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Research ArticleOriginal Research

Rates and Predictors of Uncontrolled Hypertension Among Hypertensive Homeless Adults Using New York City Shelter-Based Clinics

Ramin Asgary, Blanca Sckell, Analena Alcabes, Ramesh Naderi, Antoinette Schoenthaler and Gbenga Ogedegbe
The Annals of Family Medicine January 2016, 14 (1) 41-46; DOI: https://doi.org/10.1370/afm.1882
Ramin Asgary
1Departments of Population Health and Medicine, New York University School of Medicine, New York, New York
2Community Medicine Program, NYU Lutheran, New York, New York
MD, MPH
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  • For correspondence: ramin.asgary@caa.columbia.edu
Blanca Sckell
2Community Medicine Program, NYU Lutheran, New York, New York
MD, MPH
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Analena Alcabes
2Community Medicine Program, NYU Lutheran, New York, New York
BS
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Ramesh Naderi
1Departments of Population Health and Medicine, New York University School of Medicine, New York, New York
MD
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Antoinette Schoenthaler
1Departments of Population Health and Medicine, New York University School of Medicine, New York, New York
EdD, MA
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Gbenga Ogedegbe
1Departments of Population Health and Medicine, New York University School of Medicine, New York, New York
MD, MPH
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    Table 1

    Study Variables Among Homeless and Nonhomeless Hypertensive Patients, New York City, 2014

    VariableTotal Patients N = 210Homeless (n = 177)Nonhomeless (n = 33)
    Sociodemographic characteristic
    Age, mean (SD) [range], ya55.74 (10.99) [28–92]55.10 (11.07)59.15 (10.01)
    Systolic blood pressure, mean (SD) [range], mm Hg131.04 (19.47) [86–210]131.76 (20.05)127.18 (15.70)
    Diastolic blood pressure, mean (SD) [range], mm Hg79.76 (12.34) [30–111]80.06 (12.91)78.18 (8.71)
    Blood pressure level (n = 210)
     Normal (<135/85 mm Hg), No. (%)46 (21.9)38 (21.4)8 (24.2)
     At risk (≥135/85 to <140/90 mm Hg), No. (%)c82 (39)68 (38.4)14 (42.4)
     Stage 1, uncontrolled (≥140/90 to <160/100 mm Hg), No. (%)53 (25.2)43 (24.2)10 (30.3)
     Stage 2, very uncontrolled (≥160/100), No. (%)29 (13.8)28 (15.8) 1 (0.03)
    Hypertension, uncontrolled (n = 210), No. (%)82 (39)7111
    Sex (n = 210), male, No. (%)158 (75.2)13622
    Race (n = 206)
     White, No. (%)32 (15.5)266
     African American, No. (%)114 (55.3)10113
     Hispanic, No. (%)40 (19.4)319
     Asian, Native American, others, No. (%)20 (9.7)173
    Health insurance (n = 209), No. (%)b180 (86.1)14733
    Insurance type (n = 176)
     Medicaid, No. (%)118 (67)10018
     Medicare, No. (%)56 (31.8)4115
     Other, No. (%)2 (1.1)20
    Clinical indicator
    Diabetes (n = 204), No. (%)75 (36.8)6015
    Coronary artery diseases (n = 204), No. (%)a41 (20.1)3011
    Kidney disease (n = 204), No. (%)8 (3.9)53
    Hypercholesterolemia (n = 204), No. (%)b63 (30.9)4419
    Number of chronic diseases (n = 176), mean (SD) [range]b1.91 (0.97) [0–5 ]1.82 (0.93)2.39 (1.02)
    Mental illness (n = 201), No. (%)127 (63.2)10423
    Number of mental illness (n = 100), mean (SD) [range]1.18 (0.44) [0–3]1.16 (0.44)1.26 (0.45)
    Body mass index (n = 205), mean (SD) [range]30.55 (6.97) [18.36–51.24]30.36 (6.42)31.58 (9.36)
    Obesity (n = 176), No. (%)95 (46.6)7916
    Substance abuse (n = 160), No. (%)30 (18.8)255
    Alcohol abuse (n = 164), No. (%)a25 (15.2)241
    Smoking cigarettes (n = 181), No. (%)a89 (49.2)809
    Number of current daily cigarettes (n = 84), mean (SD) [range]9.08 (5.71) [2–31]8.98 (5.47)9.89 (7.84)
    • ↵a P <.05.

    • ↵b P <.01.

    • ↵c Participants with blood pressure readings of ≥135/85 mm Hg to <140/90 mm Hg are at higher risk of developing hypertension compared with the general population.

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    Table 2

    Bivariate Analysis of Hypertension Among Homeless Hypertensive Patients, New York City, 2014

    VariableTotal Patients n = 177Controlled Hypertension n = 106 (59.9%)Uncontrolled Hypertension n = 71 (40.1%)
    Age (n = 177), mean (SD) [range], y55.10 (11.07) [28–92]55.27 (10.65)54.85 (11.76)
    Duration of homelessness (n = 39), mean (SD) [range], y3. 07 (5.04) [0.03–23]3.08 (4.24)3.07 (5.97)
    Systolic blood pressure (n = 177), mean (SD) [range]b131.76 (20.05) [86–210]118.85 (10.99)151.03 (14.17)
    Diastolic blood pressure (n = 177), mean (SD) [range]b80.06 (12.91) [30–111]73.71 (8.73)89.54 (12.34)
    Blood pressure level (n = 177)
     Normal (<135/85 mm Hg), No. (%)38 (21.5)……
     At risk (≥135/85 to <140/90 mm Hg)68 (38.4)……
     Stage 1, uncontrolled (≥140/0 to <160/100 mm Hg)43 (24.3)……
     Stage 2, very uncontrolled (≥160/100 mm Hg)28 (15.8)……
    Sex, male (n = 177)136 (76.8)7957
    Race (n = 175)
     White, No. (%)26 (14.9)1511
     African American, No. (%)101 (57.7)5843
     Hispanic, No. (%)31 (17.7)1912
     Asian, Native American, others, No. (%)17 (9.7)134
    Health insurance (n = 176), No. (%)a147 (83.5)9354
    Insurance type (n = 143)
     Medicaid, No. (%)100 (69.9)6238
     Medicare, No. (%)41 (28.7)2912
     Other, No. (%)2 (1.4)02
    Diabetes (n = 171), No. (%)b60 (35.1)4515
    Coronary artery disease (n = 171), No. (%)30 (17.5)1911
    Kidney disease (n = 171), No. (%)5 (2.9)32
    Hypercholesterolemia (n = 171), No. (%)44 (25.7)3113
    Mental illness (n = 168), No. (%)a104 (61.9)7034
    Number of mental illness (n = 100), mean (SD) [range]1.16 (0.44) [0–3]1.17 (0.45)1.15 (0.43)
    Body mass index (n = 172), mean (SD) [range]30.36 (6.42) [18–49]30.68 (6.07)29.87 (6.93)
    Obesity (n = 171), No. (%)79 (46.2)5128
    Substance abuse (n = 131), No. (%)25 (19.1)1510
    Alcohol abuse (n = 133), No. (%)24 (18)1212
    Smoking cigarettes (n = 150), No. (%)80 (53.3)5030
    Number of current daily cigarettes (n = 76), mean (SD) [range]8.98 (5.47) [2–31]8.99 (5.92)8.96 (4.67)
    • ↵a P <.05.

    • ↵b P <.01.

    • View popup
    Table 3

    Logistic Regression Analysis of Independent Variables on Uncontrolled Hypertension Among Homeless Adults, New York City, 2014

    VariableUncontrolled Hypertension
    Unadjusted OR95% CIAdjusted ORa95% CI
    Age……1.0070.97–1.03
    Health insuranceb0.410.18–0.920.390.16–0.97
    Diabetes0.350.17–0.700.380.18–0.81
    Hypercholesterolemiab0.530.25–1.110.520.23–1.19
    Mental illnessb0.450.24–0.860.420.21–0.84
    • OR = odds ratio.

    • ↵a Adjusted for age, health insurance, mental health, diabetes, high cholesterol, alcohol abuse, and obesity.

    • ↵b P <.05.

Additional Files

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  • The Article in Brief

    Rates and Predictors of Uncontrolled Hypertension Among Hypertensive Homeless Adults Using New York City Shelter-Based Clinics

    Ramin Asgary , and colleagues

    Background As the homeless population ages, they are at higher risk of developing hypertension (high blood pressure). This study assesses the rates and predictors of uncontrolled blood pressure among hypertensive homeless and non-homeless adults using New York City's shelter-based clinics.

    What This Study Found There is an alarmingly high rate of uncontrolled hypertension among homeless adults. In this study, forty percent of homeless patients have uncontrolled blood pressure. In comparison, the rates of uncontrolled blood pressure among hypertensive adults who are under treatment are 20 percent (for those aged 40 to 59 years) and 25 percent (for those 60 to 79 years). Lack of health insurance is a strong predictor of uncontrolled blood pressure among homeless and non-homeless hypertensive adults using shelter-based clinics.

    Implications

    • Hypertension is less controlled among the homeless, who often lack social support and resources to cope with its complications.
    • The authors call for comprehensive approaches to provide targeted social services, address psychosocial issues, and improve health insurance for the homeless, as well as strategies to prevent and address homelessness.
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The Annals of Family Medicine: 14 (1)
The Annals of Family Medicine: 14 (1)
Vol. 14, Issue 1
January/February 2016
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Rates and Predictors of Uncontrolled Hypertension Among Hypertensive Homeless Adults Using New York City Shelter-Based Clinics
Ramin Asgary, Blanca Sckell, Analena Alcabes, Ramesh Naderi, Antoinette Schoenthaler, Gbenga Ogedegbe
The Annals of Family Medicine Jan 2016, 14 (1) 41-46; DOI: 10.1370/afm.1882

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Rates and Predictors of Uncontrolled Hypertension Among Hypertensive Homeless Adults Using New York City Shelter-Based Clinics
Ramin Asgary, Blanca Sckell, Analena Alcabes, Ramesh Naderi, Antoinette Schoenthaler, Gbenga Ogedegbe
The Annals of Family Medicine Jan 2016, 14 (1) 41-46; DOI: 10.1370/afm.1882
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