.initials: CM
authors.lastname: Bartels
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, H4/512 CSC, MC 3248, 600 Highland Avenue, Madison, WI, 53792, USA.|Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 210, Box 9445, Madison, WI, 53705, USA.
authors.forename: Jamie N
authors.initials: JN
authors.lastname: LaMantia
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D019468:Disease Management; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D010349:Patient Compliance; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration; D036301:Qualitative Research; D012424:Rural Population; D012648:Self Care; D019037:Urban Health Services; D014922:Wisconsin; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents
keywords: Ambulatory care; Health behavior; Hypertension; Medication adherence; Primary healthcare; Qualitative research