Hypertension management and lifestyle changes following screening for hypertension in an Asian low socioeconomic status community: a prospective study.
- Author:
Liang En WEE
1
;
Jolene WONG
;
Run Ting CHIN
;
Zhi Yong LIN
;
Daniel E Q GOH
;
Kalpana VIJAKUMAR
;
Kiat Yee VONG
;
Wei Ling TAY
;
Hui Ting LIM
;
Gerald C H KOH
Author Information
- Publication Type:Journal Article
- MeSH: Adult; Age Factors; Aged; Antihypertensive Agents; therapeutic use; Asian Continental Ancestry Group; statistics & numerical data; Diet, Sodium-Restricted; methods; Exercise Therapy; methods; Female; Health Services Accessibility; statistics & numerical data; Humans; Hypertension; diagnosis; ethnology; therapy; Male; Mass Screening; Middle Aged; Multivariate Analysis; Patient Compliance; ethnology; statistics & numerical data; Patient Dropouts; statistics & numerical data; Poverty; statistics & numerical data; Proportional Hazards Models; Prospective Studies; Risk Reduction Behavior; Singapore; Smoking Cessation; methods; Social Class; Treatment Outcome; Weight Reduction Programs; methods
- From:Annals of the Academy of Medicine, Singapore 2013;42(9):451-465
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTIONThis study investigated the effect of an access-enhanced intervention on hypertension screening and management, as well as on health behaviours among newly diagnosed hypertensives, in a multi-ethnic low socioeconomic status (SES) community. Factors associated with hypertension screening, treatment, and control in the community were also determined.
MATERIALS AND METHODSThe study involved all residents aged ≥40 years in 2 public rental housing precincts (low SES), between 2009 and 2011, who were followed-up prospectively for 1 year after a 6-month community-based intervention comprising a 3-month access-enhanced screening component and a 3-month follow-up (outreach) component. Blood pressure was measured at baseline and follow-up. Multivariate Cox regression determined predictors of hypertension management at follow-up.
RESULTSThe follow-up rate 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, postintervention, 51.6% (78/151) of untreated hypertensives were treated; combined with treated hypertensives previously uncontrolled, 53.0% (79/149) achieved control. Older age independently predicted treatment (adjusted relative risk, aRR = 1.98, CI, 1.08 to 3.65); majority ethnicity (aRR = 1.76, CI, 1.05 to 2.96), employment (aRR = 1.85, CI, 1.26 to 2.80) and newly treated hypertension (aRR=1.52, CI, 1.01 to 2.32) predicted control. A total of 52.4% (97/185) were irregularly screened at baseline; at follow-up 61.9% (60/97) were regularly screened. Cost and misperceptions were common barriers to screening and treatment. Newly diagnosed hypertensives were also less likely to go for additional cardiovascular screening (aRR = 0.54, CI, 0.29 to 0.99).
CONCLUSIONAn access-enhanced intervention had some success in improving hypertension management within low SES communities; however, it was less successful in improving cardiovascular risk management, especially in encouraging lifestyle changes and additional cardiovascular screening amongst newly diagnosed hypertensives.
