695 HYPERTENSION SCREENING, TREATMENT AND CONTROL IN AN ASIAN LOW-INCOME URBAN COMMUNITY- A PROSPECTIVE STUDY

Abstract

Background: We investigated hypertension management and screening in a multi-ethnic low socioeconomic status (SES) community at baseline and after 1-year. Methods: The study involved all residents aged ≥40 years in two housing precincts comprising rental blocks (low-SES) and adjacent owner-occupied blocks (higher-SES) in Singapore (2009-2011). Nationally 85.7% own homes. Those in rental blocks were followed-up prospectively for 1 year. Blood pressure was measured at baseline/follow-up. Multivariate logistic regression/Cox regression determined predictors of hypertension management at baseline/follow-up respectively. Results: Participation was 78.2% (1081/1383). Hypertension prevalence (baseline) in the low-SES community was 60.8% (351/577); 38.2% (134/351) were newly-diagnosed. Of known hypertensives, 69.6%(151/217) were treated; of treated hypertensives, 45.0% (68/151) achieved control. Adjusting for sociodemographic variables, treatment (aOR = 0.34, CI = 0.19-0.62) and control (aOR = 0.42, CI = 0.26–0.67) were poorer in the low-SES community than the higher-SES community. After 1 year, follow-up in the low-SES community was 80.9% (467/577). At baseline 60.4% (282/467) were hypertensive; 53.5% (151/282) were untreated; 54.2% (71/131) uncontrolled. One year later, 51.6% (78/151) of untreated hypertensives were treated; combined with treated hypertensives previously uncontrolled, 53.0% (79/149) achieved control. Older age was independently predictive of treatment (aRR = 1.98, CI = 1.08–3.65); majority ethnicity (aRR = 1.76, CI = 1.05–2.96), employment (aRR = 1.85, CI = 1.26–2.80) and newly-diagnosed hypertension (aRR = 1.52, CI = 1.01–2.32) predicted control. 52.4% (97/185) were irregularly screened at baseline; at follow-up 61.9% (60/97) were regularly screened. Majority ethnicity (aRR = 1.91, CI = 1.08–3.40) and employment (aRR = 1.72, CI = 1.25–2.69) predicted screening. Cost and misperceptions were common barriers to screening and treatment. Conclusions: Hypertension management is poor within low-SES communities, independent of individual SES. Minorities and unemployment predicted poorer hypertension management.