Behavioral Factors Associated with Blood Pressure Control in Hypertensive Adults 35 to 64 Years of Age at Risk of Future Stroke: A cross-sectional survey study

ABSTRACT BACKGROUND The incidence of stroke has increased for those < 64 years of age over the last decade. Control of hypertension is one of the greatest modifiable risk factors for preventing stroke but remains elusive. In 2017, the American College of Cardiology and American Heart Association national blood pressure guidelines tightened the definition of a normal blood pressure to <120/80 mm Hg, which if achieved would reduce stroke incidence by up to 21%. METHODS This IRB approved cross-sectional study utilized stratified random sampling to recruit adults, 35 to 64 years of age with an active diagnosis of hypertension, no prior history of stroke or transient ischemic attack (TIA) and under current primary care. Blood pressure was dichotomized into controlled blood pressure (≤120/80 mm Hg) and uncontrolled blood pressure (>120/80 mm Hg). Guided by a modified Health Belief Model, electronic surveys assessing individual medication compliance and beliefs about future stroke risk were distributed. Bivariate and multivariate logistic regression models analyzed the data with α set at 0.05 and observational cohort guidelines were followed. RESULTS Of the 304 subjects, 83% (n=253) had uncontrolled blood pressure, 78% of women and 89% of men, (77% of total subjects) classified as stage 1 or stage 2 hypertension. Men and women had mean composite compliancy scores below the 50 th percentile (21.53 +/-2.89). Women with uncontrolled hypertension were statistically less likely to be compliant ( p = 0.040), with lower perceived susceptibility ( p= 0.04 ) and severity of stroke ( p=0.037 ) and less likely to see barriers to initiating exercise ( p=0.04) but did not view exercise as beneficial in preventing stroke ( p =0.039). CONCLUSION Uncontrolled blood pressure remains problematic for both men and women. Women are known to have greater longevity and this study has identified targeted beliefs and behaviors that may more effectively address uncontrolled blood pressure in women at risk for future stroke.