03/13/2023
By Maureen Martin

The Zuckerberg College of Health Sciences, Solomont School of Nursing, invites you to attend a doctoral dissertation defense by Patricia Railsback Masson on " Factors Influencing Blood Pressure Control in Hypertensive Adults 35 to 64 Years of Age at Risk for Stroke."

Date: Monday, March 27, 2023
Time: 9 a.m. to noon
Location: Donna Manning Health & Social Sciences Building, 113 Wilder St., Room 342, Lowell, and remotely. Please email Patricia_Masson@student.uml.edu and committee Chair Barbara_Mawn@uml.edu at least 24 hours prior to the defense to request Zoom access to the meeting.

Committee Chair: Barbara Mawn, Ph.D., RN, Professor Emerita, Solomont School of Nursing, University of Massachusetts Lowell

Committee Members:

  • Asst. Teaching Prof. Karyn Heavner, Public Health Department, University of Massachusetts Lowell
  • Prof. Kristen Sethares, Ph.D., RN, College of Nursing & Health Sciences, University of Massachusetts Dartmouth
  • Leslie-Mazwi, MD, Chair of Neurology at Washington University, Seattle
  • Assoc. Prof. Jason Rydberg, Ph.D., Associate Professor, School of Criminology and Justice Studies, University of Massachusetts Lowell

Abstract:

Background: Hypertension (HTN), also referred to as high blood pressure (HBP), continues to be the single greatest modifiable risk factor for both ischemic and hemorrhagic stroke (Tsao et al., 2023). The Centers for Disease Control and Prevention (CDC) reported no significant improvements in blood pressure control for adults 35 to 64 years of age from 2011 through 2016 (CDC, 2021). In 2017 the American College of Cardiology (ACC), the American Heart Association (AHA) and the Joint National Committee (JNC), ACC/AHA 2017, revised blood pressure guidelines. It is estimated that the prevalence of adult HTN in the US is 46% (Bress et al., 2017).

Much of the research to date has focused on secondary prevention strategies after a stroke has occurred in adults 65 and older. The Million Hearts 2027® (CDC, 2021; U.S. Department of Health and Human Services, 2021) initiative has called for future research to focus on opportunities to improve primary prevention for those who are at risk for, but have not yet experienced, a stroke (Tsao et al., 2023; Wall et al., 2017).

Aim: The aim of this study was to identify individual factors associated with blood pressure control in men and women, 35 to 64 years of age, who have been diagnosed with HTN and are at risk for, but have not yet experienced, a stroke.

Method: A modified Health Belief Model was used to guide this study. Stratified random sampling was used to invite 1,200 eligible patients to participate through the electronic patient portal. The study consisted of a participant survey and a review of the electronic medical record (EMR) to obtain current clinical data: BP, BMI, antihypertensive medications, and problem list documentation.
 
Results: Three hundred and four (304) surveys and EMR abstractions were completed. One hundred and sixty-two (53%) of the participants were female. For this study blood pressure control was dichotomized into controlled blood pressure (normal) and uncontrolled blood pressure (elevated, stage I, stage II and crisis). Eighty-three percent (253) of the study population were classified as having uncontrolled blood pressure. Sixty-five percent of the study population with uncontrolled blood pressure were white, had higher incomes, college degrees and access to routine primary care. Heart conditions, diabetes, obesity, smoking (past and present), and incongruency between patient reported risk factors and clinician EMR problem lists were identified as associated clinical factors. Behavioral factors such as, belief in future stroke risk, management of blood pressure compliance, beliefs surrounding susceptibility and benefits and barriers to exercise were also associated with blood pressure control.

Conclusion: Blood pressure was poorly controlled in this sample of adults 35 to 64 years of age. This study provided directional insights and warrants further investigation into subgroup patient populations and clinician risk factor(s) assessment, greater understanding of self-perceived risk of future stroke, self-management of blood pressure and treatment compliance, and challenges facing primary care to escalate treatments which could impact blood pressure control.

Keywords: Hypertension, high blood pressure, stroke, antihypertensives, clinical and behavioral factors, blood pressure control, health belief model.