Study: Better Primary Health Care Access Leads to Improved Control of High Blood Pressure

A new study has found that having easier access to primary care physicians may increase high blood pressure awareness and control regardless of where a person lives, according to the authors of a study published in Circulation: Cardiovascular Quality and Outcomes.

In the study, the authors noted that health care professionals at community clinics and primary care practices specifically can help expand awareness and detection of high blood pressure by providing affordable treatment and management.

“Access to primary care is the key to hypertension management, however, many Americans have limited access to primary care where they live. This is especially true of people in economically disadvantaged neighborhoods or people from diverse racial and ethnic groups, particularly among African American individuals,” said senior study author Brisa Aschebrook-Kilfoy, PhD, an associate professor of public health sciences at the University of Chicago in Illinois, in a press release.

The study analyzed neighborhood socioeconomic status using the Area Deprivation Index (ADI) created by the Health Resources & Services Administration over 3 decades ago. This system allows for rankings of neighborhoods by socioeconomic status in a region and can be valuable to inform health care delivery and policy, especially for populations living in the most disadvantaged neighborhoods.

“Some argue that minority health disparities are solely the product of socioeconomic factors, or that increasing the number of primary care professionals in diverse racial and ethnic neighborhoods would not reduce health disparities and improve public health. To our knowledge, there is little research to support or rebut this argument,” first study author Jiajun Luo, PhD, a post-doctoral fellow at the University of Chicago’s Institute for Population and Precision Health, said in a press release. “We conducted this study to examine whether accessibility of primary care is associated with better hypertension control and awareness across various socioeconomic and neighborhood factors.”

The study focused on Chicago, which saw a 30-year gap in life expectancy that was observed between people who live in southern neighborhoods in Chicago versus northern neighborhoods, the latter of which is more affluent compared to the former. The researchers looked specifically to assess whether the socioeconomic differences impacted the higher rates of high blood pressure, heart disease, and stroke in the southern neighborhoods of the city.

Health data was analyzed for more than 5000 predominantly African American adults who participated in the Chicago Multiethnic Prevention and Surveillance Study (COMPASS) between 2013 to 2019, which is an initiative that explores the health of Chicagoans, primarily who are in communities in the south of the city. When the researchers did their analysis, they considered annual income, BMI, ADI, the effect of distance to primary care, and spatial accessibility during their investigation.

The study data showed:

• Approximately 80% of the COMPASS participants had previously experienced hypertension, using the standard American Heart Association guideline-based blood pressure criteria of measures ≥130 mm Hg systolic (top number) or ≥80 mm Hg diastolic (bottom number).
• Approximately 38% of those with hypertension did not have their blood pressure under control, whereas 41% were not aware they had high blood pressure.
• Spatial accessibility scores ranged from 16.4 (lower access to primary care) to 86.6 (higher access) per 100,000 residents.
• Adults living in areas with the fewest primary health care professionals had 37% increased odds of having hypertension in comparison to the adults living in neighborhoods with the most primary care physicians.
• The listed associations existed in both poor and wealthy neighborhoods, which the researchers suggest that residents in all neighborhoods may benefit from increasing the number of primary care professionals.
• When clarified by neighborhood type (advantaged or disadvantaged), accessibility to primary care was not associated with use of anti-hypertension medications among those who reported they had hypertension prior to enrolling in the study.

“Based on these findings, we need to encourage primary care physicians to expand access to people who live in underserved communities with the fewest primary care professionals,” Aschebrook-Kilfoy said in the press release. “Mobile health units may be one approach to increase primary care service in underserved areas by eliminating the challenge of getting transportation to and from an office visit. The use of anti-hypertension medications also needs to be studied and addressed, especially as it was not linked to primary care accessibility in this study.”

REFERENCE

High blood pressure awareness, control improved with better access to primary health care. American Heart Association. September 6, 2022. Accessed September 9, 2022. https://newsroom.heart.org/news/high-blood-pressure-awareness-control-improved-with-better-access-to-primary-health-care