High Blood Pressure Seldom Controlled in Underserved Urban Neighborhoods

A health survey of adults living in an urban African-American neighborhood in Baltimore has revealed that, although most residents were aware of the problem of high blood pressure (hypertension), the community continues to have very high rates of uncontrolled hypertension, even among those taking blood pressure medications. The study, conducted by researchers at the Johns Hopkins Schools of Public Health, Medicine, and Nursing in collaboration with the Sandtown-Winchester community, appeared in the March 2000 issue of Ethnicity & Disease.

Hypertension affects over six million adults in the United States, with an incidence rate 30 percent greater among African Americans than among whites. While considerable improvements have been made over the last 30 years in hypertension awareness, treatment, and control, these positive trends have recently been reversed, so that a majority of individuals with hypertension continue to have uncontrolled blood pressure.

Lead author Lee R. Bone, RN, MPH, associate scientist, Health Policy and Management, Johns Hopkins School of Public Health, said, "Eighty-eight percent of hypertensive individuals in the Sandtown-Winchester community were aware of their blood pressure problems, compared to 74 percent of African Americans nationally. This high level of awareness suggests widespread hypertension screening may no longer be necessary, but that efforts must now be directed toward screening the small percentage of primarily younger African-American adult males who are more likely to be unaware of their hypertension."

Sixty-six percent of the hypertensive respondents reported taking high blood pressure medication, compared with 57 percent nationally; however, the blood pressure control rate among treated hypertensives in the survey was significantly lower (28 percent) than among those in the national survey (44 percent). And overall, only 18 percent of hypertensives had their blood pressure under control, compared to 25 percent of hypertensive African Americans nationally.

The researchers emphasized that further improvements in the rates of hypertension control within a community could also be achieved by programs that encourage people to keep taking their medications and to adopt beneficial lifestyle behaviors such as reducing weight, salt, and excessive alcohol consumption, while increasing physical activity and stopping smoking.

The study was a product of a partnership that has grown between academic researchers from the Johns Hopkins Medical Institutions and members of Baltimore's Sandtown-Winchester neighborhood. The researchers requested community leaders to serve on the study's health advisory board and to select six local residents to be trained in conducting the neighborhood survey. Over a 19-month period, these six health workers attempted to access every household in randomly selected blocks of Sandtown-Winchester during weekdays, weekends, and evenings. During face-to-face interviews, they collected demographic data on 2,196 adults and conducted a general health survey that included blood pressure measurements. The data gathered were then compared with national data for African Americans from the 1989-91 NHANES III survey.

Interviewees were 98 percent African American -- 63 percent female and with an average age of 43 years. Forty-two percent of respondents had a high school diploma or GED; 45 percent had less than a twelfth grade education; 31 percent were unemployed, and 51 percent had an annual income of less than $10,000. Of those interviewed, 854 (39 percent) were identified as having hypertension, with 755 (88 percent) having previously been diagnosed with hypertension and 99 (12 percent) being newly diagnosed by the community health workers.

When compared to individuals in the neighborhood with normal blood pressure, the participants with hypertension were, among other characteristics, significantly more likely to be older, unemployed, and less well educated; to have lower annual incomes; and to rate their health as poor or fair. Twenty percent of hypertensive individuals had no health insurance.

The authors stressed that to eliminate the gap in health status in African-American populations compared to the majority, partnerships between academic health centers and communities are crucial, since 75 percent of such academic health centers are located in urban African-American communities.

Support for this four-year study was provided by a grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health.