Association of health literacy with elevated blood pressure: a cohort study of hospitalized patients.

McNaughton CD, Kripalani S, Cawthon C, Mion LC, Wallston KA, Roumie CL
Med Care. 2014 52 (4): 346-53

PMID: 24556896 · PMCID: PMC4031281 · DOI:10.1097/MLR.0000000000000101

BACKGROUND - The clinical consequences of low health literacy are not fully understood.

OBJECTIVES - We evaluated the relationship between low health literacy and elevated blood pressure (BP) at hospital presentation.

RESEARCH DESIGN AND SUBJECTS - We conducted a cross-sectional evaluation of adult patients hospitalized at a university hospital between November 1, 2010 and April 30, 2012.

MEASURES - Health literacy was assessed using the Brief Health Literacy Screen (BHLS). Low health literacy was defined as a BHLS score ≤9. BP was assessed using clinical measurements. The outcome was elevated BP (≥140/90 mm Hg; ≥130/80 mm Hg with diabetes or renal disease) or extremely elevated BP (>160/100 mm Hg) at hospital presentation. Multivariate logistic regression adjusted for age, sex, race, insurance, comorbidities, and antihypertensive medications; preplanned restricted analysis among patients with diagnosed hypertension was performed.

RESULTS - Of 46,263 hospitalizations, 23% had low health literacy, which occurred more often among patients who were older (61 vs. 54 y), less educated (28.4% vs. 11.2% had not completed high school), and more often admitted through the emergency department (54.3% vs. 48.1%) than those with BHLS>9. Elevated BP was more frequent among those with low health literacy [40.0% vs. 35.5%; adjusted odds ratio (aOR) 1.06; 95% confidence interval (CI), 1.01-1.12]. Low health literacy was associated with extremely elevated BP (aOR 1.08; 95% CI, 1.01-1.16) and elevated BP among those without diagnosed hypertension (aOR 1.09; 95% CI, 1.02-1.16).

CONCLUSIONS - More than ⅓ of patients had elevated BP at hospital presentation. Low health literacy was independently associated with elevated BP, particularly among patients without diagnosed hypertension.

MeSH Terms (13)

Adult Aged Age Factors Blood Pressure Cross-Sectional Studies Educational Status Female Health Literacy Hospitalization Humans Hypertension Male Middle Aged

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