Abstract
OBJECTIVE: Improved recognition of the importance of systolic blood pressure (SBP) has been identified as one of the major public health and medical challenges in the prevention and treatment of hypertension (HTN). SBP is a strong independent risk factor for cardiovascular disease but no information is available on whether patients understand the importance of their SBP level. The purpose of this study was to assess HTN knowledge, awareness, and attitudes, especially related to SBP in a hypertensive population.
DESIGN/SETTING/PATIENTS: We identified patients with HTN (N=2,264) in the primary care setting of a large midwestern health system using automated claims data (International Classification of Diseases, Ninth Revision [ICD-9] codes 401.0–401.9). We randomly selected 1,250 patients and, after excluding ineligible patients, report the results on 826 completed patient telephone interviews (72% response rate [826/1,151]).
MAIN RESULTS: Ninety percent of hypertensive patients knew that lowering blood pressure (BP) would improve health and 91% reported that a health care provider had told them that they have HTN or high BP. However, 41% of patients did not know their BP level. Eighty-two percent of all patients correctly identified the meaning of HTN as “high blood pressure.” Thirty-four percent of patients correctly identified SBP as the “top” number of their reading; 32% correctly identified diastolic blood pressure (DBP) as the “bottom” number; and, overall, only 30% of patients were able to correctly identify both systolic and diastolic BP measures. Twenty-seven percent of patients with elevated SBP and DBP (as indicated by their medical records) perceived that their BP was high. Twenty-four percent of patients did not know the optimal level for either SBP or DBP. When asked whether the DBP or SBP level was more important in the control and prevention of disease, 41% reported DBP, 13% reported SBP, 30% reported that both were important, and 17% did not know.
CONCLUSIONS: These results suggest that, although general knowledge and awareness of HTN is adequate, patients do not have a comprehensive understanding of this condition. For instance, patients do not recognize the importance of elevated SBP levels or the current status of their BP control. An opportunity exists to focus patient education programs and interventions on the cardiovascular risk associated with uncontrolled HTN, particularly elevated SBP levels.
Similar content being viewed by others
References
Rocella EJ, Burt V, Horan MJ, Cutler J. Changes in hypertension awareness, treatment, and control rates: 20-year trend data. Ann Epidemiol. 1993;3:547–9.
JNC V 1993. The fifth report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC V). Arch Intern Med. 1993;153:154–83.
JNC VI 1997. The sixth report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC VI). Arch Intern Med. 1997;157:2413–46.
Stockwell DH, Madhavan S, Cohen H, Gibson G, Alderman MH. The determinants of hypertension awareness, treatment, and control in an insured population. Am J Public Health. 1994;84:1768–74.
Burt VL, Culter JA, Higgins M, et al. Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population. Data from the health examination surveys, 1960 to 1991. Hypertension. 1995;26:60–9.
Burt VL, Whelton P, Roccella EJ, et al. Prevalence of hypertension in the US adult population: results from the Third National Health and Nutrition Examination Survey, 1988–1991. Hypertension. 1995;25:303–13.
Berlowitz DR, Ash AS, Hickey EC, et al. Inadequate management of blood pressure in a hypertensive population. N Engl J Med. 1998;339:1957–63.
Mancia G, Sega R, Milesi C, Cesana G, Zanchetti A. Blood-pressure control in the hypertensive population. Lancet. 1997;349:454–7.
Alexander M, Tekawa I, Hunkeler E, et al. Evaluating hypertension control in a managed care setting. Arch Intern Med. 1999;159:2673–7.
National High Blood Pressure Education Program. National High Blood Pressure Education Program Working Group Report on Primary Prevention of Hypertension. Bethesda, MD: U.S. Department of Health and Human Service, National Heart, Lung, and Blood Institute; NIH publication no. 93-2669; 1993.
Roccella EJ, Horan MJ. The National High Blood Pressure Education Program: measuring progress and assessing its impact. Health Psychol. 1988;(suppl):297–303.
Roccella EJ, Bowler AE, Ames MV, Horan MJ. Hypertension knowledge, attitudes, and behavior: 1985 NHIS findings. Public Health Rep. 1986;101:599–606.
Hunink MG, Goldman L, Tosteson AN, et al. The recent decline in mortality from coronary heart disease, 1980–1990. The effect of secular trends in risk factors and treatment. JAMA. 1997;277:535–42.
Schmeiser-Rieder A, Kunze U. Blood pressure awareness in Austria: a 20-year evaluation, 1978–1998. Eur Heart J. 2000;21:414–20.
Hinds C. A hypertension survey: respondents’ knowledge of high blood pressure. Int Nurs Rev. 1983;30:12–4.
Weiland SK, Keil U, Spelsberg A. Knowledge and attitudes towards hypertension and hypercholesterolemia in a population of southern Germany: results from a population survey in the Augsburg area. Soz Praventivmed. 1991;36:5–8.
Chockalingam A, Fodor JG. Treatment of raised blood pressure in the population: the Canadian experience. Am J Hypertens. 1998;11:747–9.
Ahluwalia JS, McNagny SE, Rask KJ. Correlates of controlled hypertension in indigent, inner-city hypertensive patients. J Gen Intern Med. 1997;12:7–14.
Kjellgren KI, Svensson S, Ahlner J, Saljo R. Hypertensive patients’ knowledge of high blood pressure. Scand J Prim Health Care. 1997;15:188–92.
Carney S, Gillies A, Smith A, Taylor M. Hypertension education: patient knowledge and satisfaction. J Hum Hypertens. 1993;7:505–8.
Steyn K, Levitt N, Fourie J, Rossouw K, Martell R, Stander I. Treatment status and experiences of hypertension patients at a large health center in Cape Town. Ethn Dis. 1999;9:441–50.
Kjellgren KI, Ahlner J, Dahlof B, Gill H, Hedner T, Saljo R. Patients’ and physicians’ assessment of risks associated with hypertension and benefits from treatment. J Cardiovasc Risk. 1998;5:161–6.
Sharkness CM, Snow DA. The patient’s view of hypertension and compliance. Am J Prev Med. 1992;8:141–6.
Hansson L, Hedner T, Himmelman A. The growing importance of systolic blood pressure. Blood Press. 1998;7:131–2.
O’Donnell CJ, Kannel WB. Cardiovascular risk of hypertension: lessons from observational studies. J Hypertens. 1998;16(suppl 6):S3-S7.
Perry HM Jr, Davis BR, Price TR, et al. Effect of treating isolated systolic hypertension on the risk of developing various types and subtypes of stroke: the Systolic Hypertension in the Elderly Program (SHEP). JAMA. 2000;284:465–71.
Izzo JL, Levy D, Black HR. Importance of systolic blood pressure in older Americans. Hypertension. 2000;35:1021–4.
Hyman DJ, Pavlik VN. Characteristics of patients with uncontrolled hypertension in the United States. N Engl J Med. 2001;345:479–86.
Knight EL, Bohn RL, Wang PS, Glynn RJ, Mogun H, Avorn J. Predictors of uncontrolled hypertension in ambulatory patients. Hypertension. 2001;38:809–14.
Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. JAMA. 2003;289:2560–72.
Oliveria SA, Lapuerta P, McCarthy BD, L’Italien GJ, Berlowitz DR, Asch SM. Physician barriers to the effective management of uncontrolled hypertension. Arch Intern Med. 2002;162:413–20.
McCarthy BD, Yood MU, Boohaker EA, Ward RE, Rebner M, Johnson CC. Inadequate follow-up of abnormal mammograms. Am J Prev Med. 1996;12:282–8.
McCarthy BD, Yood MU, Janz NK, Boohaker EA, Ward RE, Johnson CC. Evaluation of factors potentially associated with inadequate follow-up of mammographic abnormalities. Cancer. 1996;77:2070–6.
SAS Institute Inc. Logistic Regression Examples Using SAS System, Version 6, 1st ed. Cary, NC: SAS Institute Inc.; 1995.
Balazovjech I, Hnilica P. Compliance with antihypertensive treatment in consultation rooms for hypertensive patients. J Hum Hypertens. 1993;7:581–3.
Knight EL, Bohn RL, Wang PS, Glynn RJ, Mogun H, Avorn J. Predictors of uncontrolled hypertension in ambulatory patients. Hypertension. 2001;38:809–14.
Gonzalez-Fernandez RA, Rivera M, Torres D, Quiles J, Jackson A. Usefulness of a systemic in-hospital educational program. Am J Cardiol. 1990;65:1384–6.
Author information
Authors and Affiliations
Corresponding author
Additional information
The funds to conduct this study were provided by a grant from Bristol-Myers Squibb.
Rights and permissions
About this article
Cite this article
Oliveria, S.A., Chen, R.S., McCarthy, B.D. et al. Hypertension knowledge, awareness, and attitudes in a hypertensive population. J GEN INTERN MED 20, 219–225 (2005). https://doi.org/10.1111/j.1525-1497.2005.30353.x
Accepted:
Issue Date:
DOI: https://doi.org/10.1111/j.1525-1497.2005.30353.x