The 2002 Official Patients Sourcebook on High Blood Pressure
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Use the link below to share a full-text version of this article with your friends and colleagues. Learn more. The purposes of this study were to determine whether there is a significant correlation between the perceived and actual stroke risk among hypertensive patients and to identify patient characteristics associated with inaccurate estimation of stroke risk. Patients who underestimated their stroke risk were significantly less likely to be worried about their blood pressure than patients with accurate risk perception The lack of correlation between hypertensive patients' perceived stroke risk and FSR supports the need for better patient education on the risks associated with hypertension.
Stroke is the third most common cause of death and the most common cause of disability in the United States. One concept that may be important in better understanding adherence in hypertensive patients is perceived risk of adverse outcomes such as stroke. Although behavioral theories incorporate perceived risk as an important component, they do not account for the accuracy of patient risk perceptions. Thus, the current study adds to the existing literature by examining the relationship between hypertensive patients' perceived personal risk for stroke and their actual stroke risk estimated by the Framingham stroke risk FSR profile.
The aims of the current study were to assess the correlation between perceived and actual stroke risk in patients with hypertension and to identify variables related to inaccurate stroke risk perceptions. Of the initial pool of potential veteran participants, the research assistants approached patients. Because recruitment occurred at patients' primary care visits, these patients were selected from the available pool based on the schedule of primary care appointments.
Patients were recruited consecutively until the target sample size for the primary study hypothesis was achieved.
The Official Patient's Sourcebook on High Blood Pressure by - purlatuterti.ml
Of the approached, refused and 38 were excluded; a total of patients were enrolled between March and April Race was dichotomized as white or nonwhite. Financial situation was assessed by asking patients to report whether they had enough money after paying bills for special things; enough to pay bills but not to purchase extra things; enough money to pay bills by cutting back on things; or difficulty paying bills no matter what was done.
Hypertension knowledge was measured by 10 questions that assessed patients' knowledge about hypertension facts eg, high BP can cause kidney problems: true or false. A total score was calculated by summing all 10 of the responses. Patients with a score of 9 or 10 were categorized as having high hypertension knowledge. The first 2 responses were categorized as believing that hypertension is serious. Patients with scores of 6 through 10 were categorized as being more worried about hypertension. Framingham Stroke Risk. Stroke risk was assessed for each participant based on the adjusted FSR according to D'Agostino and colleagues.
The FSR was used to represent the patient's actual risk of stroke. Perceived Risk. The item was similar to one used in other studies. We compared the characteristics of the patients included in the current analysis with those of the remaining patients enrolled in the trial but excluded from this analysis. We then categorized patients' perceived risk and FSR as low or high.
The median perceived stroke risk score was 5; therefore, low perceived risk was categorized as a score of 1 to 5 and high perceived risk as a score of 6 to Based on the definitions of high and low perceived risk and actual risk FSR , we further categorized patients according to their accuracy of risk perceptions. Patients with low FSR were categorized as accurate estimators if they perceived their risk as low or risk overestimators if they perceived their risk as high.
We compared the characteristics of patients with accurate vs inaccurate ie, overestimators in the low FSR group and underestimators in the high FSR group risk perceptions in analyses stratified by high vs low FSR. No adjusted analyses were performed due to the small numbers of patients in each cell. All statistical analyses were performed using SAS software, version 9.
The remaining patients were excluded for the following reasons: patients were missing recent ECG results; 35 patients had a prior history of stroke; 33 patients were missing the perceived risk variable; 23 patients were missing either baseline systolic BP or diabetic status; and 10 female patients were excluded because we believed that the group of participants in our sample was insufficient to make meaningful inferences about stroke risk perceptions in women. Patients included in this study were more likely to report inadequate income odds ratio [OR], 1.
Patients with a low FSR were significantly more likely than those at high risk to have high hypertension knowledge We plotted patients' perceived stroke risk against the FSR in the Figure. Patients' stroke risk perceptions were defined as accurate, underestimation high Framingham risk, low perceived risk , or underestimation low Framingham risk, high perceived risk.
There was no significant difference in the modifiable health behaviors of exercise, medication adherence, or smoking. Among patients with high FSR, In this sample of hypertensive men, no significant correlation was found between patients' perceived and actual stroke risk estimated with the FSR score. Compared with patients with lower FSR, patients with the highest calculated FSR were less knowledgeable about hypertension and more likely to inaccurately estimate their stroke risk.
The accuracy of patients' stroke risk perception was significantly associated with their level of worry about hypertension. In spite of extensive effort to increase public awareness of stroke risk, this study suggests that patients with hypertension may not adequately translate their personal vascular risk factors into an accurate estimation of stroke risk.
The patient variable most strongly associated with inaccurate risk perception was patient worry about hypertension. Patients who were more worried about their BP had higher perceived risk of stroke. Because of the limitations of the sample size and number of other variables considered, we were not able to determine whether this association persisted after adjusting for other potential confounders.
It is potentially interesting, however, because worry and higher perceived vulnerability for a disease are associated with an increase in preventive health behavior such as changes in diet and exercise. There are a number of potential limitations to consider when interpreting the results of our study. First, it was conducted only in male veterans with hypertension. It is possible that these findings do not generalize to women or nonveteran populations.
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