Rates and predictors of uncontrolled hypertension among hypertensive adults using New York City shelter-based clinics

Hypertension is one the most common conditions among millions of homeless Americans. We determined the rates, predictors, and barriers to blood pressure (BP) control among homeless and domicile hypertensive patients from 10 New York City shelter-based clinics. BP measurements, sociodemographics, and factors associated with homelessness and hypertension were extracted from medical records of a random sample of hypertensive patients (n=210) in 2014. The majority of patients were African American or Hispanic; 24.8% were female and 84.3 % homeless (mean|=|3.07 years; SD|=|5.04 years). Compared to domicile patients, homeless were younger, less insured, and more likely a current smoker and alcohol abuser. Homeless and domicile patients had 40.1% and 33.3% uncontrolled BP, respectively (P|=|.29); stage II BP was 15% and 9%, respectively (P|=|.27). Homeless hypertensive patients with diabetes or multiple chronic diseases had better BP control (P|<|.01). In logistic regression, age, race or ethnicity, substance or alcohol abuse were not associated with inadequate BP control but mental health and lack of insurance were (P|<|.05). We propose comprehensive approaches to address psychosocial issues and lack of insurance that complicate BP control. Improving adherence, health education, and life style modifications using mHealth strategies in this mobile population may be considered.