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Sociodemographics and hypertension control among young adults with incident hypertension: a multidisciplinary group practice observational study

Haggart, Ryan C.a,b; Bartels, Christie M.a,b; Smith, Maureen A.b,c,d; Johnson, Heather M.a,b

doi: 10.1097/HJH.0000000000001872
ORIGINAL PAPERS: Treatment

Objective: Despite a growing prevalence of hypertension, young adults (18–39-year-olds) have lower hypertension control rates compared with older adults. The purpose of this study was to evaluate the role of sociodemographic factors in hypertension control among young adults with regular primary care access.

Methods: A retrospective analysis included 3208 patients, 18–39 years old, who met clinical criteria for an initial (incident) hypertension diagnosis in a large, Midwestern, academic practice from 2008 to 2011. Patients with a prior antihypertensive medication prescription were excluded. Kaplan–Meier analysis was used to estimate the probability of achieving hypertension control over 24 months by sex. Cox proportional hazard models were fit to identify sociodemographic predictors of delays in hypertension control.

Results: Among the 3208 young adults with incident hypertension, 48% achieved hypertension control within 24 months. Kaplan–Meier analysis demonstrated that young women had a higher hypertension control rate at 24 months (57%) compared with young men (41%). According to adjusted hazard models, young men had a 39% lower rate of hypertension control (hazard ratio 0.61; 95% confidence interval 0.55–0.69) compared with women. Being unmarried (0.87; 0.78–0.98) and a non-English primary language speaker (0.47; 0.37–0.60) also predicted lower hypertension control rates.

Conclusion: Sex disparities, being unmarried, and non-English primary language are important barriers to hypertension control among young adults with regular primary care use. Interventions tailored to sociodemographic characteristics may improve hypertension control in this challenging population.

aDepartment of Medicine

bHealth Innovation Program

cDepartment of Family Medicine and Community Health

dDepartment of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA

Correspondence to Heather M. Johnson, MD, MS, FAHA, Associate Professor, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, H4/512 CSC, MC 3248, 600 Highland Avenue, Madison, WI 53792, USA. Tel: +1 608 262 2075; fax: +1 608 263 0405; e-mail: hm2@medicine.wisc.edu

Abbreviations: ACC, American College of Cardiology; ACG, Adjusted Clinical Group; Add Health Study, The National Longitudinal Study of Adolescent to Adult Health; AHA, American Heart Association; CVD, cardiovascular disease; JNC 7, The Seventh Report of the Joint National Committee on Prevention Detection Evaluation and Treatment of High Blood Pressure; MESA, Multi-Ethnic Study of Atherosclerosis; WCHQ, Wisconsin Collaborative for Healthcare Quality

Received 25 May, 2018

Revised 19 June, 2018

Accepted 29 June, 2018

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