High blood pressure awareness, control improved with better access to primary health care

Research Highlights:

  • In a study of socioeconomically disadvantaged and socioeconomically advantaged neighborhoods, better access to primary health care was associated with better high blood pressure awareness and control.

  • These associations existed whether residents lived in socioeconomically disadvantaged or socioeconomically advantaged neighborhoods.

  • The study findings suggest that regardless of where people live, they can benefit from blood pressure control programs that increase access to primary health care.

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(NewMediaWire) – September 6, 2022 – DALLAS Easier access to primary care physicians may increase high blood pressure awareness and control regardless of where a person lives, according to new research published today in Circulation: Cardiovascular quality and outcomesa peer-reviewed journal of the American Heart Association.

According to the American Heart Association, nearly half of all Americans have hypertension (high blood pressure), and many don’t even know they have it. High blood pressure is often called the “silent murderer” because high blood pressure often has no obvious symptoms. The best way to protect yourself is to be aware of the risks Y make healthy life changes that matter.

In a new study, researchers note that health professionals in community clinics and primary care practices can help expand high blood pressure awareness and screening by providing affordable treatment and management. High blood pressure is one of the main preventable risk factors for cardiovascular diseaseand effective blood pressure control reduces associated cardiovascular health risks.

“Access to primary care is the key to controlling hypertension, yet many Americans have limited access to primary care where they live. This is especially true for people in economically disadvantaged neighborhoods or people of diverse racial and ethnic groups, particularly among African Americans,” said the study’s lead author, Brisa Aschebrook-Kilfoy, Ph.D., an associate professor of public health sciences at the University of Chicago in Illinois.

It is well known that better access to primary health care is related to better awareness and control of high blood pressure. This study sought to clarify whether people living in disadvantaged neighborhoods can benefit from better access to primary care health professionals.

In this study, the socioeconomic status of the neighborhood was assessed using the Area Deprivation Index (ADI) created by the Health Resources and Services Administration (HRSA) more than three decades ago. The ADI was chosen because it allows neighborhoods to be ranked by socioeconomic disadvantage in a region of interest (eg, at the state or national level) and is valuable in informing health delivery and policy, especially for the most disadvantaged neighborhood groups . ADI is made up of 17 indicators covering income, education, employment and housing quality. In this study, socioeconomically disadvantaged neighborhoods were defined as those in census tracts ranked in the top 50the percentile and above.

“Some argue that minority health disparities are solely the product of socioeconomic factors, or that increasing the number of primary care providers in racially and ethnically diverse neighborhoods would not reduce health disparities or improve public health. To our knowledge , there is little research to support or refute this argument,” said the study’s first author, Jiajun Luo, Ph.D., a postdoctoral fellow at the University of Chicago Institute for Precision Population and Health. “We conducted this study to examine whether primary care accessibility is associated with better hypertension control and awareness of various neighborhood and socioeconomic factors.”

The study examined Chicago, one of the most racially segregated cities in the US Chicago’s South Side is the largest African-American urban community in the US, with substantial challenges including poverty, violence and reduced access to fresh and healthy food. According to the study, a 30-year gap in life expectancy has been observed between people living in Chicago’s southside neighborhoods and wealthier northside neighborhoods, which can be largely attributed to higher rates. high blood pressure, heart disease, and race.

Researchers analyzed health data from more than 5,000 predominantly African-American adults who participated in the Chicago Multi-Ethnic Prevention and Surveillance Study (COMPASS) between 2013 and 2019. COMPASS is a long-term initiative at the University of Chicago exploring health of Chicagoans, primarily those who live in communities on the South Side. MAPSCorps, a nonprofit organization, provided information on the location of primary care professionals providing care in those Chicago neighborhoods.

More than half of the study participants were smokers and reported an annual household income of less than $15,000, and more than 37% were obese based on body mass index (BMI). Most of the study population resided in a Chicago neighborhood with an ADI rank greater than the 70th percentile (the most disadvantaged communities).

The researchers also evaluated spatial accessibility, which is a composite score that considers the distance between an individual’s residence and local primary health care facilities; the relationship between the number of doctors and the population; and the effect of distance to primary care on an individual’s willingness to seek primary health care. A higher spatial accessibility score indicated better accessibility to primary care. Primary health care professionals included family physicians, general practitioners, and general internists.

The investigation found:

  • Nearly 80% of COMPASS participants had documented hypertension, using standard blood pressure criteria based on American Heart Association guidelines of 130 mm Hg systolic (top number) or 80 mm Hg diastolic (bottom number). lower).

  • Nearly 38% of people with hypertension did not have their blood pressure under control (they were not receiving treatment based on self-report) and 41% did not know they had high blood pressure.

  • Spatial accessibility scores ranged from 16.4 (lowest access to primary care) to 86.6 (highest access) per 100,000 population.

  • Adults who lived in areas with the fewest primary care providers were 37% more likely to have high blood pressure compared to adults who lived in neighborhoods with the most primary care physicians.

  • The associations listed existed in both poor and wealthy neighborhoods, suggesting that residents of all neighborhoods may benefit from increased numbers of primary care providers.

  • When stratified by neighborhood type (advantaged or disadvantaged), accessibility to primary care was not associated with antihypertensive medication use among those who reported having hypertension before study enrollment.

“Based on these findings, we should encourage primary care physicians to expand access to people living in underserved communities with the fewest primary care providers,” Aschebrook-Kilfoy said. “Mobile health units may be an approach to increasing primary care service in underserved areas by removing the challenge of obtaining transportation to and from an office visit. The use of antihypertensive medications also needs to be studied and addressed, especially as was not linked to the accessibility of primary care in this study.”

Although the method used in this study to measure spatial accessibility can be used anywhere with sufficient information on the location of primary care professionals, an important limitation of this study is that these specific results may not be representative of other communities. and population groups, such as the middle-aged. urban class communities or people from other diverse racial and ethnic groups, etc.

Coauthors are Muhammad G. Kibriya, Ph.D.; Paul Zakin, Bachelor of Science; Andrew Craver, MPH; Liz Connellan, MPH; Saira Tasmin, Ph.D.; Tamar Polonsky, MD; Dr. Karen Kim; and Habibul Ahsan, MD Authors’ declarations are listed in the manuscript.

The National Institutes of Health (NIH) funded this study.

Studies published in American Heart Association scientific journals are peer-reviewed. Statements and conclusions in each manuscript are solely those of the study authors and do not necessarily reflect the policy or position of the Association. The Association does not represent or guarantee its accuracy or reliability. The Association receives funding mainly from individuals; Foundations and corporations (including pharmaceutical companies, device manufacturers, and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing scientific content. Revenues from pharmaceutical and biotechnology companies, device manufacturers and health insurance providers and general financial information for the Association are available here.

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