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Barriers to hypertension care and control in young urban black men
1Johns Hopkins University School of Nursing, Baltimore, Maryland 21205-2110, USA. mnhill@son.jhmi.edu
Insights
Young black men face significant barriers to high blood pressure (HBP) care, including socioeconomic and lifestyle factors. Addressing these issues is crucial for effective HBP management in this high-risk population.
Area of Science:
- Cardiovascular Health
- Public Health
- Health Disparities
Background:
- High blood pressure (HBP) care barriers are well-documented but rarely focus on young black men.
- This demographic exhibits the highest rates of severe HBP and lowest control rates.
Purpose of the Study:
- To assess barriers to HBP care and control in young urban black men.
- To identify factors associated with HBP care and medication adherence.
Main Methods:
- Randomized clinical trial involving 309 young urban black men with HBP.
- Baseline assessment of socioeconomic, lifestyle, and health-related factors.
- Statistical analysis to determine predictors of HBP care and control.
Main Results:
- A majority experienced barriers: unemployment (40%), illicit drug use (45%), social isolation (47%), alcoholism risk (62%), lack of insurance (51%).
- Health insurance and negative drug screens predicted HBP care.
- Employment and low alcoholism risk predicted medication adherence.
- Illicit drug use was linked to poorer BP control; medication use to better control.
Conclusions:
- Young black men face multifaceted barriers to HBP care and control.
- Comprehensive interventions addressing socioeconomic and lifestyle factors are essential.
- Targeted strategies are needed to improve HBP management in this vulnerable group.
Abstract:
Barriers to high blood pressure (HBP) care and control have been reported in the literature for > 30 years. Few reports on barriers, however, have focused on the young black man with HBP, the age/sex/race group with the highest rates of early severe and complicated HBP and the lowest rates of awareness, treatment, and control. In a randomized clinical trial of comprehensive care for hypertensive young urban black men, factors potentially associated with care and control were assessed at baseline for the 309 enrolled men. A majority of the men encountered a variety of barriers including economic, social, and lifestyle obstacles to adequate BP care and control, including no current HBP care (49%), risk of alcoholism (62%), use of illicit drugs (45%), social isolation (47%), unemployment (40%), and lack of health insurance (51%). Having health insurance (odds ratio = 7.20, P = .00) and a negative urine drug screen (odds ratio = .56, P = .04) were significant predictors of being in HBP care. Low alcoholism risk and employment were identified as significant predictors of compliance with HBP medication-taking behavior. Men currently using illicit drugs were 2.64 times less likely to have controlled BP compared with their counterparts who did not use illicit drugs, and men currently taking HBP medication were 63 times more likely have controlled BP compared with men not taking HBP medication. Comprehensive interventions are needed to address socioeconomic and lifestyle issues as well as other barriers to care and treatment, if HBP care is to be salient and effective in this high risk group.