Hypertension is one of the most common diagnoses carried by adults yet is often difficult to manage. A combination of medical therapy, patient engagement, and self-care is required to achieve blood pressure control. We, therefore, sought to elicit patient views on lifestyle factors that are known to influence optimal management of hypertension.
From outpatient clinics, we identified patients with documented hypertension and taking at least one antihypertensive medication. Patients with secondary causes of hypertension or end-organ damage were excluded. Following informed consent, patient views were elicited using the Kear Hypertension Management Instrument (KHMI), the Motivators of and Barriers to Health-Smart Behaviors Inventory (MB-HSBI), and the Stages of Change questionnaire (SOC). Participants were also provided with a 10-point Likert scale (10-very highly motivated/confident) to rate their level of motivation and confidence to maintain heart-healthy behaviors. Data are summarized using descriptive statistics for continuous and categorical variables.
Between 12/02/17 and 01/16/18, 19 eligible individuals of at least age 18 provided data; 95% (n=18) were African-American and 68% (n=13) were female. On the KHMI, 63% (n=12) reported either seldom or never forgetting to take medication. 84% (n=16) reported following a low salt diet a good bit of the time or more frequently. Only 32% (n=6) reported exercising as prescribed and 47% (n=9) reported participating in stress-reducing activities with similar frequency. 58% (n=11), reported never experiencing medication side effects. Only 1 in 3 patients reported financial barriers in obtaining medication. Interestingly, the relationship between motivators and barriers to adopt a healthy lifestyle varied by type of behavior. On the MB-HSBI, 53% (n=10) patients shared being highly motivated to eat a healthy breakfast while only 21% (n=4) reported having the least barriers to do so. However, only 26% (n=5) reported being highly motivated to increase physical activity and 37% (n=7) reported having the least barriers to do so. The SOC revealed 74% (n=14) of patients saying they have been maintaining heart-healthy behaviors for 6+ months. When asked to rate motivation to maintain behaviors on the 10-point scale, the median=8 and IQR=5. For confidence in maintaining these behaviors, the median=8 and IQR=4.
In our setting of safety-net outpatient care, patients with documented hypertension were highly motivated to pursue healthy lifestyle behaviors with a low prevalence of financial barriers to medication access. However, self-reported access to and awareness of physical activity and stress management options is less encouraging and warrant attention. Further analyses are planned to continue study and elucidate the relationship of these patient reported outcomes with temporal change in clinical outcomes including blood pressure.