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Original Investigation
June 23, 2008

Factors Associated With Hypertension Awareness, Treatment, and Control in Dallas County, Texas

Author Affiliations

Author Affiliations: Division of Hypertension, Department of Internal Medicine (Drs Victor, Leonard, Hess, Jones, and Ravenell and Ms Bhat), Donald W. Reynolds Cardiovascular Clinical Research Center (Drs Victor, Leonard, Ravenell, and Haley), Division of Biostatistics, Department of Clinical Sciences (Dr Leonard), Community Prevention and Intervention Unit, School of Allied Health Sciences (Ms Freeman), and Division of Epidemiology, Department of Internal Medicine (Dr Haley), The University of Texas Southwestern Medical Center at Dallas; Health Promotion and Behavioral Science Division, The University of Texas School of Public Health, Houston (Dr Vaeth); and College of Social Sciences, African-American Studies Department, San José State University, San José, California (Dr Wilson).

Arch Intern Med. 2008;168(12):1285-1293. doi:10.1001/archinte.168.12.1285

Background  Hypertension (HTN) control rates in the United States remain lower in black than white persons, particularly before 65 years of age. Potential sociocultural factors have not been sufficiently addressed.

Methods  We analyzed data from structured interviews and blood pressure measurements in a population-based sample of 1514 hypertensive (1194 non-Hispanic black and 320 non-Hispanic white) subjects aged 18 to 64 years in Dallas County, Texas, from 2000 to 2002 to identify sociocultural factors associated with low rates of HTN control. We calculated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) using multivariate logistic regression.

Results  Awareness, treatment, and control of HTN were negatively associated with a common perception of good health, with aORs (95% CIs) of 0.37 (0.27-0.50) for awareness, 0.47 (0.36-0.62) for treatment, and 0.66 (0.51-0.86) for control. They were positively associated with having a regular physician, with aORs (95% CIs) of 3.81 (2.86-5.07) for awareness, 8.36 (5.95-11.74) for treatment, and 5.23 (3.30-8.29) for control. Among untreated hypertensive subjects, lack of perceived need for a regular physician was associated with perceived good health (aOR [95% CI], 2.2 [1.2-4.0]), male gender (aOR [95% CI], 2.4 [1.4-4.1]), and black race/ethnicity (aOR [95% CI], 2.1 [1.0-4.4]). The HTN outcomes were unrelated to perceived racism or lay beliefs about the causes, consequences, and treatment of HTN.

Conclusions  Among young to middle-aged hypertensive subjects, a perception of good health and the lack of perceived need for a regular physician remain major factors associated with untreated and uncontrolled HTN at the community level—particularly among black men. These factors merit greater emphasis in professional education and public health programs on HTN.