Abstract and Introduction
Abstract
Introduction Effective strategies are needed to reach and treat people who lack awareness of or have uncontrolled hypertension. We used data from a community-based participatory research initiative, Hub City Steps, to quantify the prevalence of undiagnosed hypertension and determine the relationship between hypertension status at baseline and postintervention improvements in blood pressure and health-related quality of life.
Methods Hub City Steps was a 6-month preintervention–postintervention lifestyle intervention targeting hypertension risk factors. Outcome measures were collected at baseline, 3 months, and 6 months. Generalized linear mixed models were used to test for effects by time and hypertension status.
Results. Of the enrolled sample (N = 269), most were overweight or obese (91%), African American (94%), and women (85%). When considering hypertension status, 42% had self-reported diagnosis of hypertension (self-reported subgroup; 84% with antihypertensive medication use); 36% had no self-reported medical history of hypertension, but when blood pressure was measured they had a clinical diagnosis of prehypertension or hypertension (undiagnosed subgroup); and 22% had no self-reported or clinical hypertension diagnosis (no hypertension subgroup). From baseline to 6 months, systolic blood pressure significantly improved for participants with self-reported hypertension [8.2 (SD, 18.2) mm Hg] and undiagnosed hypertension [12.3 (SD, 16.3) mm Hg], with undiagnosed participants experiencing the greatest improvements (P < .001). Effects remained significant after controlling for covariates. Health-related quality of life significantly improved for all 3 hypertension subgroups, with no apparent subgroup differences.
Conclusion. This study reveals advantages of a culturally appropriate community-based participatory research initiative to reach those with undetected hypertension and effectively improve blood pressure status and health-related quality of life.
Introduction
The overall prevalence of hypertension in the United States is estimated at 34%, with a disproportionate prevalence among African Americans (44%). Hypertension is a leading risk factor for cardiovascular and cerebrovascular events and a leading cause of morbidity and mortality. Furthermore, annual health-care expenditures for hypertension are approximately $131 billion.
To complicate issues related to the high prevalence, racial disparities, cultural disparities, and higher health care costs, hypertension has also been termed a silent epidemic. Because hypertension can be asymptomatic, people often do not seek medical care, leaving it undetected and untreated. Likewise, even among those who are aware and treated, rates for uncontrolled hypertension are high. For example, the Centers for Disease Control and Prevention (CDC) examined awareness and pharmacologic treatment of uncontrolled hypertension in the United States. Using National Health and Nutrition Examination Survey (NHANES) data sets and weighted population counts for 2003 through 2010, an estimated 66.9 million adults have hypertension, of which 35.8 million (54%) have uncontrolled hypertension. Among those with uncontrolled hypertension, an estimated 39% are not aware of their hypertension status, 16% are aware but untreated, and 45% are aware and treated.
Hub City Steps was a lifestyle intervention targeting hypertension risk factors in Hattiesburg, Mississippi. Hattiesburg includes about 47,000 residents, of which approximately 53% are African Americans and 42% are whites. Data from NHANES and Behavioral Risk Factor Surveillance System indicate that the prevalence of hypertension is 44% for women and 40% for men in Forrest County. Likewise, hypertension unawareness is approximately 18% among both women and men.
All phases of Hub City Steps were guided by community-based participatory research (CBPR) principles. CBPR aims to build equitable community–academic partnerships and promote community participation in all aspects of the research process. CBPR is recognized as a key strategy for translating research into practice that can help in reducing health disparities. Overarching research goals of this CBPR initiative were to 1) develop and assess community capacity to promote physical activity and healthy food choices, 2) test treatment effects of a 6-month CBPR lifestyle intervention on systolic blood pressure (SBP) among community participants, and 3) test the dose effects of 4 versus 10 follow-up motivational interviewing contacts on SBP over a 12-month maintenance phase. Given the emphasis on overall health within the Hub City Steps intervention, another objective of this CBPR initiative was to understand health-related quality of life (HRQOL).
We sought to quantify the prevalence of undiagnosed hypertension and determine the relationship between hypertension status at baseline and postintervention improvements in blood pressure using data at 3 and 6 months. We focus on 3 subgroups, those with 1) self-reported diagnosis of hypertension, with or without antihypertensive medication use (self-reported subgroup); 2) no self-reported medical history of hypertension, yet measured clinical diagnosis of pre-hypertension or hypertension (ie, SBP greater than 120 or diastolic blood pressure [DBP] greater than 80 mm Hg) (undiagnosed subgroup); and 3) no self-reported or clinical diagnosis of hypertension (no hypertension subgroup). A secondary aim was to examine changes in HRQOL.