Behavioral Factors Associated with Blood Pressure Control in Hypertensive Adults 35 to 64 Years of Age at Risk of Future Stroke: A cross-sectional survey study

BACKGROUND The incidence of stroke has increased for those < 64 years of age over the last decade. Control of hypertension is one of the greatest modifiable risk factors for preventing stroke but remains elusive. In 2017, the American College of Cardiology and American Heart Association national blood pressure guidelines tightened the definition of a normal blood pressure to <120/80 mm Hg, which if achieved would reduce stroke incidence by up to 21%. METHODS This IRB approved cross-sectional study utilized stratified random sampling to recruit adults, 35 to 64 years of age with an active diagnosis of hypertension, no prior history of stroke or transient ischemic attack (TIA) and under current primary care. Blood pressure was dichotomized into controlled blood pressure (≤120/80 mm Hg) and uncontrolled blood pressure (>120/80 mm Hg). Guided by a modified Health Belief Model, electronic surveys assessing individual medication compliance and beliefs about future stroke risk were distributed. Bivariate and multivariate logistic regression models analyzed the data with α set at 0.05 and observational cohort guidelines were followed. RESULTS Of the 304 subjects, 83% (n=253) had uncontrolled blood pressure, 78% of women and 89% of men, (77% of total subjects) classified as stage 1 or stage 2 hypertension. Men and women had mean composite compliancy scores below the 50th percentile (21.53 +/-2.89). Women with uncontrolled hypertension were statistically less likely to be compliant ( p = 0.040), with lower perceived susceptibility ( p= 0.04 ) and severity of stroke ( p=0.037 ) and less likely to see barriers to initiating exercise ( p=0.04) but did not view exercise as beneficial in preventing stroke ( p =0.039). CONCLUSION Uncontrolled blood pressure remains problematic for both men and women. Women are known to have greater longevity and this study has identified targeted beliefs and behaviors that may more effectively address uncontrolled blood pressure in women at risk for future stroke. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial This study was deemed to be a non-risk study by the IRB and given expedited review at the Mass General Brigham IRB June of 2020. The submission was not registered with clinical trials.gov ### Funding Statement This study was financially supported by a grant from the Yvonne L. Munn Center for Nursing Research at the Massachusetts General Hospital. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Mass General Brigham IRB reviewed and determined this study was minimal risk and given expedited exempt review June 2020. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes deidentified data is available for review upon request