Abstract
Better understanding is needed for antihypertensive medication initiation and lifestyle modification among younger populations with elevated blood pressure. This study aimed to assess health behavior change after receiving a report of elevated blood pressure among African Americans and Caucasians younger than 50 years old. We used the Coronary Artery Risk Development in Young Adults (CARDIA) repository dataset. By examination year twenty, 424 out of 2,478 Caucasian and 2,637 African American participants had received feedback from the CARDIA study due to elevated blood pressure readings. Blood pressure was measured by trained CARDIA researchers at the participant’s home and was repeatedly recorded at seven examinations over twenty years. A feedback/referral letter was sent to participants with an elevated blood pressure reading. On average, participants first had an elevated blood pressure reading at the age of 34. After receiving the feedback letter, 44% of the previously undiagnosed participants received a formal diagnosis. In addition, 23% initiated the use of antihypertensive medication if they had not received medication treatment before. Among the participants with at-risk lifestyle behaviors, 40% reduced alcohol consumption, 14% increased exercise level, 11% stopped smoking, and 8% reached normal weight. While none of the studied patient factors were associated with lifestyle modification, age had a positive impact on antihypertensive medication initiation (p<0.05). We found no evidence of differences in health behavior change between African American and Caucasian participants after receiving the feedback letter. This research is one of the first to study what followed after receiving a feedback letter about elevated blood pressure outside of healthcare settings. Although additional referral care and behavior interventions are needed to facilitate medication initiation and lifestyle modification, our observations suggest that providing blood pressure feedback may have promise as part of a multi-method approach involving blood pressure screening and follow up.
Highlights
There is a need for additional information regarding health behaviors such as antihypertensive medication initiation and lifestyle modification among younger populations with elevated blood pressure
This research is one of the first to study what followed after receiving a feedback letter about elevated blood pressure from the Coronary Artery Risk Development in Young Adults (CARDIA) study
We found receiving feedback about elevated blood pressure was associated with an increase in the use of antihypertensive medication and receiving a formal diagnosis of hypertension for both African Americans and Caucasian participants
Summary
The current guidelines released by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 8) provide specific recommendations to initiate antihypertensive medication and modify lifestyle behaviors in an effort to manage hypertension.[7] few studies have targeted elevated blood pressure control in young adults or newly diagnosed populations. There is a need for additional information regarding health behaviors such as antihypertensive medication initiation and lifestyle modification among younger populations with elevated blood pressure. This is true for African Americans considering their elevated risk of hypertension and cardiovascular disease.[8]
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