Low literacy is associated with uncontrolled blood pressure in primary care patients with hypertension and heart disease

Abstract

Objectives: To evaluate the association between low literacy and uncontrolled blood pressure (BP) and their associations with medication adherence.

Methods: Cross-sectional study of 423 urban, primary care patients with hypertension and coronary disease. The relationship between low literacy (Rapid Estimate of Adult Literacy in Medicine ≤ 44) and uncontrolled BP (≥140/90 mmHg, ≥130/80 mmHg for patients with diabetes) was evaluated by crude and adjusted logistic regression. Relationships with self-reported adherence and refill adherence were explored using adjusted linear and logistic regression.

Results: Overall, 192 (45%) subjects had low literacy and 227 (52.9%) had uncontrolled BP. Adjusting for age, gender, race, employment, education, mental status, and self-reported adherence, low literacy was associated with uncontrolled BP (OR 1.75, 95% CI 1.06-2.87). Lower self-reported adherence was associated with uncontrolled BP; the relationship between refill adherence and uncontrolled BP was not statistically significant.

Conclusion: Low literacy is independently associated with uncontrolled BP.

Practice implications: Awareness of the relationships among patient literacy, BP control, and medication adherence may guide healthcare providers as they communicate with patients.

Keywords: Blood pressure control; Hypertension control; Literacy; Medication adherence.

Conflict of interest statement

Conflicts of Interest:

Dr. McNaughton declares that she has no relevant conflicts of interest. She has served on an advisory board for Cornerstone Therapeutics, Inc.

Dr. Jacobson declares that he has no conflicts of interest.

Dr. Kripalani declares that he has no conflicts of interest.

We confirm all patient/personal identifiers have been removed or disguised so the patient/person(s) described are not identifiable and cannot be identified through the details of the story

Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Figures

Figure 1

Study flow and patient selection for analysis Abbreviations: IMAGE-CHD Study, Improving Medication Adherence through Graphically Enhanced Interventions in Coronary Heart Disease; Rx, prescription