Learning Objective 1: describe patient, provider, and organizational level barriers to hypertension control.
Learning Objective 2: discuss implications for design of comprehensive interventions to improve HTN care and control in these high-risk populations.
Purpose: To report and compare findings of two studies examining barriers to HTN control among Black men in East Baltimore and Black South African men and women with hypertension.
Methods: The Precede-Proceed Model guided this research. In the first study, 309 hypertensive Black men, ages 18-54 years, were recruited from the East Baltimore community for participation in a 5-year clinical trial. In the second study, 403 hypertensive Blacks (183 men, 220 women), ages 35–65 years were recruited from primary care sites in three townships near Cape Town. Cross-sectional, descriptive analyses at baseline for each study are reported. In these studies, blood pressure (BP) and self-reported sociodemographics, health behaviors, health service utilization, quality of life, and social support were assessed.
Results: In the first study, mean BP (mm Hg) was 146/99; BP control (<140/90 mm Hg) rate was 19%. A majority of the men encountered a variety of barriers including economic, social, and lifestyle obstacles to adequate BP care and control, including no current HBP care (49%), risk of alcoholism (62%), use of illicit drugs (45%), social isolation (47%), unemployment (40%), and lack of health insurance (51%).
In the second study, mean BP was 146/89; BP control rate was 39%. Barriers to HTN care included limited HTN-related knowledge, poor quality of life and stressors such as family death. An unhealthy lifestyle involving physical inactivity (65%), using alcohol excessively (32%), and smoking cigarettes (30%) was common.
Conclusions: These studies identified a high level of barriers to HTN control and the need for comprehensive multilevel interventions to improve HTN care and control in these high-risk populations.
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