Beliefs about Hypertension Among People with Uncontrolled Hypertension

Abstract

Background: Uncontrolled hypertension leads to severe yet preventable outcomes including heart attack, stroke, and chronic kidney disease. Almost a third of the adults in the US have hypertension and only about half of them have their blood pressure (BP) under control. Although increases in public knowledge and awareness about hypertension have improved BP control rates, a better understanding of the hypertension beliefs among uncontrolled hypertensives is needed to create new behavioral interventions to further improve BP control. Using a well-established framework, such as the Health Belief Model (HBM), to systematically study these beliefs is essential in learning how certain beliefs may impact BP self-management behavior. Objectives: The aim of this study was to examine the beliefs about hypertension among people identified with high blood pressure and to find possible associations between demographics, beliefs, and the behavior of taking prescribed antihypertensive medication. Methods: Using an existing dataset from a previous study, hypertension beliefs, defined by the HBM framework, and BP medication use in a Pacific Northwest community were analyzed. The data came from a 2007-2009 population-based survey and included the responses of 181 Seattle area residents who had a markedly elevated BP during a recent, non-life threatening 911-call visit and who reported awareness of their current or previous high blood pressure diagnosis. Relationships between variables were examined using chi-square, Mantel-Haenszel, and Fisher’s exact tests, as well as bivariate and multivariate logistic regression. Results: Demographics, beliefs, and behaviors: Increasing age was associated with low perceived susceptibility and high self-efficacy. Living with others was associated with perceived benefits of treatment. White race and speaking only English were each associated with high self-efficacy. Lower educational attainment and income were each associated with perceived financial barriers to treatment. Increasing age and having health insurance each independently increased the likelihood of taking BP medications. Beliefs and behaviors: Medication use was associated with lower perceived susceptibility and greater perceived expense of treatment. Among females, lower perceived susceptibility and greater self-efficacy were positively associated with medication use. Conclusion: This study found several beliefs to be associated with demographic groups at risk for uncontrolled hypertension, and some beliefs were associated with medication use. These must be further studied in hopes of guiding intervention design to improve BP self-management behavior.