Hypertension awareness and control in an inner-city African–American sample

Abstract

African–Americans in the US are at high risk for hypertension-related morbidity and mortality. The majority of African–Americans live in central city areas, and lower socioeconomic status and health care utilization patterns have been hypothesized to contribute to higher blood pressure (BP) levels and poorer control of treated hypertension in this group. In order to plan an intervention to improve hypertension care for inner city African–Americans in Houston, Texas, we conducted a baseline survey of residents in 12 low-income ZIP code areas with a >70% African–American population to determine the level of hypertension awareness, treatment and control, and associated sociodemographic, health care utilization, and medication compliance variables. Subjects were recruited to attend a BP measurement and assessment of knowledge, attitudes and behaviors through random digit phone dialing in the target ZIP code areas. Of the 962 subjects examined, 433 (45%) were hypertensive (systolic BP ⩾140 mm Hg or diastolic pressure ⩾90 mm Hg or taking antihypertensive medication). Among all hypertensives, 73% were aware, 64% were on treatment, and 28% were controlled to 140/90 mm Hg. Of hypertensives on treatment, 43% were controlled to 140/90 mm Hg, but 72% were controlled using the criterion of 160/95 mm Hg, and 75% were controlled using a diastolic pressure <90 mm hg only. these results are similar to those reported for african–americans in the most recent us national health survey. males were less likely to be aware, receiving treatment and controlled than were females. although lack of awareness was associated with less frequent bp measurement, 77% of those unaware reported a measurement within the past 2 years. the majority of aware hypertensives reported frequent physician contact and high compliance with medication. we conclude that intervention to improve hypertension control in this population should focus on ensuring that health providers diagnose bp and establish treatment goals based on the current standard of 140/90 mm hg.