Barriers to hypertension care and control in young urban black men

Barriers to high blood pressure (HBP) care and control have been reported i n the literature, for > 30 years. Few reports on barriers, however, have fo cused on the young black man with HBP, the age/sex/race group with the high est rates of early severe and complicated HBP and the lowest rates of aware ness, treatment, and control. In a randomized clinical trial of comprehensi ve care for hypertensive young urban black men, factors potentially associa ted with care and control were assessed at baseline for the 309 enrolled me n. A majority of the men encountered a variety of barriers including econom ic, social, and lifestyle obstacles to adequate BP care and control, includ ing no current HBP care (49%), risk of alcoholism (62%), use of illicit dru gs (45%), social isolation (47%), unemployment (40%), and lack of health in surance (51%). Having health insurance (odds ratio = 7.20, P = .00) and a n egative urine drug screen (odds ratio = .56, P = .04) were significant pred ictors of being in HBP care. Low alcoholism risk and employment were identi fied as significant predictors of compliance with HBP medication-taking beh avior. Men currently using illicit drugs were 2.64 times less likely to hav e controlled BP compared with their counterparts who did not use illicit dr ugs, and men currently taking HBP medication were 63 times more likely have controlled BP compared with men not taking HBP medication. Comprehensive i nterventions are needed to address socioeconomic and lifestyle issues as we ll as other barriers to care and treatment, if HBP care is to be salient an d effective in this high risk group. (C) 1999 American Journal of Hypertens ion, Ltd.