Untreated hypertension: prevalence and patient factors and beliefs associated with under-treatment in a population sample

Abstract

Identifying barriers to hypertension management may facilitate cardiovascular risk reduction. Therefore, our objective, was to determine the prevalence of hypertension not managed with medication (‘untreated’) in a representative adult sample and identify patient factors/beliefs, and aspects of the patient–general practitioner (GP) relationship associated with untreated hypertension. The North West Adelaide Health Study, a biomedical cohort study over three stages from 2000–2009, assesses hypertension (systolicX140mmHg and/orX90mmHg or current treatment with anti-hypertensive medication), chronic disease and associated risk factors and health-care experiences, including risk perception, decision-making preferences, GP/primary care provider affiliation and satisfaction with care (n¼2425). The prevalence of hypertension was 32.1% (n¼781) comprised of treated (19.0%, n¼462) and untreated (13.1%, n¼319) hypertension. Thus, 40.8% of hypertension was untreated. Among hypertensive subjects, nontreatment was significantly associated with male sex, age o45 years, workforce participation, infrequent GP visits, dissatisfaction with recent medical care, high total cholesterol, moderate-level physical activity and lower body weights. Compared with participants without hypertension (and no treatment), untreated subjects demonstrated significant (15%) 10-year Framingham general cardiovascular risk (odds ratio¼6.44, 95% confidence interval¼4.52–9.17). Novel screening strategies and public health messages to address beliefs and perceptions of both patients and the health system are required to identify untreated, at-risk hypertensive individuals.