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Documented Lifestyle Education Among Young Adults with Incident Hypertension

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ABSTRACT

BACKGROUND

Only 38 % of young adults with hypertension have controlled blood pressure. Lifestyle education is a critical initial step for hypertension control. Previous studies have not assessed the type and frequency of lifestyle education in young adults with incident hypertension.

OBJECTIVE

The purpose of this study was to determine patient, provider, and visit predictors of documented lifestyle education among young adults with incident hypertension.

DESIGN

We conducted a retrospective analysis of manually abstracted electronic health record data.

PARTICIPANTS

A random selection of adults 18–39 years old (n = 500), managed by a large academic practice from 2008 to 2011 and who met JNC 7 clinical criteria for incident hypertension, participated in the study.

MAIN MEASURES

The primary outcome was the presence of any documented lifestyle education during one year after meeting criteria for incident hypertension. Abstracted topics included documented patient education for exercise, tobacco cessation, alcohol use, stress management/stress reduction, Dietary Approaches to Stop Hypertension (DASH) diet, and weight loss. Clinic visits were categorized based upon a modified established taxonomy to characterize patients’ patterns of outpatient service. We excluded patients with previous hypertension diagnoses, previous antihypertensive medications, or pregnancy. Logistic regression was used to identify predictors of documented education.

KEY RESULTS

Overall, 55 % (n = 275) of patients had documented lifestyle education within one year of incident hypertension. Exercise was the most frequent topic (64 %). Young adult males had significantly decreased odds of receiving documented education. Patients with a previous diagnosis of hyperlipidemia or a family history of hypertension or coronary artery disease had increased odds of documented education. Among visit types, chronic disease visits predicted documented lifestyle education, but not acute or other/preventive visits.

CONCLUSIONS

Among young adults with incident hypertension, only 55 % had documented lifestyle education within one year. Knowledge of patient, provider, and visit predictors of education can help better target the development of interventions to improve young adult health education and hypertension control.

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Acknowledgements

Contributors

The authors gratefully acknowledge Patrick Ferguson and Katie Ronk for data preparation, and Colleen Brown for manuscript preparation.

Funders

Research reported in this manuscript was supported by the Health Innovation Program and the Clinical and Translational Science Award (CTSA) program, previously through the National Center for Research Resources (NCRR) under award number UL1RR025011, and now by the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health under award number U54TR000021. Heather Johnson is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under award number K23HL112907, and also by the University of Wisconsin Centennial Scholars Program of the University of Wisconsin School of Medicine and Public Health. Amy Kind is supported by the National Institute on Aging of the National Institutes of Health under award number K23AG034551, the American Federation for Aging Research, the Atlantic Philanthropies, the Starr Foundation, and the Madison VA Geriatric Research, Education, and Clinical Center. Nancy Pandhi is supported by the National Institute on Aging of the National Institutes of Health under award number K08AG029527. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Additional funding for this project was provided by the University of Wisconsin Health Innovation Program and the University of Wisconsin School of Medicine and Public Health from the Wisconsin Partnership Program.

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Conflict of Interest

The authors declare that they do not have a conflict of interest.

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Authors and Affiliations

  1. Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Heather M. Johnson MD, MS, Andrea G. Olson MD, Jamie N. LaMantia BS & Amy J. H. Kind MD, PhD

  2. Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Heather M. Johnson MD, MS, Jamie N. LaMantia BS, Amy J. H. Kind MD, PhD, Nancy Pandhi MD, MPH & Maureen A. Smith MD, PhD, MPH

  3. William S. Middleton Memorial Veterans Hospital Geriatric Research Education and Clinical Center, Madison, WI, USA

    Amy J. H. Kind MD, PhD

  4. Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Nancy Pandhi MD, MPH & Maureen A. Smith MD, PhD, MPH

  5. Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Eneida A. Mendonça MD, PhD & Mark Craven PhD

  6. Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Eneida A. Mendonça MD, PhD

  7. Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Maureen A. Smith MD, PhD, MPH

  8. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Maureen A. Smith MD, PhD, MPH

  9. Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, H4/512 CSC, MC 3248 600 Highland Avenue, Madison, WI, 53792, USA

    Heather M. Johnson MD, MS

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  1. Heather M. Johnson MD, MS
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  2. Andrea G. Olson MD
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  3. Jamie N. LaMantia BS
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  8. Maureen A. Smith MD, PhD, MPH
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Correspondence to Heather M. Johnson MD, MS.

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Johnson, H.M., Olson, A.G., LaMantia, J.N. et al. Documented Lifestyle Education Among Young Adults with Incident Hypertension. J GEN INTERN MED 30, 556–564 (2015). https://doi.org/10.1007/s11606-014-3059-7

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  • DOI: https://doi.org/10.1007/s11606-014-3059-7

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