Low literacy is associated with uncontrolled blood pressure in primary care patients with hypertension and heart disease

Abstract

Objectives: To evaluate the association between low literacy and uncontrolled blood pressure (BP) and their associations with medication adherence.

Methods: Cross-sectional study of 423 urban, primary care patients with hypertension and coronary disease. The relationship between low literacy (Rapid Estimate of Adult Literacy in Medicine ≤ 44) and uncontrolled BP (≥140/90 mmHg, ≥130/80 mmHg for patients with diabetes) was evaluated by crude and adjusted logistic regression. Relationships with self-reported adherence and refill adherence were explored using adjusted linear and logistic regression.

Results: Overall, 192 (45%) subjects had low literacy and 227 (52.9%) had uncontrolled BP. Adjusting for age, gender, race, employment, education, mental status, and self-reported adherence, low literacy was associated with uncontrolled BP (OR 1.75, 95% CI 1.06-2.87). Lower self-reported adherence was associated with uncontrolled BP; the relationship between refill adherence and uncontrolled BP was not statistically significant.

Conclusion: Low literacy is independently associated with uncontrolled BP.

Practice implications: Awareness of the relationships among patient literacy, BP control, and medication adherence may guide healthcare providers as they communicate with patients.

Keywords: Blood pressure control; Hypertension control; Literacy; Medication adherence.