The association of health literacy and blood pressure reduction in a cohort of patients with hypertension: The heart healthy lenoir trial.
Jacqueline R Halladay, Katrina E Donahue, Crystal W Cené and 10 others
PMID 27776790WHAT IT FOUND
The multi-level hypertension programme did not reduce blood pressure more in patients with low versus higher health literacy.
Mean systolic blood pressure fell in both groups, but there was no control group, so the programme may not have caused the fall.
Key findings
01Mean systolic blood pressure fell by 5.6 mm Hg at 12 months and 5.5 mm Hg at 24 months in the overall sample.
02Low and higher health literacy groups both had significant 12-month reductions, 6.6 mm Hg and 5.3 mm Hg, but the 1.3 mm Hg between-group difference was not significant.
03At 24 months, low literacy reduced 8.1 mm Hg and higher literacy 4.6 mm Hg, but the 3.5 mm Hg between-group difference was not significant.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
There was no control group, so changes could be due to time, other care or trends unrelated to the programme. The intervention included many components at once, so any single element cannot be credited. Participants were volunteers and had lower baseline blood pressure than expected, leaving little room for further reduction. Only 74% attended the 12-month visit and 71% attended the 24-month visit; attendees were older, more African American and more often low literacy. Low literacy was only 23% of the analysed sample, so the groups were unequal and it was hard to detect a small difference between literacy groups. The sample size was based on comparing African American and White patients, not the literacy comparison reported here. Some practices declined participation, and no data were available for people invited but not responding.
The easy way to misread this
Do not read the 8.1 mm Hg reduction in the low literacy group as proof that the programme works or that it reduced literacy disparities. There was no control group, the between-group difference at 24 months was not significant, and many intervention components were delivered together.