Barriers to Hypertension Control among Underserved Blacks in the United States and South Africa

Friday, 11 July 2008: 9:10 AM
Cheryl R. Dennison, RN, ANP, PhD , School of Nursing, The Johns Hopkins University, Baltimore, MD
Krisela Steyn, MD , Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Naomi S. Levitt, MD , Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Lee Bone, RN, MPH , School of Public Health, Johns Hopkins University, Baltimore, MD
David Levine, MD , School of Medicine, Johns Hopkins University, Baltimore, MD
Martha N. Hill, RN, PhD , School of Nursing, The Johns Hopkins University, Baltimore, MD

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.

Background: Barriers to hypertension (HTN) care and control exist at patient, provider, and organizational levels. It is necessary to identify and address these barriers in order to develop culturally salient interventions to reduce racial disparities.

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 3565 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.