Understanding the complexity of hypertensive African American home care patients: challenges to intervention.

OBJECTIVE: To examine sociodemographic, clinical, and self-management characteristics of a sample of urban, African American patients admitted to home health care with uncontrolled hypertension and to determine the extent to which these factors are associated with disease severity.
METHODS: We conducted a cross-sectional study of 498 hypertensive African American patients newly admitted to home health care. Data for this study were drawn from patient-level clinical and functional assessment data derived from the uniform home health assessment system mandated by the Centers for Medicare and Medicaid Services and patient in-home interviews.
RESULTS: Forty percent of patients had stage 1 hypertension, and 60% had the more severe uncontrolled stage 2. Multivariate analyses found that factors associated with stage 2 were co-morbid diabetes, poor appointment keeping, low activation, and longer time since diagnosis. Protective factors associated with a lower likelihood of severe uncontrolled hypertension were older age and recent discharge from a hospital. More co-morbid conditions also appeared to be protective, although the association did not reach significance.
CONCLUSIONS: Our findings highlight the need to address hypertension control among the African American, dually diagnosed diabetic hypertensive population and underscore the critical role of treatment adherence, widely recognized as a key issue in managing hypertension and other chronic conditions. Successful strategies will likely require more aggressive action by home health nurses, both to alert patients' primary care providers to ongoing, unsuccessfully treated hypertension and to remediate patients' inadequate self-management preparedness.