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Title: Undiagnosed hypertensive participants demonstrate the largest blood pressure improvements from a community based lifestyle intervention: implications for addressing the silent hypertension epidemic

item Zoellner, Jamie - Virginia Biotechnology Institute
item Thomson, Jessica
item Landry, Alicia - University Of Southern Mississippi
item Anderson-lewis, Chakarra - University Of Southern Mississippi
item Connell, Carol - University Of Southern Mississippi
item Molaison, Elaine - University Of Southern Mississippi
item Yadrick, Kathy - University Of Southern Mississippi

Submitted to: Preventing Chronic Disease
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 9/24/2013
Publication Date: 4/3/2014
Publication URL:
Citation: Zoellner, J., Thomson, J.L., Landry, A.S., Anderson-Lewis, C., Connell, C., Molaison, E., Yadrick, K. 2014. Undiagnosed hypertensive participants demonstrate the largest blood pressure improvements from a community based lifestyle intervention: implications for addressing the silent hypertension epidemic. Preventing Chronic Disease. 11:130269.

Interpretive Summary: Thirty-four percent of American adults have high blood pressure or hypertension with rates even higher in African American adults (44%). Hypertension can lead to heart attack or stroke, eventually resulting in death. Further, healthcare costs associated with hypertension are approximately $131 billion. Some of these costs can be attributed to the “silent” condition of hypertension meaning it often occurs without symptoms leaving it undiagnosed and therefore untreated. The main goal of this study was to use data from a previously conducted lifestyle intervention to estimate the presence of undiagnosed hypertension and determine the relationship between hypertension and improvements in blood pressure and health-related quality of life (general well being). The HUB City Steps study was a 6-month intervention designed to improve hypertension risk factors in a southern Mississippi community. The design and implementation of the study was guided by a community advisory board. The HUB City Steps study sample consisted of mostly African American, overweight or obese, females. Diagnosed hypertension in this community sample was 42% with 84% of these participants reporting anti-hypertensive medication use. Undiagnosed hypertension was 36%, almost double the rate reported for the area in general, implying the study may have been successful at reaching a high proportion of individuals with undiagnosed hypertension. While blood pressure improved significantly for both the diagnosed hypertensive and non-hypertensive participants, the largest improvements were observed in undiagnosed participants. These results suggest that those most in need of effective hypertension treatment achieved the greatest benefits from this study. Additionally, health-related quality of life improved for all participants, regardless of hypertensive classification. Hence, even those participants that did not benefit from blood pressure improvements did have an improved sense of well being. Given that the majority of individuals with uncontrolled hypertension have a usual source of health care and health insurance suggests that the healthcare system has not been effective in treating this epidemic chronic disease. Thus, effective community-based efforts, such as HUB City Steps, that compliment the healthcare system are needed to address the high rates of undiagnosed and uncontrolled hypertension.

Technical Abstract: Introduction: It is important to understand effective strategies to reach and treat individuals who lack awareness of or have uncontrolled hypertension (HTN). The objectives of this secondary analysis from a community-based participatory research initiative, HUB City Steps, were to quantify the prevalence of undiagnosed HTN, and determine the relationship between HTN status at baseline and post intervention improvements in blood pressure (BP) and health related quality of life (HRQOL). Methods: HUB City Steps was a 6-month pre- post- experimental lifestyle intervention targeting HTN risk factors. Outcome measures were collected at baseline, 3-months, and 6-months. Generalized linear mixed models were used to test for effects by time and HTN status. Results: Of the enrolled sample (n=269), the majority were overweight or obese (91%), African American (94%), females (85%). When considering HTN status, 42% had self-reported diagnosis of HTN (self-reported subgroup; 84% with antihypertensive medication use); 36% had no self-reported medical history of HTN, yet measured clinical diagnosis of pre-HTN or HTN (undiagnosed subgroup); and 22% had no self-reported or clinical HTN diagnosis (no HTN subgroup). Across all models, BP significantly improved for participants with self-reported HTN [8.2 (SD=18.2) mm/Hg] and undiagnosed HTN [12.3 (SD=16.3) mm/Hg], with undiagnosed participants experiencing the greatest improvements (p<0.001). Effects remained significant after controlling for covariates. HRQOL significantly improved for all three HTN subgroups, with no apparent subgroup differences. Conclusion: This study reveals advantages of a culturally appropriate community-based participatory research initiative to reach those with undetected HTN, and effectively improve BP status and HRQOL.