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Abstract

  1. Top of page
  2. Abstract
  3. METHODS
  4. RESULTS
  5. DISCUSSION
  6. CONCLUSIONS
  7. Disclosure:
  8. References

Lifestyle modifications (LSMs) are important in hypertension management. Using data from a population-based sample of hypertensive adults (N=28,457), the authors examined variations in reports of receipt of LSM advice by patient characteristics. Most adults (90.3%) with known hypertension reported receiving some type of advice. Exercise advice was reported most frequently (74.6%), followed by advice to reduce salt intake (69.3%), change eating habits (61.9%), and reduce alcohol intake (43.5%). Compared with adults aged 60 years or older, persons aged 18 to 39 years were more likely to report receipt of advice (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.11–1.81). Overweight persons (OR, 1.64; 95% CI, 1.40–1.93) and obese persons (OR, 2.75; 95% CI, 2.28–3.31) were more likely to report receipt of advice. Persons receiving antihypertensive medication were also more likely to report receiving advice (OR, 2.35; 95% CI, 1.98–2.81). This study demonstrates that older persons, persons not taking antihypertensive medication, and individuals who are not overweight or obese are less likely to report receiving LSM advice.

Approximately 65 million adults in the United States have hypertension, a major risk factor for coronary heart disease, stroke, congestive heart failure, peripheral vascular disease, and end-stage renal disease.1,2 Many lifestyle factors—obesity, physical inactivity, insufficient fruit and vegetable intake with large amounts of saturated fat and salt in the diet, and excessive alcohol intake—may contribute to high blood pressure (BP) levels. Modifying these lifestyle factors has proven effective in lowering BP levels.3–10

National guidelines recommend that all patients with hypertension adopt lifestyle modifications (LSMs) as an “indispensable part” of their management.10 For most patients with stage 1 hypertension and no evidence of target organ damage, a trial of LSM is warranted before initiating antihypertensive medication therapy.11,12 Health care professionals usually have the first opportunity to discuss these nonpharmacologic strategies with individuals who have newly diagnosed hypertension. Yet the time constraints of outpatient care and questions about effectiveness may limit the clinician's efforts to engage patients in this necessary discussion.

To date, there have been few studies quantifying the extent of LSM advice given by health professionals in the routine care of hypertensive patients. It is also not clear whether provision of LSM advice for management of high BP varies by patient characteristics, such as sex and race/ethnicity. In this study, we used data from a sample of the US population to examine the prevalence of LSM advice received by US adults with known high BP levels. We also examined variations in the reporting of receipt of such advice within categories of patient characteristics.

METHODS

  1. Top of page
  2. Abstract
  3. METHODS
  4. RESULTS
  5. DISCUSSION
  6. CONCLUSIONS
  7. Disclosure:
  8. References

Design

We used data from the 2005 Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is a random-digit dial landline telephone survey of the noninstitutionalized US population aged 18 years and older. It is an ongoing survey administered by the US Centers for Disease Control and Prevention. The core survey used a stratified, multistage probability sampling design and was administered to a nationally representative sample of US adults from all 50 states as well as the District of Columbia, Puerto Rico, and the US Virgin Islands. The median annual response rate based on persons estimated to be eligible to participate was 51.1%.13 The core survey includes the question, “Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?” In 2005, 16 states included a module containing items pertaining to receipt of LSM advice to lower or control BP (Table I). This module was included only for the 28,457 participants who answered in the core survey that they had been told by a health professional that they had high BP (excluding those who only had hypertension related to pregnancy). We selected all the participants who completed this module.

Table I.  Lifestyle Modification Advice Questions
Has a doctor or other health care professional ever advised you to do any of the following to help lower or control your high blood pressure?
• Change your eating habits
• Cut down on salt
• Reduce alcohol use
• Exercise

Variables

Our outcomes comprised reported receipt of each of the 4 separate types of LSM advice shown in Table I. We also created an “any advice” variable defined as affirmative report of receipt of any 1 or more of the 4 types of advice. We included several independent variables either shown to be associated with receipt of health advice—either generally or specifically for high BP14–17—or that we hypothesized to be associated with receipt of LSM advice to lower or control high BP. Participants were divided into 3 age groups, 4 race/ethnicity groups, and 4 education level groups. Body mass index (BMI) was calculated based on reported weight and height, and patients were divided into 3 BMI categories. The core survey included the question, “Do you have one person you think of as your personal doctor or health care provider?” If a respondent answered “no,” he or she was asked, “Is there more than one, or is there no person who you think of as your personal doctor or health care provider?” We considered a respondent to have a personal health care provider if he or she had one person or more than one person considered to serve in that role. Other independent variables included reported health status (5 categories), routine health examination in the past 2 years (yes/no), diabetes excluding gestational (yes/no), and whether antihypertensive medication is currently being taken (yes/no).

We created 2 subgroups of patients for whom certain types of advice would be warranted. First, we created a subgroup of respondents for whom alcohol reduction advice would be warranted: men who indicated in the core survey that they drank an average of >2 drinks per day and women who indicated that they drank an average of >1 drink per day in the last 30 days (on the days that they drank). We also created a subgroup of respondents for whom exercise advice would be appropriate: those who indicated that they either engaged in moderate or vigorous physical activity <4 days per week or who did so an adequate number of days per week but for an insufficient amount of time (<30 minutes).

Analyses

After incorporating appropriate population weights, primary sampling units, and strata adjustments to account for the complex survey design, we first determined the weighted percentage of respondents who had been told they had hypertension. Of those participants, we then determined weighted percentages of persons within categories of selected independent variables. Within each category, we determined weighted percentages of those reporting receipt of each of the advice outcomes, including receipt of any advice. For alcohol and exercise advice, analyses were restricted to the subgroups specified above. Differences within each category were tested for significance using Pearson chi-squared test. Last, we performed multivariable analyses to determine the independent associations of each of the selected characteristics with receipt of each kind of advice. We report these associations as odds ratios. Missing values were handled by exclusion, as were refusals and responses of “don't know/not sure.” All analyses were performed using Stata 8.1 statistical software (StataCorp, College Station, TX).

Study Approval

A report of our plan to conduct this secondary analysis using publicly available data was submitted to and exempted from human subjects review by the Office of Human Research Ethics of the University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.

RESULTS

  1. Top of page
  2. Abstract
  3. METHODS
  4. RESULTS
  5. DISCUSSION
  6. CONCLUSIONS
  7. Disclosure:
  8. References

In 2005, over one-fourth (26.4%) of US adults from the 16 sample states reported that they had been told by a health professional they had high BP. The majority (86.5%) were aged 40 years or older, were overweight/obese (76.4%), had a personal health care provider or providers (89.9%), and had a routine health examination within the past 2 years (Table II). Slightly more than 80% were taking antihypertensive medication. Approximately 20% also reported being told they had diabetes.

Table II.  Characteristics of a Sample of US Adults Reporting Hypertension, 2005 (unweighted N=27,163–28,625)
CharacteristicWeighted Percentage95% Confidence Interval
Age group, y
 18–3913.512.7–14.3
 40–5938.537.5–39.4
 Older than 6048.047.1–49.0
Sex
 Male48.047.1–49.0
 Female52.051.0–53.0
Race/ethnicity
 White70.769.7–71.6
 Black16.115.4–16.8
 Hispanic8.67.9–9.3
 Other4.74.2–5.2
Education level
 No high school diploma15.414.7–16.1
 High school diploma34.133.2–35.0
 Some college24.423.6–25.2
 College graduate26.125.3–26.9
Reported health status
 Excellent8.07.5–8.6
 Very good23.823.0–24.6
 Good35.334.4–36.2
 Fair21.620.9–22.4
 Poor11.310.7–11.9
Personal health care provider(s)89.989.2–90.5
Routine health examination in past 2 years90.489.8–90.9
Body mass index (BMI)
 Underweight or healthy-weight (BMI <25.0 kg/m2)23.622.8–24.4
 Overweight (BMI 25.0–29.9 kg/m2)39.138.1–40.1
 Obese (BMI ≥30 kg/m2)37.336.4–38.3
Diabetes19.819.0–20.6
Currently taking antihypertensive medication80.479.5–81.2

Any Advice

Nine of 10 known hypertensive adults reported receiving at least 1 of the 4 types of lifestyle advice examined in this study (Table III). Certain groups were more likely to report receipt of advice. As self-reported health status worsened, more persons reported receiving advice, as expected: 93.2% of those reporting poor health got some (any) advice compared with 83.9% of those in excellent health. Overweight and obese individuals were more likely to report receiving at least 1 type of advice. Almost 95% of obese hypertensive patients reported receiving any advice compared with 84% of underweight/healthy-weight hypertensive patients. Similarly, 97% of diabetic hypertensive persons reported receiving any advice compared with 89% of nondiabetic persons. Other groups of hypertensive persons more likely to report receipt of any advice included those who had a personal health care provider (91.0% vs 83.8%), those who had a routine health examination within the past 2 years (91.0% vs 83.8%), and those taking antihypertensive medication (92.2% vs 82.3%). Differences in receipt of any advice were statistically significant by race/ethnicity and by age group but were small in magnitude. Reports of receipt of any advice did not differ by education level or sex.

Table III.  Weighted Percentages of Known Hypertensive US Adults Reporting Receipt of Lifestyle Advice to Lower or Control Blood Pressure
 Any AdviceP ValueChange Eating HabitsP ValueReduce Salt IntakeP ValueExerciseP ValueReduce Alcohol IntakeP Value
All ages90.3 61.9 69.3 78.0 43.5 
Age group, y
 18–3987.1<.00164.9<.00168.2.0167.0<.00143.3<.001
 40–5991.8 71.2 71.2 84.3 48.9 
 Older than 6090.0 53.7 67.9 75.4 35.1 
Sex
 Male90.0.3064.6<.00169.9.1978.2.8352.8<.001
 Female90.6 59.4 68.7 77.6 32.3 
Race/ethnicity
 White89.3<.00159.3<.00165.9<.00177.9.4639.9.008
 Black93.4 71.0 79.7 81.8 55.2 
 Hispanic92.1 68.0 77.2 75.3 49.0 
 Other92.3 61.6 71.6 68.2 52.2 
Education level
 No high school diploma90.8.1462.2.6573.8<.00176.9.8253.0<.001
 High school diploma91.1 62.6 71.6 76.5 49.7 
 Some college89.7 61.0 67.3 78.0 39.0 
 College graduate89.7 61.9 65.8 80.0 37.4 
Health status
 Excellent83.9<.00156.0<.00161.3<.00167.4.0741.2.12
 Very good88.5 58.9 64.8 77.9 39.6 
 Good91.0 62.2 69.3 80.1 42.6 
 Fair92.2 64.4 73.8 81.0 48.9 
 Poor93.267.575.980.257.2
Personal health care provider(s)
 Yes91.0<.00162.6<.00170.0<.00180.4<.00142.6.16
 No83.8 56.2 62.9 59.9 48.9 
Routine health examination in past 2 years
 Yes91.0<.00162.9<.00170.2<.00179.4.0144.0.39
 No83.8 52.4 60.1 67.0 40.3 
BMI
 Underweight or healthy-weight (BMI <25.0 kg/m2)83.8<.00145.5<.00161.9<.00161.9<.00135.5.006
 Overweight (BMI 25.0–29.9 kg/m2)90.0 59.5 68.9 77.1 46.3 
 Obese (BMI ≥30 kg/m2)94.7 75.0 74.5 88.1 46.1 
Diabetes
 Yes96.7<.00173.6<.00178.7<.00188.6.00153.0.06
 No88.7 59.0 66.9 76.5 42.2 
Currently taking antihypertensive medication
 Yes92.2<.00163.2<.00172.0<.00182.6<.00144.0.62
No82.3 56.9 58.1 65.9 42.4 
For alcohol reduction advice, unweighted N varied from 15,526 to 16,192. For exercise advice, unweighted N varied from 11,575 to 12,007. For other categories, unweighted N varied from 24,190 to 26,909. Abbreviations: BMI, body mass index; BP, blood pressure.

Eating Habit Advice

Fewer than two-thirds (61.9%) of hypertensive patients reported receiving advice to change their eating habits. The differences within categories of characteristics of interest were largely similar to the differences noted with report of receipt of any advice; however, there was a larger difference in percentages of participants who reported receiving advice within categories of BMI. While 75.0%of obese hypertensive patients reported receiving diet advice, only 45.5% of healthy-weight or underweight hypertensives reported receiving such advice. There was also a greater difference noted among categories of race/ethnicity: 71.0%of black and 68.0% of Hispanic hypertensive persons reported receiving diet advice, compared with 59.3% of white and 61.6% of hypertensive persons of other races. Men were also more likely than women to report receiving such advice (64.6% vs 59.4%). Older hypertensive patients were less likely to report receiving advice about eating habits (53.7% of those aged 60 years or older vs 71.2% of those aged 40–59 years).

Salt Reduction Advice

Among all hypertensive participants, 69.3%reported receiving advice to reduce salt intake. This percentage did not vary by sex and only varied slightly by age group. Black (79.7%) and Hispanic (77.2%) persons were more likely to report receiving this advice than white persons (65.9%) and patients of other races (71.6%). Hypertensive persons who reported poorer health, those with a personal health care provider, those who had had a health examination within the past 2 years, persons currently taking antihypertensive medication, and individuals with concomitant diabetes or overweight/obesity were also more likely to report receipt of advice to lower salt intake.

Exercise Advice

Exercise advice was the most commonly reported: 78% of hypertensive adults not engaging in sufficient physical activity reported receiving advice to exercise. Among those aged 40 to 59 years, approximately 84% reported receiving advice to exercise while among persons aged 18 to 39 years, 67% did, and among individuals aged 60 years or older, 75% reported receiving such advice. Reports of receipt of advice to exercise were more frequent among overweight (77.1%) and obese (88.1%) persons than those who were not overweight or who were underweight (61.9%).

Similar to the patterns noted with receipt of the other types of advice, persons with a personal health care provider, who had a health examination within the past 2 years, who had diabetes, or who were currently taking antihypertensive medication were more likely to report receipt of exercise advice.

Alcohol Advice

Of the individual components of advice we examined in this study, advice to reduce alcohol intake was the least commonly reported: among individuals whose responses indicated that they drank alcohol in greater than acceptable amounts, 43.5%of hypertensive adults reported receiving advice to reduce their intake. Men were more likely than women to report receiving such advice (52.8% vs 32.3%). Younger or middle-aged individuals, nonwhites, persons with lower levels of education and, persons who were overweight or obese were also more likely to report receiving advice to reduce their alcohol intake.

Independent Associations

The effects of adjustment for all the characteristics we included are shown in Table IV. The factors most strongly associated with receipt of any advice were obesity (odds ratio [OR], 2.75; 95% confidence interval [CI], 2.23–3.31), diabetes (OR, 2.57; 95% CI, 2.03–3.26), and taking antihypertensive medication (OR, 2.35; 95% CI, 1.98–2.81). Obesity remained strongly associated with reported receipt of advice to change eating habits (OR, 2.80; 95% CI, 2.50–3.13). Younger age was also associated with receipt of such advice. Compared with those aged 60 years or older, hypertensive persons aged 18 to 39 years were more likely to report receipt of advice to change eating habits (OR, 2.14; 95% CI, 1.79–2.54). The characteristics most strongly associated with reported receipt of advice to reduce salt intake were black race (OR, 1.83; 95% CI, 1.58–2.12), Hispanic race (OR, 1.80; 95% CI, 1.43–2.26), and receiving antihypertensive medication (OR, 1.96; 95% CI, 1.72–2.23).

Table IV.  Independent Associations With Report of Receipt of Lifestyle Modification Advice to Lower or Control Blood Pressurea
 Adjusted Odds Ratiob
Any Advice95% CIChange Eating Habits95% CIReduce Salt Intake95% CIExercise95% CIReduce Alcoho Intake95% CI
Age group, y
 18–391.421.11–1.812.141.79–2.541.541.29–1.831.030.58–1.841.390.94–2.05
 40–591.451.23–1.692.101.90–2.301.241.12–1.371.921.27–2.881.771.36–2.30
 Older than 60Referent
Sex
 Male0.990.86–1.151.221.12–1.331.141.04–1.241.140.79–1.642.181.74–2.73
 FemaleReferent
Race/ethnicity
 WhiteReferent
 Black1.431.13–1.811.371.18–1.581.831.58–2.121.200.70–2.051.721.19–2.48
 Hispanic1.671.16–2.411.471.19–1.811.801.43–2.261.100.51–2.381.060.68–1.74
 Other1.460.97–2.180.950.74–1.221.240.94–1.640.560.23–1.361.250.62–2.51
Education level
 No high school diplomaReferent
 High school diploma1.210.96–1.531.050.92–1.201.030.89–1.191.070.56–2.060.940.61–1.46
 Some college1.040.82–1.320.940.81–1.080.850.73–0.991.190.62–2.290.700.45–1.07
 College graduate1.120.88–1.431.050.90–1.210.840.72–0.981.290.67–2.450.660.42–1.02
Health status
 ExcellentReferent
 Very good1.351.06–1.731.060.89–1.251.110.94–1.321.610.93–2.800.910.60–1.37
 Good1.571.24–2.001.140.97–1.341.261.07–1.491.771.01–3.110.940.62–1.41
 Fair1.681.28–2.201.231.04–1.471.431.19–1.711.900.96–3.781.070.69–1.67
 Poor1.681.22–2.301.311.07–1.601.481.20–1.832.100.75–5.901.250.53–2.94
Personal health care provider(s)1.421.10–1.831.291.08–1.541.281.07–1.521.951.12–3.420.800.54–1.19
Routine health examination in past 2 years1.311.04–1.641.531.31–1.191.271.09–1.491.090.63–1.891.320.88–1.98
BMI
 Underweight or healthy-weight (BMI <25.0 kg/m2)Referent
 Overweight (BMI 25.0–29.9 kg/m2)1.641.40–1.931.591.43–1.771.281.15–1.431.821.18–2.821.190.88–1.60
 Obese (BMI ≥30 kg/m2)2.752.28–3.312.802.50–3.131.491.32–1.673.642.29–5.771.220.90–1.65
Diabetes2.572.03–3.261.571.39–1.771.421.25–1.611.991.10–3.591.150.74–1.79
Currently taking antihypertensive medication2.351.98–2.811.491.31–1.701.961.72–2.231.831.18–2.831.441.04–2.00
aFor alcohol reduction advice, unweighted N=15,174; for exercise advice, unweighted N=11,348. For other categories, unweighted N varied from 23,735 to 25,134. bAdjusted for all other characteristics in the Table. Abbreviations: BMI, body mass index; B P, blood pressure; CI, confidence interval.

Other than having a personal health care provider, factors strongly associated with reported advice to exercise were age of 40 to 59 years (OR, 1.92; 95% CI, 1.27–2.88), obesity (OR, 3.64; 95% CI, 2.29–5.77), diabetes (OR, 1.99; 95% CI, 1.10–3.59), and receiving antihypertensive medication (OR, 1.83; 95% CI, 1.18–2.83). Finally, the factors most strongly associated with reported receipt of advice to reduce alcohol intake (among those who drank an amount considered excessive) were age of 40 to 59 years (OR, 1.77; 95% CI, 1.36–2.30), black race (OR, 1.72; 95% CI, 1.19–2.48), and receiving antihypertensive medication (OR, 1.44; 95% CI, 1.04–2.00).

DISCUSSION

  1. Top of page
  2. Abstract
  3. METHODS
  4. RESULTS
  5. DISCUSSION
  6. CONCLUSIONS
  7. Disclosure:
  8. References

In this analysis using data from a large sample of the US population, we found that most adults with known hypertension receive some form of LSM advice to lower or control high BP. Overall, reports of receipt of advice to exercise were most frequent and reports of receipt of advice to reduce alcohol intake were least frequent. While advice to lose weight for overweight/obese persons was not specifically evaluated, some component of this advice is likely reflected in the reports of advice to change eating habits and exercise. These results are consistent with findings from a recent national Harris survey for the Hypertension Education Foundation.18 In that survey, 62% of respondents reported following a “healthy” diet and limiting salt intake, but only 32% reported limiting alcohol intake. Forty-two percent of the overall population reported exercising regularly; this percentage was highest (54%) in black respondents. Obviously, advice was being given, but a large number of participants believed that they did not have to change lifestyles if they took medication. In the Hypertension Education Foundation survey of hypertensive patients, 91% were receiving medication.18 In the present survey, >80% were on medication. These percentages are higher than previously reported.

We found that advice to change eating habits was much more likely to be reported by persons who were overweight/obese. It is plausible that much of this advice was given as caloric restriction advice as part of counseling to lose weight. While weight loss for persons who are overweight/obese is certainly one of the recommended LSMs to lower BP, it must be remembered that persons with hypertension who are not overweight or obese can also benefit from changing the composition of their diet. The finding that blacks were more likely to receive advice to reduce salt intake may partly reflect clinicians' perception, based on good data, that hypertension in black patients tends to be more salt-sensitive, and the advice is being given to those who may have the most benefit. Obese individuals were more likely to report receiving advice to exercise. Again, this could have been given in the context of weight loss counseling.

Exercise advice, while commonly given, may not be very effective. One randomized trial evaluating the effectiveness of a physician's advice to increase physical activity among hypertensive patients in a primary care setting found that it made no difference.19 While certain complex interventions and dietary counseling may be effective in helping patients change their diets for a short time, it is unclear whether brief office advice for hypertensive patients is effective in getting them to change their eating habits.20 On the other hand, there are data showing that giving advice to reduce alcohol consumption can be effective.21,22 Unfortunately, alcohol reduction advice was the least frequently reported form of advice received. Although we took steps to try to exclude those who drank amounts considered acceptable, it is still possible that some individuals who were classified as such were actually queried by clinicians and alcohol reduction advice was deemed not warranted. Considering that respondents to the survey may actually have underreported the amount of alcohol they drank, however, the estimates we obtained were probably reasonable.

If some forms of advice are effective in getting patients to make LSMs as part of their hypertension management, the importance of these data and those from other surveys rests not in who is getting advice but in who is less likely to be getting it. Three such groups worth noting are older persons, individuals not receiving antihypertensive medications, and those who are not overweight/obese. It is possible that health care providers may put aside or even abandon the notion of giving LSM advice to older patients, perhaps feeling that their hypertension mandates the use of medication. Even for individuals on medication, however, LSM should remain an important part of hypertension management; it can help reduce the need for higher doses of medication or multiple antihypertensive agents. In some hypertensive persons, LSM may even allow step-down therapy or cessation of medication use.11,23 This may be especially true in the elderly.24

As for hypertensive patients not yet receiving medication, LSM advice would be expected as their treatment strategy. LSMs may delay or prevent the need for antihypertensive medication use in some individuals. Thus, the expectation would be for more patients than we found in this study who reported high BP levels and who are not taking medications to have received LSM advice.

Finally, the recommendations to change eating habits and to exercise do not only pertain to hypertensive persons who are overweight/obese. Persons with high BP levels who are at normal weight or underweight can still benefit from adopting the Dietary Approaches to Stop Hypertension (DASH) eating plan (fruits, vegetables, low-fat dairy products) and therefore should be given the advice. Similarly, exercise can benefit all hypertensive persons, including those whose weight is not excessive.

Limitations

One potential limitation of our study is recall bias. Respondents may not accurately remember whether they were given specific advice by a health care professional; however, it is unlikely that recall was different between or among most categories of the characteristics we studied. For example, as long as there was no substantial difference in the rates of recall of advice between men and women, the percentages might be lower, but the bivariate association would not be biased. Older respondents likely have had hypertension for a longer period of time and could have received advice from a health care professional but not recall receiving it at the same rate as younger respondents who may have been diagnosed with hypertension more recently. In that case, our results of the association of younger age with receipt of LSM advice would be biased away from the null.

Giving of advice can take on many forms, from simple statements (eg, “You should cut down on your salt intake”) to more elaborate educational or counseling sessions. We are unable to say anything more specific about any of the advice given. For example, we do not know whether receipt of advice to change eating habits means that respondents were given information about the DASH diet, attended a nutrition class, or were simply told to “eat healthier.”

For assessments of alcohol advice, we were able to exclude persons for whom advice to reduce alcohol would not necessarily be warranted. For exercise advice, we excluded those who reported sufficient physical activity. We could not similarly exclude persons who might be eating an appropriate diet or consuming low enough quantities of sodium.

CONCLUSIONS

  1. Top of page
  2. Abstract
  3. METHODS
  4. RESULTS
  5. DISCUSSION
  6. CONCLUSIONS
  7. Disclosure:
  8. References

Most adults who are aware that they have hypertension report getting at least some form of LSM advice, but older persons, those not already receiving antihypertensive medication, and those who are not overweight/obese are less likely to get such recommendations. LSM should certainly not be abandoned in older hypertensive patients; they are a way to manage hypertension in persons not taking medication, and they are beneficial in hypertensive persons even when their weight is considered healthy.

The differences in receipt of advice by certain other groups are, for the most part, understandable. Persons with other health problems (eg, diabetes) may get more advice because the advice is part of the management of those conditions as well as hypertension. Persons who have a personal health care provider and who get regular physical examinations have more opportunities to be given advice. In this survey, >80% of hypertensive patients were receiving some medication.

Disclosure:

  1. Top of page
  2. Abstract
  3. METHODS
  4. RESULTS
  5. DISCUSSION
  6. CONCLUSIONS
  7. Disclosure:
  8. References

Dr Viera's time to conduct the analyses and develop this manuscript was funded by the Department of Family Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC.

References

  1. Top of page
  2. Abstract
  3. METHODS
  4. RESULTS
  5. DISCUSSION
  6. CONCLUSIONS
  7. Disclosure:
  8. References
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