Understanding Barriers to Hypertension Control in the Elderly

Abstract: 
This population-based study in primary care settings will evaluate the effect of attitudinal, subjective norms, and perceived behavioral control/structural factors on achieving sustained blood pressure (BP) control in hypertensive elderly patients aged >=70. We will also examine the impact of functional status/comorbidities as barriers to BP control. We hypothesize that patients with sustained uncontrolled hypertension (HTN) will: 1) place a higher priority on managing their other competing medical conditions; 2) have a poorer functional status; 3) have subjective norms that do not value HTN control; and 4) have more structural barriers to filling prescribed anti-hypertensive (anti-HTN) medications. We will randomly sample 100 individuals from each of two strata of all elderly HTN patients in affiliated urban primary care practices. We will conduct 30-minute telephone surveys of 200 patients to examine constructs within Ajzen's Theory of Planned Behavior. Survey items are primarily drawn from validated instruments. Analyses will be conducted in Stata using its svy features. Our dependent variable is sustained controlled HTN. We will examine multivariate models using generalized estimating equations and examine adjusted associations of the domains of interest both separately and together. This project will offer novel information on poorly understood patient-level barriers to HTN control in the elderly and will suggest targets for interventions to address uncontrolled HTN. The project has important relevance to reducing the most important risk factor for stroke and heart disease and offers an excellent basis for an NIH application.
Funded By: 
PARC
Award Dates: 
July 1, 2006 - June 30, 2007
PARC Grant Year: 
Year 13