Validation of self-reported hypertension status and predictors of uncontrolled blood pressure levels in the Community initiative to eliminate stroke (CITIES) project

UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)
Gaurav Dave (Creator)
The University of North Carolina at Greensboro (UNCG )
Web Site:
Daniel Bibeau

Abstract: Few studies have comprehensively investigated the validity of self-reported hypertension (HT) and assessed predictors of HT status in the stroke belt. The purpose of phase I of this study aims to evaluate self-reporting as a valid tool to screen large study populations and determine predictors of congruency between self-reported HT and clinical measures. Community Initiative to Eliminate Stroke project (n=16,598) was conducted in two counties of North Carolina in 2004-2007, which included collection of self-reported data and clinical data of stroke-related risk factors. Congruency between self-reported hypertension status and clinical measures was based on epidemiological parameters of sensitivity, specificity and predictive values. McNemar's test and Kappa agreement levels assessed differences in congruency, while unadjusted odds ratios and logistic regression determined significant correlates of congruency. Sensitivity of self-reported HT was low (33.3%), but specificity was high (89.5%). Prevalence of self-reported HT was 16.15%. Kappa agreement between self-report and clinical measures for BP was fair (ĸ = 0.25). Females, whites and young adults were most likely to be positively congruent, whereas individuals in high risk categories for total blood cholesterol, LDL, triglycerides and diabetes were least likely to be accurate about their HT status. Self-report HT information should be used with caution for epidemiological investigations. The purpose of phase II of this study was to evaluate demographic sub-groups, self-reported health information and clinical measures as predictors of uncontrolled systolic and diastolic hypertension among individuals taking blood pressure lowering medications. Systolic hypertension is the most common form of hypertension among older individuals. Inadequate controls of systolic blood pressure have been largely attributable for poor control of overall hypertension rates. The National Heart Blood Pressure Education Program's guidelines for management of hypertension emphasize the importance of controlling isolated systolic hypertension in older individuals. The Community Initiative to Eliminate Stroke was a stroke risk-factor screening and reduction/prevention project conducted in two North Carolina counties. The initiative collected self-reported information such as personal history of atrial fibrillation and clinical measures, such as blood pressure levels, among other cardiovascular and stroke risk factors. Statistical modeling of predictors was based on odds ratios and logistic regression analyses. Of the 2,663 participants, 43.5% and 22.8% had uncontrolled systolic and diastolic hypertension, respectively. African Americans were more likely to have uncontrolled systolic or diastolic hypertension as compared to whites. Similarly, participants older than 55 years of age were more likely to have uncontrolled systolic hypertension compared to younger individuals. Regression analyses indicated that race (OR = 1.239, p = 0.00), age (OR = 1.683, p = 0.00) and non-adherence with medications (OR = 2.593, p = 0.00) were significant predictors of uncontrolled systolic blood pressure levels. Based on the recommendations made by national guidelines and our findings, future interventions should focus on management of systolic hypertension among older individuals and African Americans to increase the overall control of hypertension.

Additional Information

Language: English
Date: 2011
Hypertension, Community Initiative to Eliminate Stroke (CITIES) Project, Blood Pressure, Stroke
Hypertension $x Diagnosis
Cerebrovascular disease $x Prevention

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