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THE PUBLIC
AND

HIGH BLOOD'PRESSURE:

A SURVEY

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Study No. 2313

THE PUBLIC AND HIGH BLOOD PRESSURE

A Survey Conducted for

THE NATIONAL HEART AND LUNG INSTITUTE

June 1973

by
LOUIS HARRIS AND ASSOCIATES, INC.

DHEW Publication No. (NIH) 74—356

Rgegg
H2 Légl
M73
PUBLIC,
HEALTH

CD ~7/7e» iM

The research and study forming the basis for this report was
conducted pursuant to a contract with the National Heart and Lung Insti-
tute. The statements and conclusions contained herein are those of the

contractor and do not neceSsarily reflect the views of NHLI.

AUG 6 1975‘

 

   

TABLE OF CONTENTS

Page
INTRODUCTIONOQQCQIOIOOO.U...U.IOI.IUOCU..II...OOOOCGOIOOOQIOOIQOQO. 1

Purpose of the survey 0 U C C I U U U C O I U C .U U U U U U U C U Q I I C O O O O U Q C U U U 1
How the Survey Was Conducted.....................L....... 3
Analytic Dimensions ...................................... 8

SECTION I: GENERAL ATTITUDES TOWARD HEALTH -- HEALTH
INFORMATION SOURCES.I.IO.UU.UCOUOUUUUUCUUUIUQUIIUOOIUUU 13

General Attitudes Toward Health.......................... 15
Information Sources About Health......................... 23

SECTION II: KNOWLEDGE OF HYPERTENSION AND RELATED DISEASES........ 37

Seriousness of Diseases.................................. 39
What Is High Blood Pressure.............................. 42
Causes of High Blood Pressure............................ 51
Other Illnesses and Symptoms Caused by High Blood Pressure 57
The Treatment of High Blood Pressure..................... 68

SECTION III: THE HYPERTENSIW...’0'.Ito...OCOOOOOOIIOOIIODOOIIIOOO 77.

Demographic Profile of the Hypertensive.................. 79
Experience with Hypertension............................. 86
The Treatment of Hypertension............................ 89
Medication............................................... 92
The Use of Salt in the Diet.............................. 102
Weight Control........................................... 105
Cigarette Smoking........................................ 108
How Has High Blood Pressure Affected the Lives

of Hypertensives...................................... 113
Awareness of Hypertension................................ 128

APPENDIXOOO.U...U.0.0...OI.9..I.I0.0.0.0...OOIOOOOOODOODCOOOIIIOOOO 13]-

 

INTRODUCTION

Purpose of the Survey

 

High blood pressure is a chronic, lifelong, usually incurable
condition which can nearly always be controlled with appropriate contin-
uing treatment. Few if any symptoms are present until the blood pressure
has been elevated for a long period of time, often many years, and some
damage has occurred to major organs of the body such as the heart,
kidneys or brain. The chronic aspect, the long asymptomatic period
characteristic of the condition and the need for continuing treatment
are the major factors which give rise to the present public health
problems related to high blood pressure.

The public is attuned to responding to diseases producing
episodes of pain or discomfort. Silent diseases requiring preventive
action based upon intellectual awareness rather than physical awareness
attract minimal attention. And yet, if those with high blood pressure
can be reached with information on its consequences and convinced that
it can and should be controlled, then there can be a significant reduc-
tion in the number and severity of premature heart attacks, strokes and
kidney disease.

Not surprisingly, many physicians find the excitement and
rewards of successful response to acute, curable illness more to their
liking than involvement in this plodding, long—term challenge of managing
chronic, usually incurable conditions with the remote goal that of pre-
venting or postponing severe organ damage or catastrophic events such

as strokes.

The net result of all these factors is that too many people
consider high blood pressure of only moderate importance and are reluc—
tant to accept or.are unaware of its consequences. It is a disease that,
because of its quiet insidious character, is easy to ignore.

The National Heart and Lung Institute (NHLI) has been charged
with the responsibility for coordinating a national program of informa-
tion and education which will make hypertension difficult to ignore.

To help in designing that program, NHLI contracted with Louis Harris
and Associates to conduct a survey of current public awareness and

experience of high blood pressure and related issues.

More specifically, this survey was intended to develop data in the
following areas:

-— What sources are used and relied upon by the public for
obtaining information about health problems?

-- How much does the public know about the likely causes and
treatment for heart disease, stroke and kidney disease?

-- How much does the public know about the likely causes,
consequences and treatment of hypertension?

-- Where does the public rank hypertension among the major
diseases in terms of seriousness?

-- How often are physical examinations obtained and how
often has an individual had his blood pressure checked?

-- Among hypertensives, what kinds of treatments have been
presented and followed (with a special emphasis on medication)
and to what extent do hypertensives watch their salt intake,
weight and smoking habits?

-- Among hypertensives, what effect, if any, has high blood
pressure had on their job situations and on their health?

The responses to questions in these general areas are presented

in this report.

How the Survey Was Conducted

1. Sample Design: Because a major focus of the survey was on
the attitudes and experience of people aware they had high blood pressure
--<a group that was expected to be only a relatively small proportion of
the population —— it was necessary both to use a large cross-section
sample and a number of oversamples to insure that sufficient numbers of
hypertensives would be interviewed.

The basic sample was a cross-section of 3,181 individuals 17 years
of age or older drawn from 200 locations throughout the United States (exclud—

ing Alaska and Hawaii). This Sample is representative of the civilian non-

institutional population of the country 17 years of age or older.

In addition, three oversamples were developed:

(1) Blacks: It was considered necessary to have a large enough
sample of blacks to be able to discuss black hypertensives as a separate
group. Since the cross-section was unlikely to produce more than 250-300
blacks in total, a separate cross-section of 686 blacks was interviewed
in 100 locations drawn proportional to the distribution of blacks in the
country. Combined with the 209 blacks from the basic cross—section, this
produced a total of 895 black;.

(ii) Low Income: It was also considered necessary to be able
to look at the lowest 20% of the income spectrum in some detail. However,

since a relatively large proportion of blacks fall into this category and

blacks were already being oversampled, it was decided to limit the low
income oversample to whites. This low income oversample was obtained
by increasing the interview quota in 30 sampled areas of the cross—
section which were thought to have higher proportions of low income
white families than the other 170 clusters. (The number of interviews
obtained in this oversample is included in the 3,181 interviews of the
cross-section.)

In the data presented in the report, both the black oversample
and low income oversample have been combined with the cross—section,
using statistical weights so that they represent their true proportion
in the population.

The first step in the weighting procedure was to weight down
the "low-income" clusters so that they actually comprise only 15% of
the weighted total interviews in the cross-section.

After this preliminary weighting, the interviews were split
into black and non-black (combining the cross—section and black over-
sample). The sample distributions of these two groups by region of
the country (four regions) and by size of place of residence (central
city, suburb, town, and rural) were compared with the true distributions
(derived from the 1970 census tabulations). The weights were determined
for each of the 32 cells (two races x four regions x four size-of—place
categories) by dividing the true percentage value by the sample percen—
tage value. The effect of this weighting is to guarantee that the
weighted totals correctly reflect the known race, regional, and size-

of—place distributions of the United States.

(iii) Hypertensives: In order to increase even further the base
of hypertensives, each respondent in the cross-section and the two over-
samples described above was asked if there was any other family member 17
years of age or older who lived in the household who had high blood pressure.
If there was, an attempt was made to interview that individual (or one of
these individuals if there were more than one) in addition to the initial
respondent in the household. Two hundred and eleven interviews were completed,
and this Oversample of hypertensives was combined in the analysis with hyper-
tensives found in the cross—section and in the black and low income oversamples.
2. Questionnaire Development: The actual questionnaire to be
used was developed in close consultation with NHLI staff members. Before
it was considered ready for use, a pretest of 40 interviews (10 interviews with
known hypertensives and 30 distributed across the country) was completed.
The pretest was designed not to develop preliminary substantive
data but rather to insure that the questions were clearly worded and would
be easily understood by the spectrum of possible respondents, that the
flow of the questionnaire made sense and that the questionnaire was not
overlong.
3. Interviewing: All interviewers were personally briefed by
Harris field supervisors or home office personnel (most in person, some
by telephone).
Each interviewer was given a quotaxxfdwellingunits(households)and a
map of the area in which to interview, the map generally containing a marked starting
point and detailed path of movement to follow in setting up the initial

contacts.

Interviewers were required to attempt contacts*at all normally
occupied dwelling units (beginning with the map starting point and moving
in the prescribed direction) until their quota of dwelling units was reached.

Within this number of dwelling units they were to make up to
three callbacks at each, in addition to the initial contact, to complete an
interview with a designated respondent in the household who was determined
by a randomized selection pattern.

If, after three callbacks at each of ‘these dwelling unitS, a num-
mum quota of completed interviews had not been obtained, the interviewer

was required to make as many callbacks as necessary at the dwelling units

at which there had not been a completed interview or a flat refusal,
until the minimum quota of interviews was filled.

The above procedure applied to the cross-section and the black
and low income oversamples. For the oversample of hypertensives -- always
a second interview in the household -- only one callback was made to attempt
the interview if it could not be completed at the time the first interview
was done.

All interviews were conducted in person in the home. Interviews
averaged 53 minutes in length (52 minutes for non-hypertensives and, because
of additional questions addressed to flzln, 59 minutes for hypertensives).

As the work progressed,'it was closely monitored to assure the
schedules and quotas were being met and that all results conformed to the
specified sampling design. Returns were sent back to the New York office

as they were completed, and checked again for quality and completeness.

In addition, approximately 20% of each interviewer's respondents
were recontacted by an independent validating service to guarantee that the
interviews were actually conducted and were completed according to all speci-
fied procedures. The actual validation process works as follows:

*A contact includes any attempt to complete an interview, including approaching
a household where no one is at home.

Interviewers send the name, address and telephone number (if available)
of respondents directly to the validation service from the field. In New York,
Louis Harris and Associates makes up a list of five questions from the study
which are given to the validation service. Approximately 20% of each inter-
viewer's respondents, randomly chosen, are contacted by the validation ser-
vice (generally by telephone but by mail if necessary) and asked the questions.
If there is any doubt about the authenticity of the interviewer's work, all of
his or her interviews are carefully checked.

The data in this report is based upon the responses of the
individuals interviewed and has not been cross-checked with other types of
data (e.g., hospital records, blood pressure tests, etc.). This is mentioned,
not to raise questions about the truthfulness of respondents, but so the reader
will recognize that inevitable recall and knowledge difficulties may, to some
extent, influence the findings.

The accuracy of survey results is also, in part, based upon the
level of response rate (proportion of households contacted which resulted
in completed interviews) and the consistency of response rate across different
demographic groupings. As the following two tables indicate the response
rate was 70% for the cross-section and 69% for the black oversample. While
there are some variations by subgroups, they are all within tolerable limits

and are unlikely to have significantly affected the survey results:

8

PROPORTION OF HOUSEHOLDS CONTACTED WHICH RESULTED IN COMPLETED INTERVIEWS

 

Igga] East Midwest South West
Z Z Z Z Z
Total Cross-Section 19 92 gg 1; 1;
Cities 66 63 65 72 ‘ 66
Suburbs 69 68 65 76 72
Towns 67 75 63 65 72
Rural 76 77 80 73 75
Total South Non-South
Total Black oversample 62 16 ,2:
Central cities 65 66 65
Other 74 V82 64

 

4. Data Processing: Once validation had been completed and editing
checks made, open—ended (unstructured) questions were coded to permit compu—
ter processing. The full questionnaire was then key punched, key verified
and put on magnetic tape. Then, using our own computer and software program,

fully annotated tables were prepared.

Analytic Dimensions

Throughout the report, the data are analyzed both in total and by a
number of key sub-groups. The following two tables define these sub-groups
and show the number of individuals in each subgroup and the weighted proportion

of the total sample it represents.

The first table is for the combined cross-section and black and

low income oversamples*:

. . the
* All results derived from a sample are subject to sampliggt::::r;hic: ;ou1d
difference between the results obtained irzz the iffigiiriztion and tab1es of
a on.

btained by surveying the entire popu
tingling error are included in an appendix to the report.

Number Unweighted Weighted

In Sample*’ Percentage Percentage
% 2

Total 3867 190 190
Race 1. White 2829 73 86
2. Black 895 23 10
3. Other 132 3 4
Education 1. Not high school graduate,
completed 0-11 years of
schooling 1646 42 37
2., High school graduate, completed
high school (12 years) and up
to 3 years of college 1736 46 49
3. College graduate and over,
completed 4 or more years of
college 466 12 14
Income 1. Under $5,000, total household
income for 1972 before taxes 1030 28 23
2. $5,000-$9,999, total household
income for 1972 before taxes 1161 32 30
3. $10,000-$14,999, total house-
hold income for 1972 before
taxes 794 21 24
4. $15,000 and over, total house-
hold income for 1972 before
taxes. ' 713 19 23
Age** 1. Under 35, ages 17 thru 34 1348 36 36
2. 35-49 961 25 25
3. 50-64 819 21 21
4. 65 on Older 690 13 18
Sex 1. Male 1823 47 47
2. Female 2044 53 53
Size of
Place 1. Cities: central cities in
urbanized areas (generally
50,000 or more) 1312 35 32
2. Suburbs: urbanized areas out-
side central cities 865 22 27
3. Towns: other urban places of
2,500 or more 552 14 15
4. Rural: anything not included ‘
above 1138 29 26
Region**? 1. East 999 26 28
2. Midwest 1011 26 28
3. South 1249 32 27
4. West 608 16 17

ALL FOOTNOTES ON FOLLOWING PAGE:

10
* Subgroup totals do not always add to 3867 because of some non—response.

** Overall, the age and sex distribution of the sample corresponds closely to
census figures, but as the next table indicates the sample has somewhat too many
males 65 and over (9% in the sample vs. 6% in the census) and too few males under
50 (28% in the sample vs. 31% in the census). The age distribution of females in
the sample closely corresponds to the census figures:

AGE AND SEX DISTRIBUTION'

u Census Sample

2 Z

Ma—le 4_7 4.7.
17 — 34 l9 17

35 — 49 12 11

50 - 64 10 10
65+ 6. 9
Female 2; 2;
17 - 34 20 19

35 - 49 13 14

50 - 64 12 12
65+ 8 8

The variations from the true proportions are actually quite small and unlikely
to affect the survey results to any significant extent.

***East includes the following states: Connecticut, Delaware, District of Columbia,
Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania,
» Rhode Island, Vermont, West Virginia

Midwest includes the following states: Illinois, Indiana, Iowa, Kansas, Michigan,
Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, Wisconsin

South includes the following states: Alabama, Arkansas, Florida, Georgia, Kentucky,
Louisiana, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas,
Virginia »

West includes the following states: Arizona, California, Colorado, Idaho, Montana,
Nevada, New Mexico, Oregon, Utah, Washington, Wyoming

11

The next table is for the sample of hypertensives drawn from the
cross-section, the black and low income oversamples and the hypertensive over-

sample:

 

Number Unweighted Weighted
In Sample Percentage Percentage
% % %
High Blood Pressure
*Ever been told - respondents who indicated they had
ever been told they had high blood pressure, whether
or not they still felt they had it ' 1204 100 100
*1. Have now - respondents who said their blood
pressure was still high 310 26 25
*+2. Total current - respondents who said their blood
pressure was still high 95 who had been told on
more than one occasion that their blood pressure-
was high (and were not pregnant on at least one
of those occasions) gr who were now taking
medication for high blood pressure 878 73 71 100
a. Total current race - White 551 46 57 80
Black 299 25 11 15
b. Total current age - Under 35 130 11 10 14
35-49 178 15 13 18
50-64 279 23 23 32
65 and over 283 24 25 36
c. Total current sex - Male 332 28 28 39
Female 546 45 43 61
d. Total current education - Not high school
graduate 524 43 38 53
High school grad-
uate 287 24 27 38
College graduate
and over 64 6 6 9

* Each of the asterisked groupings is an attempt to define a group which one might want to
call hypertensivet The first grouping ("ever been told") is the loosest definition and each
of the others is a subgroup of this first one. The "have now" group is the smallest and pre-
sumably the most rigorous definition of the hypertensive group. The ”total current” group is

a more moderate definition. For purposes of this analysis the "total current" group is asSumed
to be the most reasonable definition of hypertensive and it is for this group that demographic
subgroups have been defined.

+ Subgroup totals do not always add to 878 because of some non-response or because some groups
(i.e., "other" racial) are too small to be shown separately.

 

SECTION I:

GENERAL ATTITUDES TOWARD HEALTH --

HEALTH INFORMATION SOURCES

 

15

General Attitudes Toward Health

The survey begins with a brief discussion of the public's general

view of their own health.

Each individual was first asked:

"Compared to your parentS' generation,do you feel that moat people
today are healthier than your parents'. generation, not as healthy as your
parentS' generation or is their health not much different?"

Only 42%‘of the public feel that today's generation is healthier

than their parents while a smaller but still significant 27% feel people today

Wtually less healthy than their parents:

Q.1a _
HEALTH OF PEOPLE TODAY COMPARED WITH PARENTS' GENERATION

(Base: Total)

 

 

Healthier Not as Not Much Not
Today Healthy Difference Sure

7., 7. 79 7°

Total Q .21 2—8 2
Cities 42 30 24 4
Suburbs 51 22 25 2
Towns 44 23 31 2
Rural 34 31 32 3
White 45 24 29 2
Black 23 52 18 7
other 42 31 25 2
Not high School graduate 29 39 28 4
High schoql graduate 48 '23 28 1
College graduate and over 59 12 26 3
Under 35 45 24 29 2
35 to 49 44 29 24 3
50 to 64 42 28 28 2
65 and over 36 31 28 '5

High Blood Pressure

Ever been told 37 33 27 3
Have now 34 40 23 3

Total current 36 35 26 '3

16

Inevitably, in responding to a question such as this, people will
be thinking in terms of their own health and it'is interesting that attitu-
dinal differences among different racial and education groups are striking.
Among blacks, for instance, a majority (52%) said their generation was less

healthy compared to less than one in four (23%) who feel their generation

is healthier (for whites the proportions are 45% healthier, 24% not as
healthy). Similarly a plurality of the least well educated (39%) feel
there has been a decline in their health relative to their parents,com-
pared to only 12% of college graduates -- among whom 59% feel today's
generation is healthier.

Two additional aspects of the above table are interesting.
First, by age, it is only among those 65 and older, that the "healthier-
not as healthy" gap is closed. Second, hypertensives, particularly those
who said their blood pressure is now high, are significantly less likely
than the general public to feel theirs is a healthier generation.

Asked why they felt people were healthier or not as healthy
today, the positive responses stressed more medical knowledge, better
facilities, better drugs and more nutritious foods. Those who feel there
has been a decline in health emphasized diet problems and an increaseuin

tension and stress:

Q,1b

 

.WHYCARE PEOPLE HEALTHIEB/NOT AS HEALTHY TODAY
(Base: Feel public today healthier or not as
healthy)
High
Blood
Pressure
Total
Total Current
Z Z
Heathier
More medical knowledge 20 14
More,better facilities 19 17
More,better drugs 17 16
More nutritious food 12 10
People take better care
of selves 11
People live longer 9
Better disease prevention,
immunization 7 4
People have morecheck-ups 5
Other 10 10
Not as Healthz
Diet used to be better 12 17
More tension, worry, stress . 9 11
More sickness 7 9
Less hard work 6 6
Drugs, smoking, drinking 5 6
Pollution 4 5
People don't take care of selves 4 5
Other 12 16

17

‘18

Next, each individual was asked to describe his or her own health.
Overall, only one in three (34%) indicated their health was "excellent",
although an additional 46% said it was "pretty good" for a total positive

health rating of 80%:

Q.2a

HOW DESCRIBE OWN HEALTH
(Base: Total)

 

Pretty Only ‘ Total
Excellent Good Fair Poor Positive
Z Z Z Z Z
T_ota1 3_4 g E 2 .82
White 36 45 14 5 81
Black 22 44 23 ll 66
Other 29 45 21 5 74
Not high school grad 21 47 23 9 68
High school grad 39 47 11 3 86
College grad and over 54 38 7 l 92
Under 35 45 44 9 2 89
35 to 49 37 47 13 3 84
50 to 64 25 47 19 9 72
65 and over 20 43 26 11 63
Male 36 44 15 5 80
Female 33 46 16 5 79
High Blood Pressure

Ever been told 18 45 26 11 63
Have now 9 40 33 18 49
Total Current 13 £2 22 lg 28
White 12 49 27 12 61
Black 9 34 36 21 43
Under 35 26 48 20 6 74
35 to 49 9 57 27 7 66
50 to 64 8 45 29 18 53
65 and over 12 38 34 16 50
Male 14 46 25 15 60
Female 11 46 31 12 57
Not high school grad 8 39 34 19 47
High school grad 13 56 24 7 69
College grad and over 30 47 18 5 77

 

Note: "Total Positive" = "excellent" + "pretty good"

20

Again, looking at the cross—section, more whites report good health
than do blacks; as a group the better educated are more positive than those

with less education, and the young more positive than the old.

Hypertensives -- by whatever definition -— are significantly less
likely than the total public to see th~ir own health in positive terms. In
part, this may be a reflection of the fact that hypertensives tend to be
somewhat older than the general adult public; but this is not the full explana-
tion by any means,for within each age group hypertensives are less positive
about their health than the general population.. In fact, hypertensives under
35 are only as positive (74%) as the total population group age 50-64 (72%).

When asked how their own health compared with that of "most people

their age", the patterns were similar:

Q.2b

OWN HEALTH COMPARED TO OTHERS 0F SAME AGE
(Base: Total)

Just as Not as Not
Healthier Healthy Healthy Sure

 

Z 1 A Z
Total 21 62 2 3
White 28 62 9 1
Black 21 62 14 3
Other 22 64 9 5
Not high school grad 24 59 15 2
High school grad 27 65 7 1
College grad and over 36 59 4 1
Under 35 21 72 6 l
35 to 49 25 65 8 2
50 to 64 29 54 15 2
65 and over 39 47 ll 3
High Blood Pressure
Ever been told 21 57 19 3
Have now 15 55 28 2
Total Current 12 26 33 3
White 19 58 20 3
Black 19 48 30 3
Under 35 22 63 14 1
35 to 49 10 65 23 2
50 to 64 16 52 29 3
65 and over 24 53 18 5
Not high school grad 14 57 26 3
High school grad 24 55 18 3
College grad and over 27 55 16 2

22

A majority among the total public and among hypertensives see
their health as average compared with others their age, but hypertensives
are nevertheless more inclined to say they are not as healthy (9% for the
total public vs. 22% for the total current hypertensive group).

By race and education, the pattern of a more positive view of
one's own health among whites compared with blacks and among'the better
educated compared with those with less education is found for both the
total population and for hypertensives.

Age, however, presents a somewhat different and fascinating
picture. Among the total population the proportion that feels they are
healthier than others increases with age (from 21% among those under 35 to
39% among those 65 and over), but among hypertensives those under 35 and
those 65 and over view their own health in relatively more positive terms

than do hypertensives between the ages of 35 and 64.

Observation

For the total public, it appears, not unreasonably,
that the longer one survives, the more likely one is
to feel that he is healthier than his peers. Among
hypertensives, it w0uld seem that the disability of
high b100deressure is recognized most sharply in the
middle years.

At the same time, of course, this conclusion must be
tempered by the recognition that,in all age groups,
hypertensives feel relatively less healthy than their
peers in the general p0pulation.

The data presented so far suggest that the public is
not ultimately satisfied with the state of their health
or that of others. Less than half (42%) feel their
generation's health is better than their parents'and
only a third (34%) see their own health as excellent.

23

While ultimate health satisfaction can probably
never be achieved this side of paradise, the level
of discontent in the population (particular1y among
certain groups) is Sufficiently high that a well
designed campaign to convince the public of the
dangers of high blood pressure may well succeed.

In any case such a campaign will not be shouting
into a wind of contentment.

Information Sources About Health

To succeed, a health information campaign must employ communication
media which are not only used by the public but are also trusted by the
public. A series of questions on this critical area were included in the
survey.

First, each individual was asked:

"Do you feel the way the health system in this country is set up
that people such as yourself are able to learn what they need to know about
health care, or are there important areas of health care they don't find out

about?"

Just under six in ten (58%) said they were able to find out what

they need to know, four in ten (42%) are either unable or unsure how to find

health information they may need:

Q.5a

WAY HEALTH SYSTEM IN COUNTRY SET UP --
ABLE TO FIND OUT WHAT NEED TO KNOW ABOUT HEALTH CARE

(Base:

Total

White
Black
Other

Not high school grad
High school grad
College grad and over

Under $5,000
$5,000-$9,999
$10,000-$14,999
$15,000 and over

Under 35
35-49

50-64

65 and over

High Blood Pressure

Ever been told
Have now

Current Total

 

Total)
Areas Don't
Able to Find Out

Learn About
% %
2 2e
58 34
55 34
53 38
54 34
5° 34
58 36
53 36
56 34
57 35
63 32
53 41
60 33
6O 31
57 28
59 33
59 31
59 32

Not
Sure

Z

Im

24

25

Observation

There is a uniformity of response across different
groups that is slightly disturbing. Considering the
rather haphazard health information delivery system
in this country, one would assume that the better
educated, for example, might have greater access to
health information than those with less education.

If one accepts this assumption, the data suggest that
those with less education may be unaware of how much
they really do not know.

In any case, the four in ten not able or unsure how

to get health information represent a significant
proportion of the American public.

-The following table shows the proportion of the public which
indicated they received either "a great deal" or "some" information from
each of 17 possible sources (the other choices presented in the question

were "only a little" or "no information at all"):

26

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27

For each of five sources a majority of the public feel it provides
a great deal or some information about health and medical care, with doctors
or clinics in first place followed by public service messages on TV, health
articles in magazines, medical columns in newspapers and medical news stories
on television.

For four of these five sources (with the exception of "doctors and

clinics") and indeed, for most of the other sources, as well, women more
than men, and the young more than the old,say they get a great deal or
some information from them.

For most sources, those with more education tend to get more
‘information from the source than do those with less education. However,
the usage pattern is flat for doctors, friends or relatives, nurses, pharmacists
or druggists -- all personal sources. Also, those who did not complete college
indicate they obtain more information from TV advertising than do college

graduates.

Observation

Union and employer sources rank lowest on the list and
government publications do not do particularly well,
although this latter source provides a great deal or
some information to almost half (46%) of the college
graduates. Nevertheless NHLI must certainly broaden
its use of media beyond normal government publications
if it is to reach a large proportion of the public.

At first glance public service messages on TV would
appear to be a valuable medium, but as will be seen in

a moment, there is some question as to how much they
are trusted.

The whole question of how to put a message across is obviously very

complicated. The public will generally deny that they are unduly influenced

28

by advertising and yet the most oblique, manipulative forms of advertising
often sell products better than straightforward informative advertising.
Accepting this one might say that one should not judge the persuasiveness

of communications directed at the public by the public's own view of the
reliability and truthfulness of the communications. In part, this is true --
but only in part -- for the pUblic, alerted by consumerist pressures and
governmental revelations,is more suspicious of what it is being told. Also
the public's willingness to accept information about a subject from different
sources is likely to be influenced by the seriousness of the subject. Some-
one may not resent seeing a cigarette presented as a spring day in the country,
but the same technique used to convince the public of the seriousness of
hypertension might well be rejected.

In short, the reliability of the medium is likely to be an important
determinant of how successfully it can communicate about a subject like hyper-
tension. To test this question of reliability all respondents were asked Which
dithe 17 sources on the list he felt would be very reliable. These proportions
are shown in the first column of the table. The second column is a measure
of reliability relative to use -- the proportion who received a great deal

or some information from the source who consider the Source very reliable:

29

 

 

 

Q.6c
WHICH ARE VERY RELIABLE SOURCES OF INFORMATION _
(Basef' Total)
”Reliability Proportion"
("Very Reliable" Among
Those Who Use Source A
To;al Great Degl or Somewhat)
Own doctor or clinic where get medical care 79 78
Public service messages on TV 33 40
Health articles in magazines 30 38
Medical columns in newspapers 24 34
Medical news stories on TV 18 24
Publications from organizations like Heart
Association, Blue Cross 24 18
Public service messages on radio 14 21
Friends or relatives 11 12
Nurses 19 34
TV advertising by drug companies, food
companies, etc. 11 23
Government publications on health 25 38
Health courses taken in school 16 34
Pharmacist or druggist used 19 36
Medical news stories on radio 8 15
Radio advertising by drug companies, food
companies, etc. 4 9
Your union (Base: Union member) 2 31
’Your employer (Base; Working) 3 26
None 1 x
Not sure 2 X

Note: The table is ranked by the great deal or some information preportions
as in the previous table.

30.

Doctors or clinics are not only the source felt to provide the
most information but also the most reliable information (with a reliability
factor of 78). Second on the reliability factor (40) is public service messages
on TV,followed closely by health articles in magazines and government publications

on health (both with reliability factors of 38).

Observation

It is significant that, aside from the doctor or clinic, all of

the sources have reliability factors below 50. While these sources,
particularly the second through fifth, from which at least half of
the public obtains a great deal or some information, should certainly
not be ignored —- for they reach many people -- it must be recognized
that the public is not convinced of their trustworthiness as sources
of health information.

Whatever else is used, the doctor or clinic cannot be ignored

as a major source of information about health problems. Despite
the fact that contact with a doctor is often fleeting and despite
the fact that the doctor may actually provide very little informa-
tion, the public believes it gets a lot of information from doctors
and trusts what it gets. In a sense, one word from a doctor is
worth a thousand in a pamphlet; and if doctors are not now really
pergorming their education function, they must somehow be convinced
to 0 so.

If an important aspect of the campaign is directed at doctors it should
be primarily at private doctors. As the next table indicates, although among
minorities and the poor the clinic is more heavily used than among any other group,
nevertheless among nearly all groups a heavy majority say they receive their

medical care from private doctors:

31

 

 

Q.3
WHEN NEED MEDICAL CARE, WHERE GET IT
(Base: Total)
High Blood
Pressure
$5,000 $10,000 Ever
[ Under to to $15,000 Been Total
Total White Black Other $5,000 $9,999 $14,999 and Over Told Current
Z 1 Z Z % % Z 1 % 1
Private doctor 85 88 64 68 '76 85 87 90 86 87
Health clinic 8 6 19 17 14 9 6 2 9 9
Emergency room in
hospital ~ 5 5 12 8 7 5 5 5 ,5 4
Medical service of ,
employer 3 v 2 3 4 l 3 3 4 2 2
Neighborhood health
center 1 l 3 2 2 l * * 1 1
Other 3 3 -5 1 5 2 2 3 3 3
Never get medical care 1 l 2 3 2 l 1 1 l *

 

 

 

The above results, by race and income, hide an even sharper racial
split in low income urban groups. In the table below the data are shown for

urban whites and blacks with annual incomes under $5,000:

32

WHEN NEED MEDICAL CARE, WHERE GET IT
(Base: Total)

Cities: Income

 

Total Under $5 000 Total
Total Black Black |White White
Z Z Z I Z Z

Private doctor .= 85 64 45 I 75 88

Health clinic 8 19 26 15 6

Emergency room 5 12 17 I 9 5
Medical service of I

employer 3 3 2 2 2
NeighborhOOd health '
center 1 3 5 |

Other‘ 3 5 7 4 3
Never get medical care 1 2 3 I
l

 

 

 

While it appears that low income urban whites are somewhat less
likely than all whites to have a private doctor (75Z vs. 88Z) they are, nevertheles
significantly more likely to have one than are their counterparts -- low income
urban blacks (in fact, low income urban whites are more likely to have a private
doctor than blacks in total).

Less than half (45ZQ of low income urban blacks have a private doctor,
and for this group, the combination of health clinic and emergency room (43Z)

serves as many people as do private doctors.

33

Supporting the importance of doctors as a possible information
source (including, of course, doctors in health clinics) contact with doctors
is not as sporadic as one might have assumed. TWO-thirds (67%) of the general
public and eight in ten hypertensives said they had been to a doctor or clinic

for a physical check-up within the last 12 months:

Q.12a

LAST TIME WENT TO DOCTOR 0R CLINIC FOR PHYSICAL CHECK~UP
(Base: Total)

Longer
Last 1 - 2 3 - 5 Ago Never
12 Years Years Ehan Had One
Months Age Ago That (M91 )
% % Z Z 1
Total 61 16 2 l 1
White 66 17 9 7 1
Black 74 15 5 5 1
Other 63 19 11 5 2
Not high school grad 64 16 10 9 1
High school grad 69 17 8 6 *
College grad and over 70 16 10 3 1
Under $5,000 67 14 9 9 l
$5,000-$9,999 66 17 9 7 1
$10,000-$14,999 65 18 ll 6 *
$15,000 and over 69 17 7 6 1
.Ma. 1e 2 12 _1_1 § 1
Under 35 55 24 14 6 1
35-49 54 24 11 10 1
50-64 71 14 8 7 —
65 and over 66 11 9 12 2
___Fema1e 2 L4 z 2 .1.
Under 35 77 14 6 2 1
35-49 73 14 7 5 1
50-64 70 13 7 9 1
65 and over 69 15 8 7 1
High Blood Pressure
Ever been told 79 12 5 3 1
3 l
W 539 1—1 2 — ’
White 80 11 5 3 1
Black 87 9 3 l *
1 .-
Under 35 80 15 4
50-64 86 9 3 2 1
65 and over 79 11 5 4
1
1 81 11 4 3
Ma e 81 10 5 3 1

Female

35

Among the general public there is a relatively sharp difference by
sex, fewer men than women reporting having had a physical check up within the
past 12 months. The difference is largely accounted for by the lower propor-
tion of men under 50 who have had a recent check-up.

Three out of four (74%) of those who have gone in the last year (67%)
said they usually have a physical check-up every year; and among those who have
not been in the past year or don't get one every year (50%), a similar 75% said,

even though they may not do it, that an annual physical check-up is a good idea:

 

Q.12b
USUALLY HAVE CHECK-UP EVERY YEAR
(Base: Had check-up in last 12 months = 67% of total)

| , High Blood Pressure
' Ever Been Current

Total White Black Told Total

% % % % %
Have every year 74 74 80 78 80
Not every year 26 26 20 22 20
Q.12c

EVEN THOUGH DON'T DO IT, IS ANNUAL LHLUK-UP GOOD IDEA
(Base: No physical in last 12 months or don't get one every year = 50% of total)

High Blood Pressure

 

Ever Been Current
Total White Black Told Total
% % % % %
Good idea to get physical
every year 75 75 74 79 81
Go to doctor only -
when sick ' 21 21 22 17 17
Not sure 4 4 4 4 2

 

 

36

Observation

A significant proportion of the public appears to accept the regimen
of annual physical check-ups from their doctor or clinic.

It is an event in which peeple are obviously most alert to

and focusing on health problems,and should be the time they

are most receptive to health care information. It is an

opportunity for communication which should not be overlooked.

SECTION II:

KNOWLEDGE 0F HYPERTENSION AND RELATED DISEASES

 

39

This chapter examines the public's understanding of hypertension --

its causes, consequences and treatments.

Seriousness of Diseases
To help set the context for this examination each individual was
first asked to rate the seriousness of various diseases for someone of his/her age.

In the table below, the proportion who consider each disease "very serious"

is shown:

0.7
“S IDER VARIOUS DISEAS :s VERY SERIOUS FOR SOMEONE YOUR AGE*
(‘msez Total)

High Hong Kong
A A Heart Blood Kidney Back A Bladder or
Cancer Stroke Condition Diabetes Pressu'e Trauble Hepatitis Ulcers Arthritis Trouble Infection London Flu

$987.1 $967.! $957,! $877.! $88:4_)__ 386%} (78%) (827.) 4787.) (727.) (677.) (602.)
7. 7, 7. ‘7. ”A 7 °

 

. Z 7. 7. /. °/. 7.

Let.“ a :32 Q E 23. fl 2 L8 a 2% 2 12
White 94 90 83 63 61 60 58 47 43 35 31 27
Black 94 91 89 75 77 72 56 60 55 49 51 47
Other 86 76 79 64 61 57 55 53 so 44 42 31
Not high school grad 93 90 9O 71 71 65 57 57 55 47 44 43
High school grad 94 88 82 61 59 59 58 43 41 34 28 22
College grad and over 94 9o 77 54 54 58 54 37 31 24 21 17
Under 35 93 89 80 54 48 57 54 39 38 35 25 18
35-49 94 88 84 61 64 61 56 48 43 36 30 26
50—64 96 91 86 73 75 63 63 53 47 39 37 34
65 and over 93 88 88 74 75 67 58 58 S6 43 50 49
Male 92 89 82 61 59 59 53 44 42 39 34 26
Female 95 89 85 66 66 64 60 51 47 36 32 2

$5 Blood Pressure

Ever been told 95 91 87 71 70 69 62 54 51 43 43 38
T_o_c__a1 c.u___rren= ' 9_4 9.1 a a 7.2 6_9 2e 2 a 5!; 5+2 L0
white 96 92 88 72 70 67 65 52 52 42 43 39
Black 94 94 95 80 84 79 61 68 62 53 59 54
Under 35 94 91 89 63 51 65 67 40 42 4O 34 26
35-49 93 92 87 68 69 70 61 54 57 45 45 33
50-64 95 92 89 76 79 67 64 51 50 42 41 4O
65 and over 95 91 91 75 77 72 65 63 61 47 57 51
Male 92 89 85 66 66 69 60 48 50 44 43 , 36
Female » 96 93 92 77 76 69 67 58 57 44 48 45
Not high school grad 95 92 92 76 78 73 63 64 63 54 55 52
High school grad 94 91 86 71 68 65 65 43 46 35 37 27

College grad and over 93 87 84 “56 55 63 59 43 36 26 30 25

*Percentages in parentheses represent total of "very" and "fairly" serious.

077

41

Not surprisingly, the list is led by cancer -- a disease the public
undoubtedly sees as a certain killer. This is followed by the often swift
and unpredictable ”stroke", which in turn is followed by a "heart condition".
Each of these is ranked very serious by more than 8 in 10 (more than 9 in
10 for cancer). Further down the list, and just above the‘60% line, are
grouped diabetes (64%), high blood pressure (63%) and kidney trouble (61%).

For most of these diseases, there is a tendency for more older
people to rate them as very serious but what is interesting is that, with the
one exception of the flu, the gap between young and old is most wide for high
blood pressure.

Hypertensives are more likely than the general public to rate each of
these diseases or conditions as very serious. Again more older hypertensives
than younger hypertensives rate each disease as very serious, and again the gap

between young and old is widest for high blood.pressure.

Observation

Overall high blood pressure is viewed with what might be
called respect. It does not have the impact of cancer,

a stroke or a heart condition, nevertheless over 6 in 10

see it as very serious. But the sharp difference in attitude
by age is indicative of some of the problems associated with
an asymptomatic disease. Its effects, for the young, at
least are in the future and they therefore tend to see it as
less serious.

When only 48% of the public between the ages of 17 and 35

and, even more striking, only 51% of hypertensives in this

age group, see high blood pressure as very serious, the need
for education directed specifically at the young seems obvious.

42.

What Is High Blood Pressure
The next step in measuring public understanding was to directly ask

each individual what the terms ”hypertension“ and "high blood pressure"

meant. First "hypertension":

Q.ll

WHAT DOES WORD "HYPERTENSION" MEAN
(Base: Total)

 

 

 

High
Hot College Blood
High High Grad Pressure
School School and Ever
Total Grad Grad Over Been Told
% % % % ' %
i
Bad nerves, extreme
nervous condition 26 23 28 27 26
High blood pressure 24 17 26 38 33
Too much tension, pressure 23 14 27 32 19
Overanxiety 7 5 8 9 5
Overactive 5 3 6 4 3
Overexcitement' 4 4 3 3 4
Other 3 3 4 4
Don't know 26 44 17 6 ‘ 24

 

Overall, just under one in four (24%) knew that "hypertension" is
the same as high blood pressure, with the proportion rising only to 38% among
college graduates and 33% among those who had ever been told they had high
blood pressure. Almost every other response took its clue from the "tension"

part of the word.

Observation

43

"Hypertension" is hardly a household word and with its somewhat
misleading cognate quality it should probably be used in conjunction
with the term "high blood pressure" in any educational campaign.

Next, the responses when the public was asked what "high blood

pressure" means:

Q.16a

WHAT DOES TERM "HIdH BLOOD PRESSURE” MEAN

(Base: Total)

Heart working harder, pressure on heart
Blood pressure above normal

Heart pumping too fast

Blood flowing too fast

Pressure on veins, arteries too high
Danger signal

Related to stress, anxiety

Arteries, veins constricted

Too much blood, blood too thick

May cause a stroke

Mentioned numeric readings

Trouble with the heart

Getting dizzy

Hypertension

Too much blood to head

Poor circulation

Other

Don't know

High
Blood Pressure

 

Total Ever Been Told
Z Z
13 14
13 10
ll 11

8 i
7 5
7 8
7 8
5 6
5 5
4 6
4 10
3 2
3 4
2 5
2 2
2 2
11 12
23 22

 

44

Many responses, such as "heart pumping too fast", "blood flowing
too fast", "too much blood, blood too thick", "too much blood to head",
suggest a minimal understanding of hypertension. In addition, just under
one in four (23%) said they did not know what high blood pressure was.
According to their report the public has had at least one experience
which could have provided the Opportunity to learn about blood pressure.
Practically everyone (99%) reports having had their blood pressure checked
at one time or.another; and in fact 77% said they have had it checked within
the past twelve months (57% within the last six months), with blacks, older
men and women in all age groupings most likely to have had it checked recently.
Persons with a history of hypertension report even higher rates of
blood pressure check-ups. Almost nine in ten (89%) have had it checked in

the past 12 months (77% in the last six months):

Q.14a

WHEN WAS LAST TIME HAD BLOOD PRESSURE CHECKED
(Base: Had blood prEssure checked =99Z of total)

Total

High Blood Pressure

White
Black
Other

Under $5,000
$5,000-$9,999
$10,000-$14,999
$15,000 and over

Male

Under 35
35-49

50-64

65 and over

 

Female

Under 35
35-49

50-64

65 and over

Ever been told

Total Current

White
Black

Under 35
35 to 49
50 to 64
65 and over

Male
Female

 

More
Within Than
Last 7 -12 1 - 2 3 - 5 5
6 Months Years Years Years
Months Ago Ago Ago Ago
Z Z Z Z Z
2 2_0 _1_4 2 2
57 . 20 14 6 3
65 18 12 3 2
51 25 13 7 4
60 18 11 6 5
58 18 15 6 3
54 21 16 7 2
56 23 13 5 3
a 22 12 § , s
43 23 21 11 2
43 23 22 7 5
58 20 13 6 3
66 10 10 6 8
Q g 1_1 a 2
64 20 12 3 1
57 22 12 5 4
61 20 9 6 4
71 14 9 4 2
77 12 8 2 1
Q .12 2 1 1
82 11 5 1 1
84 9 5 1 1
74 16 8 1 1
76 13 8 3 *
85 10 4 1 *
86 7 5 * 2
80 11 6 2 1
83 10 5 1 1

45

46

Observation:

The proportions who have had their pressure checked
recently may seem high, but when one considers that

67% report having had a physical check-up within the last 12
months and others will have gone for a specific reason,

at WhiCh time they may have had their blood pressure

checked, the 77% figure (representing those who
have had their pressure checked within the last 12
months) does not seem unreasonable.

For the most part, it is the doctor who checked their pressure:

(2.141:

WHO CHECKED BLOOD PRESSURE
(Base: Had blood pressure checked = 99% of total)

 

High Blood
Pressure
Ever
Been
Total Told
Z Z
Doctor 73 77
Nurse 26 22
Other 1 1

 

Where the doctor did not take the pressure it was done by the
nurse in practically every case; the doctor—nurse combination accounts for
99% of all blood pressure tests raported.
But,-apparent1y doctors and nurses do not always share the resuits with their
patients. Only six in ten (61%) said the person who took their blood pressure
told them anything about it. The proportion is higher, however, among college

graduates, people 50 and over and, particularly, among hypertensives:

Q.l4c

DID PERSON TELL YOU ANYTHING ABOUT YOUR HIGH BLOOD PRESSURE
(Base: Had blood pressure checked = 99% of total)

Person Did Not Not

 

Told Tell Sure
Z 1 %
Total 21 §§ E
White 62 37 1
Black 61 36 3
Other 51 46 3
Not high school grad 59 39 2
High school grad 60 39 1
College grad and over 69 30 1
Under 35 53 46 1
35-49 59 39 2
50-64 69 30 l
65 and over 72 27 1
High Blood Pressure
Eyer been told 78 22 *
Have now 85 15 *
Current Total 83 17 *

In approximately two-thirds (63%) of the cases where they

were told something about their pressure, they were told only in words

and, according to their recollection, no numbers were used:

48

Q.14d

DID PERSON DESCRIBE BLOOD PRESSURE IN NUMBERS 0R JUST WORDS
(Base: Had blood pressure checked and person told something
about blood pressure = 60% of total)

 

Used Just Numbers Not

Numbers Words and Words Sure
Z Z % %

Total 33 22 13 3
White' 25 60 13 2
Black 18 74 5 3
Other 8 85 7 -
Not high school grad 17 73 8 2
High school grad 25 59 , l4 2
{College grad and over 32 50 15 3
Under 35 20 63 14 3
35-49 21 64 13 2
50-64 27 61 10 2

65 and over 27 61 10 2

High Blood Pressure

Ever been told' 33 52 13 2
Have now 36 47 15 2
Current Total 35 50 13 2

While whites, college graduates and hypertensives are most likely
to have been 'told about their blood pressure with numbers , a majority of nearly every
group were told in just words. In fact only one in five (21%) of the total
group which has had its blood pressure checked indicated they Were told what it
was infnumbers (obtained by multiplying the 61% told something by the 35% told in
numbers).

Not surprisingly then, when asked if they knew what normal blood
pressure was for a person their age only 26% overall said they did know, and

even among hypertensives the proportion only stood at around four in ten:

'49

Q.15a

DO YOU KNOW WHAT IS CONSIDERED NORMAL BLOOD PRESSURE
FOR PERSON YOUR AGE
(Base: Total)

Don't Not

 

Know Know Sure
Z Z Z
To tal _26 6_6_ _8_
White 27 65 8
Black 13 79 8
Other 15 81 4
Not high school grad 18 75 7
High school grad 28 64 8
College grad and over 37 55 8
Under 35 23 70 7
35—49 27 64 9
50—64 31 61 8
65 and over 23 69 8
High Blood Pressure
Ever been told 37 55 8
Have now 45 48 7
Total Current 40 53 7

Even this 26% figure is too high. As indicated in the next table,
only 38% of those who said they knew what normal blood pressure was gave a

set of figures lower then 140/90:

50

Q.15b

WHAT IS NORMAL BLOOD PRESSURE FOR PERSON YOUR AGE
(Base: Know what normal blood pressure is or not sur‘e = 337. of total)

 

 

C01-
Not lege Hi h Blood Pressure
High High Grad 65 Ever
| School School And Under 35- 50- and Been Have Total
11122.1; fixeCL £3151. 92$ 3 , 99— 6—4- Over Told NOW- Current
Z Z Z Z Z Z Z Z ‘ Z ” Z Z
DoublevNumbers
Less than 140/1ess than 90 3s 21. 45 45 59 37 28 20 30 30 26
Less than 140/90 or over 5 S 4 6 7 6 3 1 5 3 4
Less than 140/not sure 3 3 3 1 3 2
140-159/1ess than 90 9 9 9 12 3 9 15 18 17 15 16
140-159/90 or over 5 3 5 7 7 8 7 E R A
140-159/not sure 2 2 2 1 1 1 2 4 2 3 2
Other deuble numbers 9 7 5 11 3 7 7 14 12 11 15
10° + my age 14 19 15 9 11 23 15 10 11 9 11
Less than 120 3 5 2 * 3 3 2 2 1 * *
120'139 5 6 5 6 4 a 3 4 8
140-159 5 10 '5 3 1 5 9 11 8 12 9
160 or over 2 7 * — * 1‘ 3 7 4 4 5

 

 

 

Causes Of

increased

51

Observation

It is interesting that, among older respondents and among
hypertensives, there are more who feel that a higher
reading -- particularly a higher diastolic reading -- is
normal.

But there is clearly some danger in an individual accepting
that, with increasing age, blood pressure must increase.
For while it may be usual for older people to have higher

blood pressure, it is also true that they are more likely
to die from its effects.

High Blood Pressure
Even though, in the above question, aging appears to be associated with

blood pressure, when asked to volunteer what they thought were the

"major likely causes" of high blood pressure, only 2% mentioned old age. The

single most important cause reported was "emotional pressure, worry, anxiety",

volunteered by 48% of the total public and 53% of those who had ever been told

they had high blood pressure:

Q-9j

MAJOR LIKELY CAUSES OF HIGH BLOOD PRESSURE
(Base: Total)

 

 

 

 

Not College Ever Been
High High Grad 35 50 65 Told Had

School School and Under to to and High Blood

Total white Black Other Grad Grad Over 35 42 £3 Over Erassure
Z Z Z Z Z Z Z Z Z Z Z ’ Z
Emotional pressure, worry, anxiety 48 50 34 31 37 53 57 50 52 45 41 53
Overweight 26 26 18 29 21 29 25 27 30 25 16 3O
Improper diet 19 19 24 ll 16 20 25 17 21 21 18 18
Fatty foods -- cholesterol 8 7 14 6 8 7 7 5 8 9 9 10
Overexertion 7 7 5 4 7 7 6 8 5 5 8 6
Alcohol -- excessive drinking 7 7 10 4 9 6 6 6 7 7 8 8
Heredity 7 7 3 3 4 7 15 6 9 7 5 8
Too much salt 5 4 14 5 7 5 3 5 5 6 5 9
Smoking 4 4 2 3 3 4 6 4 4 5 3 4
Hyp‘ertens ion 4 5 2 - 3 5 7 3 5 7 3 5
Hardening of the arteries 3 3 l - 2 2 g 8 2 3 4 3 2
Pork 3 ' 1 15 l 4 l 2 2 3 3 3 4
Lack of exercise 3 4 1 4 l 3 8 4 3 3 2 3
Old age 2 2 l - 2 2 3 2 3 1 2 2
Other 11 10 13 ll 12 10 9 15 ll 15 12 16

Don't know 19 18 17 ‘ 35 26 15 11 , 19 l5 18 24 13 m

. N)

 

 

53'

Emotional pressure is felt to be a likely cause of high blood'pressure
by relatively more whites than blacks or other minority group members, and by
more college graduates than those with less education and by more of the young
than the old.

Second on the list is "overweight",volunteered by 26% of the total
public and 30% of those who had ever been told they had high blood pressure;

If all of the diet related items are combined (these include ”overweight",
"improper diet”, "fatty foods”, "too much salt" and "pork"), diet appears to

be even more important than emotional stress. This is particularly true of
blacks, among whom "too much salt" and ”pork" have a significant number reporting
them as likely causes of high blood pressure.

In the table on page 49 it is not proper to add the individual lines
of the previous table if one wants to show the proportion of indiziduglg who chose
emotional stress or diet since one person could have mentioned any number of
factors. The next table, however, shows the response to the additional
question, "Which one of the factors do you feel is the single most important
cause of high blood pressure?" For this table it is legitimate to add the

lines to represent individuals:

Q.9K

SINGLE MOST IMPORTANT CAUSE OF HIGH BLOOD PRESSURE

Emotional pressure, worry,
anxiety ‘

Overweight
Improper diet
Fatty foods, cholesterol

Overexertion

Alcohol, excessive drinking
Heredity

Too much salt

Smoking

Hypertension

Hardening of the arteries
Pork

Lack of exercise

Old age

Other

Total

40

18

(Base: Mentioned some cause of high blood pressure = 81% of total)

High Blood

Pressure

Ever

Been Told

%

39

21

 

54

55

Emotional pressure emerges as the number one likely-cause -~ chosen by
40% of the public. The diet related items (excluding"alcohol,excessivedrinking")
are close behind, however -- added together they were mentioned by 33% of the public.
Thaabove tables were based on volunteered responses from the
public. A somewhat different measure was obtained when a list of possible
causes was shown to the respondents who were then asked how likely it was
that each was actually a cause of high blood pressure. In a sense this question
tests the public's view of the reasonableness of associating various causac

with high blood pressure:

56

 

Q/16b POSSIBLE CAUSES OF HIGH 3WD PRESSURE
(Base: Total)
No:
Iligh High 35 50 W
School School college and Under to to 65 and Ever “rota
Total we Black Other £13. 422d. M21. 35 19 64 Over 3.22% m
Hanging. Tension. Strain ‘Z . ‘7. i 7. 'l. 'l. 7. 2— T 7: '7. 7.
Definite cause 72 72 69 69 72 72 70 68 72 74 73 80 80
Possible cause 23 23 25 17 21 23 28 27 22 20 21 17 17
Not a cause 3 3 3 5 3 3 2 3 3 3 2 2 2
Not sure 2 2 3 9 4 2 * 2 3 3 4 1 1
M
Definite cause 65 65 58 65 62 64 68 67 65 60 63 68 68
Possible cause 29 30 31 22 23 31 28 29 28 32 29 25 25
' Not a cause 3 3 5 7 . 5 3 3 2 4 5 3 5 5
Not sure 3 2 6 6 5 2 l 2 3 3 5 2 2
Eating Fact! Foods
Definite cause 52 48 62 65 55 49 48 47 51 53 54 56 58
Poss ible cause 33 35 26 19 28 35 41 38 34 31 27 30 29
Nor. a cause 8 9 5 8 8 9 6 8 9 9 7 8 7
Not sure 7 8 7 8 9 7 5 7 6 7 12 6 6
Smoking
Definite cause 38 39 33 44 37 37 47 36 38 39 44 41 42
Possible cause 33 34 27 23 29 35 35 37 33 29 27 31 29
\‘o: a cause 17 16 21 18 18 18 11‘ 18 17 19 12 14 15
Not sure 12 11 19 15 16 10 7 9 12 13 17 14 14
Eating Too Much Salt
Definite cause 37 35 57 40 45 35 26 33 38 40 44 52 54
Possible cause 35 37 23 20 23 37 46 36 36 34 30 29 28
Not a cause 15 15 8 20 14 15 16 17 15 15 11 12 10
Not sure 13 13 7 20 13 13 12 14 11 11 15 7 l
Hereditz
Definite cause 28 29 28 25 26 28 37 23 31 31 31 32 33
Possible cause 37 37 36 23 31 39 45 42 38 34 33 36 36
No: a cause 24 24 19 34 27 25 12 26 22 25 19 22 21
Not sure 11 10 17 '18 16 8 6 9 9 10 17 10 10
Old Age _
Definite cause 26 26 23 31 23 24 25 26 24 26 27 27 30
Possible cause 40 42 31 26 35 43 46 43 3.9 40 38 39 36
Hot 3 cause 25 24 33 29 15 26 23 23 29 26 23 26 26
Not sure 9 8 13 1a 12 7 6 s s a 12 a a
Not Getting Enough Exercise
Definite cause 20 21 1 23 19 20 24 23 20 18 19 21 19
Possible cause 42 42 34 31 36 44 50 43 40 38 43 38 39
Not a cause 26 26 27 29 27 27 20 25 30 30 20 ‘ 27 28
Not sure 12 11 20 17 13 9 6 9 10 14 18 14 14
Too Much Blood
in the Sister:
Definite cause 14 11 36 22 21 10 9 12 14 14 18 18 19
Possible cause 19 19 25 16 24 18 12 18 17 20 25 21 22
NOE a cause 44 47 13 31 27 51 63 51 47 44 24 38 36
Not sure 23 23 21 31 28 21 16 19 22 22 33 23 23
Regular Pard Exercise
‘ 'Defin‘itercause ' 10 9 1s 13 14 s 6 9 a 10 13 13 ’ 15
Possible cause 22 22 24 20 25 22 17 21 21 23 25 24 24
Not a cause 56 53 39 44 44 6O 70 59 60 56 45 50 48
not sure 12 11 19 23 17 10 7 11 11 11 17 13 13
Underweight
Definite cause 4 3 7 l0 5 4 3 4 3 3 5 4 3
Possible cause 13 13 13 11 12 13 12 17 12 10 10 13 12
Not.- a cause 67 69 56 63 60 70 75 66 71 71 60 68 69
Not sure 16 15 24 16 23 13 10 13 14 16 25 15 16

 

 

 

 

57

The order remains essentially the same as in the volunteered
question but the level of response for each cause is considerably higher.
For example, old age, volunteered by only 2%, is felt to be a definite
cause by 26% in this question -- interestingly enough with only minimal

variation by age.

Observation

Tension and overweight are seen as the most prevalent likely
causes of high blood pressure. To the extent that these
perceived causes are felt to be necessary associations with
high blood pressure, they may prevent the public from
recognizing that hypertension also exists in the thin and

the calm among us and that overt characteristics are not
always present.

Other Illnesses And Symptoms Caused By High Blood Pressure

This section examines the public's awareness of the possible
consequences of high blood pressure in terms of other illnesses it may
lead to as well as the public's understanding that one can have high blood
pressure without visible symptoms.

Before any questions dealing specifically with high blood pressure
were asked, each individual was asked to volunteer his opinion of the major
likely causes of heart trouble, kidney trouble and stroke. Only for stroke
did a significant proportion of the public (43%) see high blood pressure as

a cause:

Q.9a

Emotional pressure, worry, anxiety
Overweight

Smoking

Overexertion

Improper diet

Lack of exercise

High blood pressure
Heredity

Fatty foods, cholesterol
Alcohol, excessive drinking
Not taking care of health
Fatigue, not enough rest
Other

Don't know

MAJOR LIKELY CAUSES OF HEART TROUBLE

(Ease:

Total)

 

Not College
High High Grad

School School and Under
Total White Black Other Grad Grad Over 35
% Z Z Z Z % % %
37 36 45 34 33 37 45 29
33 34 22 31 27 36 36 39
29 30 17 35 24 31 36 '36
23 24 23 18 27 23 14 21
17 18 13 15 ll 20 27 20
17 18 8 l7 9 21 28 28
13 13 12 5 ll 13 17 12
12 13 5 6 7 13 20 12
8 8 3 9 4. -9 14 9
7 7 7 8 8 7 6 6
5 5 4 5 3 6 6 6
4 4 4 4 4 4 2 3
12 ll 14 13 13 ll 14 ll
10 9 16 ll 16 6 3 8

 

 

 

35
to
32
7°

44
34
31
22
19
17
13

14

50
to
64

T

41

30

22

26

17

10

15

10

15

65
and

Over
%

 

35

20

21

28

11

12

12

18

 

High Blood
Pressure
Ever
Been Told
-————3E———-

26
‘14
ll
18

12

89

Q.9d

MAJOR LIKELY CAUSES OF KIDNEY TROUBLE
(Base: Total)

 

 

Not College High Blood

High High Grad Pressure
School School and Ever

Total White Black Other Grad Grad Over Been Told
% 1 % % Z Z % %
Alcohol, excessive drinking 19 18 25 27 20 19 18 18
Not drinking enough fluids 12 ll 21 12 14 12 8 12
Improper diet 12 13 9 9 9 l3 16 11
Heredity 8 9 2 5 5 8 15 8
Infections 8 9 6 3 6 9 17 7
Carbonated drinks 5 4 15 l 8 4 l 6
Too much sugar 3 3 6 1 4 2 2 4
High blood pressure 1 l l - l l 3 ' 3
Other 23 22 25 21 20 20 25 24
Don't know 43 44 37 42 44 44 38 43

 

 

69

Q-9g

MAJOR LIKELY CAUSES OF A STROKE
(Base: Total)

 

 

 

Not College High Blood

High High Grad 35 50 65 Pressure
School School and Under to' to and Ever

Total White Black Other Grad Grad Over 35 fl 6—4 Over Been Told
7° % 7° 7; "A, “Z, ‘Z. ‘70 7. 7° 7° "/0
High blood pressure 43 44 48 19 44 44 43 30 48 52 52 54
Emotional pressure, worry, anxiety 22 22 23 27 20 24 25 20 26 24 20 25
Overexertion 14 14 9 13 14 14 12 20 11 10 11 13
Hardening of the arteries 7 8 2 2 5 8 13 6 7 10 7 8
Old age 7 8 3 3 5 8 11 9 8 4 4 7
Poor diet 7 7 4 8 5 7 l3 7 8 7 5 6
Overweight 7 7 6 4 6 7 8 7 9 6 5 8
Blood clot, embolism 6 7 2 2 4 6 10 5 6 7 5 4
Heart trouble 5 5 5 5 5 6 3 6 5 5 3 5
Not enough exercise 4 4 1 6 2 4 8 6 4 1 1 2
Fatty foods, cholesterol 3 4 2 4 2 4 6 3 3 5 3 4
Poor circulation 3 3 4 1 2 2 6 2 3' 4 3 2
Heredity 3 3 1 * 1 2 8 2 4 2 1 2
Other 16 13 19 14 14 14 19 16 18 14 15 15
Don't know 18 17 21 31 22 17 9 21 15 15 19 15

 

 

 

 

09

61

While many of the same causes -- emotional pressure, overweight,
improper diet, etc. -- are mentioned for heart trouble as were mentioned for
high blood pressure, only 13% of the total and 18% of those who have ever
had high blood pressure directly mentioned high blood pressure as a major
likely cause of heart trouble.*

For kidney trouble the association is almost non-existent. Only _
1% of the total and 3% of the ever had high blood pressure group mentioned
high blood pressure as a likely cause of kidney trouble.

But luckily, this is not the whole story. The public is more aware
oi some of the consequences of high blood pressure than the above questions
would indicate, although it has to be well prodded before the awareness really
shows.

In response to a direct question just under six in ten (58%) said

that high blood pressure does cause other illnesses or symptoms:

?A secondary analysis of the data for hypertensives indicates that those who
are taking medicine for their high blood pressure are more likely to believe
hypertension is a major likely cause of heart trouble (24%) than are those
who have stopped taking medicine (15%) or who have never taken medicine for
their blood pressure (9%).

Q.l7a

DOES HIGH BLOOD PRESSURE CAUSE OTHER ILLNESSES 0R SYMPTOMS

Total

White
Black
Other

Not high school grad
High school grad
College grad and over

Under 35
35-49

50-64

65 and over

High Blood Préssure

Ever been told
Have now

Total current

White
Black

Under 35
35—49

50—64

65 and over

Not high school grad
High school grad
College grad and over

(Base:

 

Total)
Doesn't

Causes Cause

Other Other Not

IllnesSes Illnesses Sure
Z Z %
2.8. a a
58 16 26
48 21 31
48 24 28
50 19 31
59 17 24
68 10 22
54 , 19 27
65 13 22
60 16 24
50 17 33
64 15 21
67 15 18
.631 _1_7‘ £9
64 16 20
55 22 23
64 22 14
70 11 19
65 18 17
59 15 _26
6O 19 21
66 14 20
72 13 15

62

63

Awareness that high blood pressure causes other illnesses or
symptoms is somewhat higher among whites than blacks and other minorities,
increases with education and is higher among those between the ages of 35

and 64 than among the young and the old.

Observation

It is somewhat discouraging that among hypertensives, even
that group which says its blood pressure is now high, only
about two out of three said that high blood pressure causes
other illnesses or symptoms.

The fact that a third of hypertensives and over four in ten
in the total public either feel that high blood pressure does not

cause other illnesses and symptoms or are not sure is a clear
sign of the need for a major educational campaign.

When asked what illnesses or symptoms high blood pressure causes,
half of this group (50%) mentioned stroke, 42% mentioned heart attacks and
5% mentioned kidney problems -- there were also significant mentions of

dizziness, headaches, nervousness:

Q.l7b

OTHER ILLNESSES 0R SYMPTOMS CAUSED BY HIGH BLOOD PRESSURE
(Base: Causes other illness=58% of total)

64

High Blood Pressure

Ever Been Told

 

Total

Z
Stroke 50
Heart attacks, heart trouble 42
Dizziness, vertigo 21
Headaches 16
Nervousness, irritability 7
Fatigue, tiredness 5
Kidney problems 5
Blurred vision 5
Painting 4
Hardening of arteries 3
Other 26
Don't know 6

 

%

50
40
23
22

ww0\O\-l-\k0

28

W

Z

51
40
24
22

DOWO‘ONUIKO

27

65

When each individual was actually shown a list of illnesses and

symptoms and asked which ones were caused by high blood pressure the following

results were obtained*:

Q.17d

ILLNESSES AND SYMPTOMS BELIEVED CAUSED BY HIGH BLOOD PRESSURE

 

 

 

 

 

(Base: Total) High
Blood
Not College Pressure
High High Grad Ever
School School and Been Total
Total White Black Other' Grad“ Grad Over Told Current
Z Z Z Z Z Z z Z %
Caused by High Blood Pressure
Stroke (9)** 87 87 86 80 86 88 85 91 92
Dizziness (7) 86 86 84 81 83 88 85 92 92
Heart attack (10) 81 82 73 76 78 82 84 82 83
Headache (10) 75 75 79 69 73 77 74 85 86
Nosebleed (15) 65 66 66 51 63 67 65 71 72
Hardening of the
arteries (22) 50 51 42 48 49 51 49 54 54
Diabetes (22) 15 13 25 24 19 13 10 16 16
Anemia (21) 12 11 17 18 14 12 5 10 9
Hepatitis (26) 6 5 10 12 7 5 4 6 6
Arthritis (16) 6 5 13 13 8 4 6 8 8
Pneumonia (15) 5 4 7 15 7 3 3 5 5
* ”Kidney trouble" was inadvertently left off the list but the results of the previous

questions suggest that its association with high blood pressure would not have been very

strong.

** Percentages in parentheses represent "not sure" responses.

66

Stroke and heart attack were reported as being possibly caused by
high blood pressure by over 8 in 10, as was dizziness; and 75% reported high
blood pressure causes headaches, 65% that it causes nosebleeds and 50% that
it causes hardening of the arteries. Fifteen percent of the public (and a
higher 25% of blacks) are aware of the possible connection between high

blood pressure and diabetes.

Observation

These data suggest that, when educational material is designed,
one need only point out the association between heart attack,
stroke and high blood pressure to the public -- for a significant
proportion volunteered the information and when offered the choice
they obviously make the association quite easily.

The high proportion of the public which said that overt symptoms
such as headaches, nosebleeds, and dizziness are caused by high

blood pressure is somewhat troubling. While these certainly can
be symptoms they generally only appear when the disease is very

serious or long after its onset.

It is our impression,a1though the question was not asked directly,

that the public does not recognize the nature of the association

of these symptoms with hypertension but rather may assume that

they are always or generally present. To the extent that this is

the case they may also be unconcerned about the likelihood of their
having high blood pressure if these symptoms are not present. It

is important, therefore, to convince the public that the overt

symptons -- which they so readily associate with high blood pressure --
occur only late in the progress of the disease.

Another significant need suggested by these results is to inform

the public of high blood pressure's role in kidney disease and its
association with diabetes.

Another question in this section of the survey clearly delineates
the public's lack of understanding of high blood pressure as an asymptomatic
disease. Each individual was asked:

"How likely do you feel it is that someone can have high blood pressure

without having any obvious symptoms -- very likley, somewhat likely, or hardly
likely at all?”

67

Just under four in ten (39%) in the general public and half (50%) of
the current hypertensive group say it is very likely that one can have high
blood pressure with no obvious symptoms.* This, of course,1eaves 60% of the
public and 50% of hypertensives who apparently are not convinced that they can

indeed be hypertensive and not aware of it:

 

 

Q.17c
‘ HOW LIKELY SOMEONE CAN HAVE HIGH BLOOD PRESSURE
WITHOUT OBVIOUS SYMPTOMS
(Base: Total)
Hardly
Very Somewhat Likely Not
Likely Likely at All Sure
2 z‘ Z 1
Tot a1 32 3_3 22 g
White 38 35 19 8
Black 37 24 26 13
Other 43 22 22 13
Not high school grad 37 29 22 12
High school grad 37 37 19 7
College grad and over 43 36 16 5
High Blood Pressure

Ever been told 46 28 21 5
Total Current _5_9_ 25 El 2
White 50 25 20 5
Black 45 22 28 5
Not high school grad 45 23 25 7
High school grad 53 27 17 3
College grad and over 59 19 22 —

Observation:

The goal, which of course can never by fully achieved, should be to
have 100% of the public responding "very likely” to the above question.

*A secondary analysis of the hypertensive data indicates that those who
stopped taking medicine are less likely to be convinced that someone can have
high blood pressure without obvious symptoms (36% very likely) than are those
still taking medicine (51% very likely) or who never took medicine (46%). This
"stopped taking medicine" group should probably be an important focus of any
educational campaign.

68

The Treatment Of High Blood Pressure

While there may be uncertainty as to what the consequences of
high blood pressure are, there appears to be little doubt in the public's
mind that it can be controlled.

Each person was asked:

"As far as you know is there any treatment for high blood pressure
or is high blood pressure something a person just has to learn to live with?"

By 87%-7% the public says there is a treatment for high blood pressure:

Q.18a
IS THERE ANY TREATMENT FOR HIGH BLOOD PRESSURE
(Base: Total)
Col—
Not lege High
High High Grad— Blood Pressure
School School uate Ever
To- Grad— Grad— and Been Total
tal White Black Other uate uate over Told Current
2 Z Z Z Z Z Z 2
Is treatment 87 88 76 74 82 88 92 91 90
Must learn to live with 7 7 14 ll 10 7 4 7 8
Not sure 6 5 10 15 8 5 4 2 2

 

 

 

Medication leads the list of possible treatments by a wide margin:

Q. 181:

69

WHAT TREAIMENTS HELP REDUCE HIGH BLOOD PRESSURE - VOLUNTEERED

(Base: Is treatment for high blood pressure = 87% of total)

Medication

Proper diet

Salt free diet

Reduce tension, anxiety
Appropriate physical exercise
Rest

Lose weight if overweight

Do what doctor tells you

Stop smoking

Other

Don't know

The above answers were volunteered by the respondents.

lower it or would not help lower it.

Total

73
43
12
11
10
10
10

10

 

High Blood Pressure

Z

84

38

15

12

Ever Been Told

Each respondent

was also shown a list of possible treatments and asked whether they thought each

was a treatment that would definitely help lower high blood pressure, might help

In the next table are shown the proportions

which felt each treatment would definitely help lower high blood pressure:

Q.18c

Total

White
Black
Other

Not high school grad
High school grad
College grad and over

Under 35
35-49

50-64

65 and over

Male
Female

High Blood Pressure

Ever been told

Have now

Total Current

White
Black

Under 35
35-49

50-64

65 and over

Male
Female

Not high school grad
High school grad

 

70
TREATMENTS THAT DEFINITELY HELP LOWER HIGH BLOOD PRESSURE
(Base: Total)
Regu- Rest-

Low Diet Low lar ing Vita- High
Medi- Salt toLose Fat Stop Exer- a min Psycho- Salt
cine Diet Weight Diet Smoking cise Lot E theraphy Diet

Z Z Z Z Z Z Z Z Z Z

2 .62 a 5_6 22. fl 3_7 a 2 2
84 62 58 55 53 42 34 9 9 3
78 66 53 64 43 32 57 15 10 5
72 53 60 61 52 41 43 17 9 5
83 63 55 58 49 37 45 13 7 4
83 63 58 57 54 43 34 8 10 2
82 58 58 52 57 47 23 8 13 3
76 55 55 52 49 43 29 9 ll 2
87 68 62 58 55 41 37 9 10 3
87 7O 60 61 54 42 44 11 7 2
85 6O 52 55 53 38 43 11 8 4
80 55 54 52 52 42 33 10 1o ‘ 3
85 69 6O 60 53 40 40 10 9 3
88 71 61 63 53 42 44 10 3
89 78 59 68 56 42 47 9 2
2 2 a) 95+. 2 fl fl & 2 2
91 72 6O 62 54 42 42 8 9 3
84 76 60 73 44 33 70 16 8 4
77 66 63 58 45 45 33 10 9 4
92 72 70 68 57 42 43 11 12 3
92 80 65 66 53 46 52 8 9 3
92 68 50 63 53 32 51 11 fl 5 3
87 66 6O 6O 55 44 43 12 8 3
92 76 60 67 51 38 49 9 8 5
90 73 56 65 52 35 54 12 7 5
89 71 64 63 53 47 41 7 9 2
92 71 68 65 56 49 32 9 12 4

College grad and over

71

Five treatments are considered a definite help by a majority
of the general public and of hypertensives -- medicine, low salt diet,
weight losing diet, low fat diet and stopping smoking.

Vitamin E, which has received fairly wide publicity, was not

selected by many people as a means to control blood pressure.

Observation

It is interesting that,even though emotional stress

is considered the major cause of high blood pressure,

psychotherapy is not at all popular as a treatment.

It probably is fair, though, to assume that the public

includes "resting a lot" with psychotherapy as a direct

treatment for emotional stress, while others may feel

exercise provides release of emotional tensions.

Looked at by race, whites tend to be more partial than blacks to
medicine, stopping smoking and regular exercise as high blood pressure treat-

ments, while relatively more blacks than whites responded that a low fat diet

and resting a lot would definitely help.

By education, there are almost no differences on the top four
treatments. The perceived value of stopping smoking, regular exercise and
psychotherapy, however, increases with education while resting a lot and
Vitamin E find relatively more favor among those with less education.

By age, theAyoung tend to be less certain of the value of medication
than are their elders (although it is still considered an appropriate treatment
by more of the young than is any other treatment). Each of the diet treatments
is felt to be definitely beneficial by higher proportions of those between the
ages of 35 and 64 than the youngest or the oldest group. Somewhat surprisingly
there is little difference by age in the perceived value of regular exercise;
at the same time, as one gets older, one is more likely to see resting a lot

as of definite value.

72

More women than men are convinced of the value of each of the diet

treatments and of resting a lot.

Not only does the public have a reasonable view of treatment procedures

for high blood pressure, they also recognize the generally continuing need for

this treatment. Asked:

”From what you know or have heard, if a person gets his pressure down
to norma1,is he usually cured -- as one gets over a cold -- or must he usually

continue some type of treatment?“

By 83%-7% the public recognizes that treatment must usually continue:

Q118d

CAN SOMEONE BE CURED OF HIGH BLOOD PRESSURE 0R
MUST TREATMENT CONTINUE
(Base: Total)

High Blood
PreSsure

tal m

To

A Z
Usually cured 7 8
Continue treatment 83 87
Not sure 10 5

Despite the understanding of treatment demonstrated by the above
results, there is still a question as to how motivated to get treatment an
individual would be who found he was hypertensive. Earlier it was seen that
the public was somewhat vague -- until given choices -- about the possible
effects 0f high blood pressure, Interest in treatment might therefore be
weak. To some extent this was confirmed when each individual was asked

what were the best ways to prevent heart trouble and stroke:

Q.10a

BEST WAYS TO PREVENT HEARI TROUBLE

Proper diet

Exercise, stay-in shape

Avoid stress, slow down, relax
Regular checkups

Cut out smoking

Watch your weight

Don't overexert yourself
Proper rest

Don‘t drink, cut down drinking

Take care of yourself

Follow doctor's orders

Watch blood pressure

Other 0‘
No way to prevent it

Don't know-

Total

44
34
30
19
17
16
14
13

kOHUIl-‘UUIUI

 

(Base:

White Black Other

 

Z

46
36
3O
l9
18
16
14
12

5
5
3
l
6
1
8

Total)

 

Z

28
14
40
14

9

11

12
16

*waNUI

20

 

Z

34
29

28

l4
l9
l4

8
13
10

15

 

Not
High High
School School
flfl.

Z Z

31 48
19 38
30 30
16 20
14 18
12 18
l7 l3
13 13

6 4

4 5

3 4

2 l

3 7

1 l
15 6

Col-
lege
Grad
And

Over

62
56
34
21
23
17

10

*KDN N-l-‘UI

73

High Blood
Pressure
Ever
1221.211
2
40
27
35
l6
14
16
16

12

i—‘O‘UJU’DUI

11

 

 

Q.lOb
BEST WAYS TO PREVENT A STROKE
(Base: Total)

Not

High High

School School

Total White Black Other Grad Grad
Z Z Z Z Z 2

Proper diet 23 23 22 22 17 25
Avoid stress, slow down, relax 23 '23 23 27 23 23
Regular checkups 16 17 11 9 l3 18
Watch blood pressure 15 15 19 5 l7 13
Exercise, stay in shape 11 12 5 ll 6 12
Don't overexert yourself 8 8 6 8 9 9
Proper rest 6 5 9 10 6 6
Watch weight 5 5 5 3 4 6
Follow doctor's orders 4 4 4 3 3 5
Cut out smoking 3 4 * 2 2 3
Take care of yourself 3 3 2 3 2 3
Other 4 5 5 2 4 8
No yay to prevent it 3 3 1 3 3
Don't know 29 28 33 45 33 29

 

 

Col-

lege

Grad

And

Over
2

NI—‘l—‘Nw
WUIWO‘UI

woomxlmox-box

[.1
\O

 

74

High Blood
Pressure
Ever

w

UJUINNUIO\\1\0\O

N
.l.\

75

Controlling one's blood pressure as a preventative for heart trouble is
volunteered by only 1% of the public (and only 3% of the hypertensive group).
Even though high blood pressure was seen as the prime cause of stroke, only 15%
of the public (and 21% of the hypertensive group) mentioned controlling blood

pressure as a direct means to prevent strokes.

Observation

Some of the most preferred preventatives for heart trouble and
stroke -- particularly a proper diet -- are also seen as valuable
treatments for high blood pressure. Nevertheless it is apparent
that there seems to be little appreciation that simply controlling
blood pressure is an important way to reduce the possibility of
heart trouble or stroke. And if this direct link is not appreciated,
and if the fact that high blood pressure is asymptomatic is also

not widely appreciated, then the motivation to keep one's blood
pressure under control may well be weak.

 

SECTION III:

THE HYPERTENSIVE

 

79

It has been seen in the two previous chapters that the hypertensive
is more likely than the non-hypertensive to say he understands the causes,
consequences and treatments for high blood pressure, but not, it should be
pointed out, to the extent that might have been expected or hoped for. Even
for many of those who have it, high blood pressure remains a somewhat elusive
disease.

In this chapter a more detailed examination of the hypertensive is
presented, focusing particularly on his characteristics and the treatment he

may have followed. We begin with a demographic profile of the hypertensive.

Demographic Profile Of The Hypertensive
In the first table below the proportions of hypertensives in the
total adult population (17 years of age or older) and in demographic subgroups

are shown, using the three different definitions of hypertensives (see page 8):

80

HIGH BLOOD PRESSURE SUMMARY ~ PROPORTION OF GROUPS THAT ARE HYPERTENSIVE
(Base: Total)

High Blood Pressure

 

Ever

Been Total Have

Told . Current It Now

% X %
Total 23 lg 5

East 22 13 4
Midwest 22 15 5
South 27 19 6
West 24 17 7
City 23 15 5
Suburbs 20 12 4
Towns 27 18 7
Rural 26 19 6
White > 22 15 5
Black 34 25 8
Other 25 14 4
Not high school graduate 30 22 7
High school graduate 20 12 4
College graduate and over 19 11 5
Under $5,000 35 27 9
$5,000 - $9,999 23 15 5
$10,000 - $14,999 20 12 3
$15,000 and over 18 10 4
Under 35 15 7 2
35-49 18 11 4
50-64 32 23 8
65 and over 38 31 9
Male 20 14 5
Female 27 18 6

81

Just under one in four adults (24%) have ever been told that they
have high blood pressure. The variation is relatively slight by region and
size of place,and what variation there is by these factors can be largely
explained in terms of other factors (race and income in particular).

There is a sharp difference by race. Only 22% of whites and 25% of
other minorities have ever been told they have high blood pressure compared with
34% of blacks. ”

As one might expect,the variation by age is even sharper -- while
15% of those under 35 have ever been told they have high blood pressure, the
proportion rises steadily, reaching 38% of the 65 and over group.

Education and income dimensions relate to hypertension in the same
way -- as education and incdme increases, the proportion ever told they had
high blood pressure declines.

Finally, women are more likely than men to have ever been told they
have high blood pressure.

While in the overwhelming majority of cases (96%) it was a doctor who

ever told the individual he or she had high blood pressure, the "ever told"

definition may well be too loose to accurately delineate the hypertensive group
in the population. At the other end of the scale is the "have now" group which
represents 5% of the total adult pOpulation. This definition may be too narrow-
ing, for it requires that an individual know (or at least make an assumption) at
the moment whether or not his blood pressure is high.

The "total current" definition recognizes a history of being identified
as hypertensive on more than one occasion, currently taking medication for high
blood pressure, or knowing (or assuming) that one's blood pressure is high. This

definition,'which seems most reasonable, embraces 16% of the adult population.

82

For both the "have now" and "total current" groups varying
prevalence rates of hypertension among the different demographic groups
follow the same pattern as for the "ever been told" group.

The factors of race, age, income (or education) and sex all correlate
strongly with hypertension. They also, of course, correlate with each other
and the next paragraphs attempt to isolate their relative influence.

While age is the factor most obviously tied to varying levels of
hypertension, the next table suggests that particularly in the middle years,
economic status (as measured by annual income) has an effect on hypertension,
independent of age.

The percentages in the table represent the proportion of each group

that has high blood pressure, using the "current" definition:

HYPERTENSION: PROPORTIONS IN INCOME BY AGE SUBGROUPS
(Base: Total cross-section)

 

35 50 65
Under to to and
Total 35 £2 93 Over
% Z % % %
.T_ot_a1 .12 .7. .1; 22 3_1
Under $5,000 27 8 26 33 34
$5,000 to $9,999 15 7 15 23 26
$10,000 to $14,999 12 7 9 21 37
$15,000 and over 10 6 8 17 27

83

For each age group, with the exception of the 65 and over group, the
level of hypertension decreases with increasing income, Among those under 35,
starting from a lower overall level, the decline is least sharp. While the
50-64 age group has a higher level of hypertension in each income bracket than
the 35 to 49 group, the relationship between hypertension and income is sharpest
for the 35 to 49 age group, with the level of high blood pressure more than
three times as high in the under-$5,000 category compared to the $15,000-plus

category.

Observation:

It is during the years between the ages of 35 and 49 that the
pressures of family and the need to succeed in work are most
likely to be felt° The data suggest that the stress of notmak—
ing itfinanciallyumyhave an effect on blood pressure.

A correlation between race and hypertension independent of income

and of age also exists. The next table shows the proportion of current

hypertensives by age and income, separately for whites and blacks:

HYPERTENSION ~ PROPORTIONS IN INCOME BY AGE BY RACE SUB-GROUPS

 

Under 65
Total 35 35-49 50-64 and Over
% % Z Z Z
White
Total 15 6 9 21 30
Under $5,000 25 7 19 29 33

$5,000to$9,999 15 6 14 21 25
$10,000andover 11}12 7}6 7}9 18}19 32}27

Black*
T_ota_1 E 12 2_6 25: fl
Under $5,000 31 14 41 40 37
$5,000to$9,999 18 7 19 37 68

*In the sample the number of blacks with incomes of $10,000 or over is too
small to analyze by age groupings. Results are consequently shown only for
two income groups (under $5,000 and $5,000 or over).

84

First, examining the age groupings by race, without taking income into
consideration (the underlined numbers), it is clear that hypertension increases
with age among both whites and blacks. At the same time, in each age group,

a higher proportion of blacks than whites has high blood pressure.

When income is also considered, it can be seen that for the under
35 group and the 35-49 group among both whites and blacks, the prevalence
of hypertension decreases with increasing income. Among whites 50 years of
age or older, this same pattern prevails. Among older blacks the pattern
does not hold, but the sample sizes are so small for blacks earning
$5,000 or more who are 50-64 years old (41 persons) or 65-plus (9 persons)
as to make any conclusions from this data highly tentative.

What is most significant in the previous table, however, is that
blacks in all income/age combinations have a higher proportion of hyperten-

sives than do whites.

Observation:

Even after age and income differences are controlled,blacks are
relatively more likely to be hypertensive than whites.

This does not strike us as unusual. Other work we and others
have done suggests that blacks feel significantly more
alienated from society than do whites; and if emotional pressure
and tension do play a role in hypertension, it is not difficult
to see how the cumulative impact of discrimination and alienation
could raise the level of tension among blacks to the point where
blacks suffered more frequently from high blood pressure.
Finally, the factor of sex is introduced into the analysis of
hypertension rates. The next table shows the proportion of current hyper-
tnesives for men and women by age group, both in total and separately for

white and blacks. It indicates that for both whites and blacks women are more

likely to be hypertensive than are men, although the relationship between sex

and hypertension is stronger among blacks than among whites.

85

HYPERTENSION - PROPORTIONS IN SEX BY AGE BY RACE SUB-GROUPS
(Base: Total cross-section)

Male Female
% Z
Total l4 l§
Under 35 6 7
35 to 49 12 ll
50 to 64 21 26
65 and over 22 41
White 12 lg
Under 35 6 6
35 to 49 10 ' 9
50 to 64 20 22
65 and over 21 40
Black 12 39
Under 35 7 16
35 to 49 24 27
50 to 64 27 44
65 and over. 27 55

Among men, the proportion of hypertensives increases with age up
to the age of 50, but then, among both whites and blacks,appears to level
out (the leveling begins somewhat earlier for blacks than whites). At
each age level black men have higher levels of hypertension than do white
men, with the difference smallest for those under 35.

Among women, the proportion of hypertensives increases continously
with age for both whites and blacks. At each age level, without exception,

black women have higher levels of hypertension than do white women.

86

However, there are significant differences when comparisons by sex
are made for the different racial-age groupings. Among whites, there appears
to be only minimal differences in the prevalence of hypertension between
men and women up to the age of 65, at which point a significantly higher
prevalence is found among women. Among blacks, on the other hand,women

have higher levels of hypertension than do men in each age group.

Observation:

The correlation between sex and hypertension appears to be
clearly stronger for blacks than it is for whites. This
relationship, however, is likely to be influenced by income
and for a fuller understanding, requires that the data be
examined by all four factors together (age, race, sex and
income). Unfortunately, the number of individuals in

each intersection of this four dimension matrix is too small
to provide reliable results

Experience With Hypertension

It is not possible in this one study to know whether the number
of people with high blood pressure is increasing or decreasing or even
whether doctors are becoming more or less likely to diagnose hypertension.
Such measures can only be obtained in follow-up studies.

Nevertheless it seems significant that just over one in four (26%)
of the "ever told" group, 29% of the "have now" group and 26% of the "total
current” group reported they were first told they had high blood pressure

withinthe past year:

 

87

 

 

50‘

.64—

Z

18

7

16

17

19

23

65 and?
Over
%
16
9
11
18

16

Q.20a
HOW LONG AGO FIRST TOLD HAVE HIGH BLOOD PRESSURE
(Base: Ever told had high blood pressure)
_ High Blood Pressure

Ever Current
Been Have Under 35-

Told Now~ Total 35 49

Z Z Z % Z

Within last 6 months 17 21 18 27 18
7-12 months ago 9 8 8 l4 6
1—2 years ago 18 14 16 18 25
3—5 years ago 20 16 19 20 26
6-10 years ago 16 14 15 13 8
More than 10 years ago 20 27 24 8 17

 

30

It should be recognized, of course, that despite the significant

number reporting they were told within the past 12 months, a majority of

the hypertensive groups (using any of the three definitions) said they were

first told about their high blood pressure more than 2 years ago and at

least one in five were told more than 10 years ago.

A significant majority (69%) of those who were ever told they had

high blood pressure were told so on more than one occasion (91% of the "have

now" group were told more than once)*.

*Among women ever told they had high blood pressure, just under one in four

said they were first told they were hypertensive at the time they were

pregnant but 46% of this group (or 11% of the women "ever told" group) said
they were found to be hypertensive on at least one occasion when they were

not pregnant.

88

Observation

At least in terms of Opportunity, it is not surprising
that a high proportion have been told on more than one
occasion they were hypertensive for they report having
their pressure checked fairly regularly. As indicated
in the next table, 36% of the ever told group, 48% of
the "now have" group and 42% of the total current group
have had their pressure checked at least five’times
during the last 12 months:

\

Q.20c

HOW MANY TIMES IN LAST 12 MONTHS HAD BLOOD PRESSURE CHECKED
(Base: Ever told had high blood pressure)

High Blood Pressure

 

 

Ever Been. Have Total
Told NOW‘ Current

Z Z Z
None 11 8 8
Once l8 l4 13
2—4 times 34 29 - 36
5—10 times 16 20 19
More than 10 times 20 28 23
Not sure 1 1 1

It should also be pointed out, however, that there is a small
but significant minority (ranging from 21% in the total
current group to 29% in the ever told group) which have
either not had their pressure checked at all in the last

12 months or have only had it checked once. There is some
feeling among doctors that this is not often enough to
adequately keep tabs on the hypertensive patient.

‘89

The Treatment Of Hypertension

Just over three out of four (76%) of those ever told they had high
blood pressure have had some treatment prescribed for them, with the proportion
rising to 87% of the total current group and 88% of the have now group.
Most of these individuals said they are still following the prescribed

treatment although the proportion drops sharply among younger hypertensives:

 

 

 

Q. 20d
ANY TREATMENT EVER PRESCRIBED FOR YOUR HIGH BLOOD PRESSURE
(Base: Ever told had high blood pressure)
High Blood Pressure
Current

Ever Been Have 1 Under 35— 50- 65 and
Told Now Total 35 49 64 Over

Z Z Z I Z Z Z Z

Treatment prescribed 76 88 87 I 63 85 91» 94

No treatment prescribed 23 ll 12. | 35 13 9 6

Not sure 1 l l I 2 2 — —

Q.20f

ARE YOU STILL FOLLOWING TREATMENT
(Base: Treatment prescribed = 76% of ever told had high blood pressure)

High Blood Pressure

90

 

 

 

Current
Ever Been Have I Under 35— 50- 65 and
Told Now Total 35 49 64 Over
Z Z Z 1 Z Z Z 1
Still following treatment 67 86 78 | 48 74 82 85
Following different treatment 3 4 3 | 5 5 3 2
Not following treatment 30 10 19 47 21 15 13

In the great majority of cases (ranging around 9 in 10) where

treatment was prescribed it consisted of some type of medication:

91

Q.20e

WHAT TREATMENT PRESCRIBED
(Base: Treatment prescribed = 76% of ever told had high blood pressure group)

High Blood Pressure

 

 

Current
Ever Been Have | Under 35— 50- 65 and
Told Now Total 35 32_ gg_ _ng£_
Z Z Z I Z Z Z 2

Medication 86 90 89 I 65 82 94 95
Salt free diet 20 21 20 | 40 31 13 15
Diet/proper eating habits 16 18 17 l l7 17 20 15
Lose weight 13 16 13 l 15 26 10 8
Rest 8 ll 8 | 8 ll 6 9
Less fatty foods, cholesterol 6 7 6 I 6 7 5 7
Reduce tension, calm down 6 10 6 | 11 8 5 5
Appropriate physical exercise 3 3 3 l 4 9 ’3 1
Reduce or stop smoking 3 4 3 I 5 5 1 3
Other 11 13 12 I 21 10 10 12

 

92

Age appears to be a significant determinant, not only of whether

treatment is prescribed but also of the type of treatment. As reported by the
respondents medication is prescribed more frequently for the old than for the
young, while a salt-free diet shows a reverse pattern as does a diet to lose

weight (particularly prescribed for the 35-49 age group).

Medication

The above question was open-ended. To pin down the use of medication
more fully a detailed series of questions was asked. First each hypertensive
was asked directly if he/she had ever taken any medicine for high blood pressure.

The responses were consistent with the Open-ended response, although
at a slightly higher level (the percentages seem higher in the table on page 81
because the base for that table is those who reported having had treatment

prescribed rather than the total hypertensive group):

Q.ZZa

EVER TAKE MEDICINE FOR HIGH BLOOD PRESSURE
(Base: Ever told had high blood pressure)

 

Have Taken Not Taken Not
Medicine Medicine Sure
Z Z Z
High Blood Pressure
Ever been told 70 29 1
Have now 85 15 —
Total .Current §_2_ ll 3;
White 82 17 1
Black 87 13 —
Under 35 45 55 —
35—49 77 21 2
50—64 91 9 -
65 and over 93 6 1
Male 77 23 '
Female 86 13

Seven out of ten of the "ever told" group and 82% of the total current group

reported they had medicine prescribed , with the proportion increas ing with age and highe':

among blacks than whites and higher among women than men. In practically every

case (over 99.5%) where medicine was taken it was a doctor who prescribed the

medicine .

Only 2% of the ever told group (rising to 6% among those who now

have high blood pressure) indicated that medicine had been prescribed for

them even though they never take it:

94

Q.22b

WAS MEDICINE FOR HIGH BLOOD PRESSURE EVER PRESCRIBED
(Base: Never taken medicine or not sure = 30% of
ever told had high blood pressure)

High Blood Pressure

 

 

Ever Been Have Total
Told Now Current
2 X %
was prescribed 2 6 3
Not prescribed 96 94 95
Not sure 2 — 2

Among hypertensives who have taken medication for their high blood

pressure, a majority said theyaare still taking it:

 

95

Q.23c

ARE YOU STILL TAKING MEDICINE
(Base: Taken medicine = 70% of ever t01d
had high blood pressure)

 

Still Not
Taking It Taking_lt
% 2
High Blood Pressure
Ever been told 66 34
Have now 86 14
Total Current 11 2;
Under 35 52 48
35—49 69 31
50-64 78 22
65 and over 83 17

Observation:

Forty-eight percent of those taking medicine in the under 35
total current group have stopped taking it compared with only
17% of the 65 and over total current group. It is likely

that the older group has more severe hypertension, requiring
and perhaps motivating them to continue the use of medication.

Among those who have stopped taking medicine, a majority stopped
because the doétor told them they no longer needed the medicine, although
over 20% appear to have made the decision on their own because they didn't
feel they needed it anymore, with this proportion rising to 33% among
50-64 year olds. Young hypertnesives are more likely than old hyperten-
sives to complain of side effects, although for all groups, the proportion

citing this as a reason for stopping the medication is low:

96

Q.23e

WHY STOPPED TAKING MEDICINE
(Base: Stopped taking medicine = 24% of ever
told had high blood pressure)

High Blood Pressure

 

 

 

Current
Ever Been Under 65
Told Total 35 35~49 50-64 and Over
Z 1 1 % Z Z

Doctor told me to stop

because blood pressure was

normal, did not need it

anymore 54 51 52 51 49 54
I didn't feel I needed it

anymore 24 21 14 13 33 19
Doctor told me to stop (no

reason given by respondent) 8 10 9 l6 6 9
Made me sick - bad side

effects 3 3 7 5 l -
Other 13 16 19 15 11 21

The great majority (around 90%) of those who have taken medicine
said they took it (or are taking it) at least once a day, and approximately

four in ten took it even more frequently:

97

 

 

Q.24a
HOW OFTEN EVER TAKE MEDICINE *
(Base: Taken medicine = 70% of ever told had high blood pressure)
High Blood Pressure
Current
Still
Ever Been Have Taking
Told Now Total Medicine
Z Z Z Z
More than once a day 40 47 40 39
Once a day 50 48 51 52
Couple of times a week 4 3 5 6
Less often 3 2 3 3
Not sure 3 * l -

 

* Except for the column labeled "still taking medicine”, responses are for
both those who are now taking it and those who stopped.

Apparently, forgetting to take their medicine is a problem for only a small
group of hypertens ives. Only 13% of the total current group who have ever taken medicine
said they either often or sometimes forgot to take their medicine, although

the proportion tends to be somewhat higher among the young and among blacks:

Q.25a

HOW OFTEN FORGET TO TAKE MEDICINE*
(Base: Taken medicine = 70% of ever told had high blood pressure)

Some— Occa— Almost Not

Often times sionallx Never Sure
Z Z Z Z Z

High Blood Pressure
Ever been told 4 10 15 7o 1
Have now 4 9 19 68
Total Current 1 2. ll 2.0. 1
White 3 8 17 72 *
Black 8 13 18 61 -
Under 35 12 12 16 60 -
35—49 6 16 17 60 1
50-64 3 11 15 71 -
65 and over 2 5 17 76 -
Still taking medicine 3 8 18 71 *
* Except for the row labeled "still taking medicine”, responses are for

both those who are now taking it and those who stopped.

98

Nor do mosthypertensives reportbeingbotheredbythedrugtheytake.Only

around 15% said there were side effects from the medication they took for high

blood pressure, although the proportion is higher among the "have now" group

and among blacks and the young (who presumably have been taking the drug a shorter

period of time than have older hypertensives) in the total current group*:

*It is possible that some side effects were mistaken for disease symptoms and
therefore not reported in response to this question.

Q.25b

DOES MEDICINE HAVE SIDE EFFECTS*
(Base: Taken medicine = 70% of ever told had high blood pressure)

Has Side No Side Not

 

Effects Effects Sure
% Z 2
High Blood Pressure

Ever been told 15 82 3
Have now 22 75 3
Total_Current ;§_ §g I;
White 15 83 2
Black 20 78 2
Under 35 34 66 -
35—49 23 75 2
50—64 13 85 2
65 and over 13 85 2
Still taking medicine 15 83 2

* ’ ExCept'for the rOw» labeled "still taking medicine", responses are for
both those who are now taking it and those who stopped.

Practically all who are taking medicine say they pay for it

themselves:

100

 

 

Q.26a
HOW MUCH PERSONALLY HAVE TO PAY FOR MEDICINE PER MONTH*
(Base: Taken medicine = 70% of ever told had high blood pressure)
High Blood Pressure
Current
I I Still
Ever Been Have Taking
Told Now Total I White Black Medicine
Z Z Z I Z Z | 2
Nothing 10 11 9 ' 5 23 ' 11
l |
Less than $5.00 27 18 27 I 30 17 I 28
$5.00-$9.99 28 36 31 I 31 26 | 29
$10.oo—$19.99 14 19 15 ' 16 15 ' 17
I I
$20.00 and over 6 8 6 I 6 7 1 6
Not sure 15 8 12 l 12 12 I 9

 

Median (excluding "nothing") $6.80 $8.15 $7.07 $6.91 $7.99 $7.19

* Except for the column labeled "still taking medicine", responses are for both
those who are now taking it and those who stopped.

Among those now taking medicine and paying for it the median monthly
cost reported is $7. 19. It is interesting that, while a higher proportion of blacks than
whites do not personally pay for the medicine, among those who do the median
monthly cost is significantly higher for blacks ($7.99) than for whites ($6.91).

Only a slim majority of those paying (or who paid) for their medicine
feel it is good value for the money, while approximately four in ten say it

is more expensive than it should be:

Q.26b

101

IS MEDICINE GOOD VALUE FOR WHAT PAY*
(Base: Taken medicine and paid for it = 63% of "ever
told had high blood pressure" group)

High Blood Pressure

 

 

Current
Still
Ever Been Have Taking
Told Now Total Medicine
Z Z % Z
More expensive than
should be 35 43 39 39
Good value for what
paid 55 51 54 55
Not sure 10 6 7 6

 

* Except for the column labeled "still taking medicine”, responses
are for both those who are now taking it and those who stopped.

M2222:

While a majority of hypertensives who have had medicine prescribed
for them continue to take it and do so regularly and apparently
without mentioning any side effects, there is moderate dissatis-
faction with the amount they must pay for this medicine. Whether
this dissatisfaction would ever make many hypertensives give up
their medicine cannot be ascertained from this survey, but it is

a possibility, and some effort should be made to either hold the
line or reduce the cost of high blood pressure medicine.

102

The Use Of Salt In The Diet

The survey also examined the extent to which hypertensives used
other techniques which might help lower their blood pressure. In particular
the use of salt in the diet, of keeping one's weight down and of giving up
smoking were studied. ’In this section salt usage is examined.

Over one in three hypertensives said they 9:523 add salt to their

food, either in cooking or at the table:

Q.28a

HOW OFTEN ADD SALT TO FOOD, EITHER IN COOKING OR AT THE TABLE
(Base: Ever told had high blood pressure)

Some- Occasion- Almost

 

Often times ally Never
% Z % %
High Blood Pressure
Ever been told 38 14 18 30
Have now 35 15 18 32
Total Current 35 14 l§ 3;
White 36 14 18 32
Black 32 13 17 38
Under 35 60 13 15 12
35 to 49 41 14 '22 23
50 to 64 30 15 17 38
65 and over 28 12 18 42
Male 38 13 20 29
Female 34 14 17 35
Not high school grad 32 12 19 37
High school grad. 35 15 18 32

College grad and over 61 18 ll 11

103

At the other end of the scale, only about one in three hypertensives
say they almost never add salt to their food.

The frequent use of salt is most prevalent among the young (60% often
add it to their food) and the college educated (61% often).

Over half of the hypertensives (ranging from 51% of the ”ever told”

group to 64% of the "have now" group) say they have been told to eat less salt

because of their high blood pressure:

Q.28b

EVER TOLD TO EAT LESS SALT
(Base: Ever told had high blood pressure)

 

Ever Told To Not Told To
Eat Less Salt ‘ Eat Less Salt Not Sure
Z Z %
High Blood Pressure
Ever been told 51 47 2
Have nmv 64 35 1

Total Current

U1
\l
.l.\
N

||-'

White ‘

53 »46 1
Black 75 23 2
Under 35 53 46 1
35-49 55 43 2
50-64 61 38 1
65 and over 53 45 2
Male 51 47 2
Female 59 40 1
Not high school grad 60' 38 2
High school grad 52 46 2

College grad and over 47 53

104

In certain groups, apparently this advice has not been taken to
heart. This seems to be particularly the case with the young -- 53% of
them have been told to eat less salt but 60% still add salt to their food
often.
Nevertheless, as the next table indicates, this advice has had for
the most part some impact:
FREQUENCY OF ADDING SALT BY WHETHER OR NOT TOLD TO EAT LESS SALT AND

KNOWLEDGE OF THE BENEFITS OF A LOW SALT DIET
(Base: Ever told had high blood pressure)

 

 

 

Benefits of Low Salt Diet
I , Other Than
Help High lDefinitely Definitely
Told to Not Told Blood IHeln High Help High
Eat Less to Eat Pressure I Blood Blood
Salt Less Salt (volunteeredD Pressure Pressure
2 Z % I Z Z
I
Add salt to food: I
I
Often 28 49 31 I 36 46
Sometimes 13 15 15 : 12 19
Occasionally 20 l6 14 | l9 14
Almost never 39 20 40 : 33 21
l

Observation:

Once an individual has been told to eat less salt because of his
high blood pressure, he is far less inclined to frequently add
salt to his food than is someone who has not been given this
advice.

105

The last three columns of the table are interesting and also
suggest that in the use of salt, knowledge and reported behavior are
related.

The first column (of the last three in the table) represents the
responses of those in the "ever told group" who volunteered that a low salt
diet was helpful in controlling hypertension (see p.66 ). Among this group
only 31% said they often add salt to their food.

The second column (of the last three in the table) represents the
answers of those in the "ever told” group who, in response to a direct
question (p.67 ), said that a low salt diet definitely helped control high
blood pressure. Among this group 36% said they often add salt to their
food.

Finally, the last column of the table represents the answers of
those who answered other than definitely ("might help", ”would not help"
or "not sure”) to the direct question. Among this group, 46% said they
often add salt to their food.

Assuming that the "volunteered" group represents the highest
level of awareness of the benefits of a low salt diet, the ”definitely"
group a middle level of awareness and the "not definitely" group the lowest
level of awareness, then the higher the level of awareness the less likely;

one is to add salt to his food.

Weight Control

Each hypertensive* was asked if he or she felt they were now over-

weight and, if not, if they had ever felt overweight since they were an adult:

* This series would be more useful if it had been asked of everyone, not just
hypertensives. Unfortunately this was not done although it certainly should
be in any follow-up studies that are conducted.

106
Q.28c,d

FEEL OVERWEIGHT NOW OR BEFORE
(Base: Ever told had high blood pressure)

 

Don't Feel
Overweight
Feel Now, But Have
Overweight Felt Overweight Never Felt
Now in the Past Overweight
% Z %
High Blood Pressure
Ever been told 57 17 26
Have now 62 13 25
Total Current §§ 17 25
White 58 17 25
Black 51 22 27
Under 35 56 13 31
35-49 73 13 14
50-64 63 17 20
65 and over 45 21 34
Male 50 19 31
Female 63 16 21

Almost six in ten hypertensives feel they are now overwaight while
only one in four say that since they have been adults they have never felt
overweight.

Age and sex are closely related to this obesity feeling. Among the
total current group, women more than men and the 35-64 age group (particularly

35-49) more than those under 35 or 65 and over feel they are now overweight.

Those individuals who felt they were now overweight were next

asked if they were now on a weight losing diet for their blood pressure:

107

Q.28e

NOW ON WEIGHT LOSING DIET FOR HIGH BLOOD PRESSURE
(Base: 57% of ever told had high blood pressure who now feel overweight)

Now on Not on
Weight 4 Weight
Losing Losing
Diet Diet
High Blood Pressure Z Z
Ever been told 32 68
Have now 43 57
Total Current 36 64
White 35 65
Black 47 53
Under 35 36 64
35-49 36 64
50-64 39 61
65 and over 34 66
Benefits of Weight
Control Diet
Help high blood pressure
(volunteered) 41 59
Definitely help high
blood pressure 35 65
Otherthan definitely help
high blood pressure T 25 75

The proportion of those who now feel overweight and are currently
on a weight losing diet for their blood pressure remains below 50% for all
subgroups.

At the same time, as with the use of salt, knowledge of the benefits
of weight control and reported behavior appear to be related (last 3 lines

of the table).

Among hypertensives who volunteered that dieting is helpful in

controlling high blood pressure (p. 66) and who now feel overweight, the

proportion on a diet rises to 41%.

108

Similarly, when hypertensives who feel they are overweight are split
by their answers to the direct question as to whether dieting to control
weight helps high blood pressure (p. 67), 35% of those who responded
"definitely" said they are now on a diet compared with 25% of the "not
definitely" group (those who responded "might help", "would not help" or

"not sure”).

Observation:

Of course, even among those presumably more knowledgable over-
weight groups, the proportion now dieting stands well below 50%.

This conflict between awareness and the relatively low proportion
of overweight hypertensives on diets is another sign of the quiet
nature of the disease. Hypertensives don't feel bad; the effects
of the disease may not appear for many years and it must hardly

seem worthwhile giving up a good meal in return for so little
perceivable benefit.

Cigarette Smoking

The series on cigarette smoking was asked of everyone, not just of
hypertensives. In the table below the first column shows the percentage
who now smoke, the second column the percentage who have ever smoked and
the third column the proportion of those who have ever smoked who have given

up the habit:

109

 

Q.32a,b
SMOKE NOW, EVER SMOKED REGULARLY
(Base: Total)
:‘Proportion
: 0f Smokers
: Who Have
Smoke Ever : Given Up
Now~ §Eoked : Smoking
2 z i z
I
Total Q a E 35
I
White 36 57 i 36
Black 42 57 E 26
Other 40 59 : 33
I
Not high school grad 37 57 E 36
High school grad 41 59 : 31
College grad and over 29 53 : 46
I
Under $5,000 3.1 51 i 39
$5,000-$9,999 41 60 : 31
$10,000—$14,999 37 57 : 35
$15,000 and over 41 62 : 33
I
Under 35 42 58 E 27
35—49 45 65 : 31
50—64 37 58 : 36
65 and over 19 45 : 58
I
Male 44 71 E 38
Female 32 46 : 30
:
i
W :
I
Ever been told 30 53 E 42
Have HDW‘ 33 55 g 40
I
I
Total Current 22 2; E ii
I
Under 35 42 64 : 34
35-49 38 61 1 36
50—64 32 54 : 4o
65 and over 17 37 E 54
I
Male 41 76 : 46
Female _ 22 34 5 35
Not high school grad 30 48 E 38
High school grad 31 52 : 40
College grad and over 24 62 : 59
I
Not smoking definitely :
helps control high blood :
pressure 28 54 : 48
I
Other than notsmoking defini- :
tely helps control high :
blood pressure 32 51 : 41
I

110

Thirty-seven percent of the total adult public now smoke compared
with 57% who have ever smoked. This means that just over one-third (35%) of

former smokers have stopped.

~Relatively more blacks than whites now smoke, and blacks have been
least likely of any group to have stopped smoking. A smaller proportion of
college graduates than those with less education now smokeandtheyareumrelikely
to have given it up. More men than women now smoke; but starting froma s ignificant 1y
higher level of former smokers , men are also more likely to have stopped smoking. By age
there is not a great deal of difference in smoking levels until one reaches
the age of 65, at which point the proportion who currently smoke drops off
'sharply (to 19%). Over half (58%) of former smokers 65 and over have stopped
smoking.

Compared with the general publig fewer hypertensives now smoke and
a higher proportion have stepped smoking.

Age and sex are the sharpest determinants of smoking behavior.
Essentially the same proportion of hypertensives under 35 and 65 or over smoke
as is found in the general public,but there tend nabefewersmokersamong hyper-
tensives in the middle years. Similarly, essentially the same proportion of
smokers exists among male hypertensives as exists in the total population,while
the proportion of smokers among female hypertensives is lower than among females

in the total population.

111

Observation:

The relationship between knowledge of smoking's possible

effects and reported behavior is apparently not as strong as it
is for obesity and the use of salt, although it does exist.
Among hypertensives who in answer to a direct question, (p. 67)
said that stopping smoking ”definitely" helped control high
blood pressure,28% now smoke. Among those who did not answer
"definitely" ("might help", "would not help" or "not sure”),

the proportiOn of smokers stands only slightly higher at 32%.

At the same time, however, a higher proportion of the definitely
group have given up smoking (48% in the Pdefinitely" group compared
with 41% in the "not definitely" group).

As the next table indicates, almost 75% of current smokers
smoke more than a half pack a day, with little difference between the

total population and hypertensives:

112‘

 

Q.32c
NUMBER OF CIGARETTES PER DAY NOW SMOKE
(Base: New smoke = 37% of total)
1~5 OVer 1,
Cigar- to 2’ Over 2
ettes 6—10 11—20 Packs Packs

Z Z 2 Z %

____T0ta1 .19 E 3_9_, £3. 2
White 9 14 39 33 5
Black 17 28 35 18 2
Other 27 19 40 14 -
Under 35 11 17 41 26 5
35-49 9 14 35 37 5
50n64” 9 14 39 33 5

65 and over 16 22 39 20 3
Male 9 ll 40 34 6
Female 13 21 38 26 2

High Blood Pressure

Ever been told 10 17 37 33 3
Have now» 11 17 34 38 ~

Total Current 9 18 36 36 1

113

Observation

Smokers are not particularly happy with their habit.
Seventy-three percent of current smokers (74% among
hypertensive smokers) say they have tried to cut out

or reduce the number of cigarettes they smoke.

Doctors, though, do not seem to be particularly active

in dissuading people from smoking. For the total group

of current smokers only 34% say their doctor advised them
to quit or cut down,and among former smokers in the total
population the proportion is even lower -- 23%.

The picture is somewhat more encouraging for current hyper-
tensives who now smoke. An even 50% say their doctor advised

them to quit or cut down. But among those who have given it
up, the proportion, as with the total public, is lower -- 39%.

How Has High Blood Pressure Affected The Lives Of Hypertensives

The possible effects of high blood pressure were tested in three
different ways. First each individual was asked if she or he had ever had
any of the diseases associated with high blood pressure. Second, each person
was asked whether she/he had been away from work or usual daily activities
for any length of time and,if so, how long, and had they been hospitalized.
Finally, each hypertensive was asked Whether her/his job situation or ability'to
obtain insurance had been affected in any way by high blood pressure. The results
to this series of questions are presented below.

1) Associated illnesses -— the picture is relatively straight-
forward. As indicated in the next tables hypertensives report higher

prevalence of diabetes, heart attacks and strokes than does the general public:

114

Q.33a

EVER TOLD HAD DIABETES, SUGAR IN URINE 0R HIGH BLOOD SUGAR
(Base: Total)

Totd Had
Sugar In
Told Had Urine 0r High
Diabetes Blood Sugar Not Told

 

Z A A
Total _4_ 4 2g
White 4 4 92
Black 4 4 92
Other 1 2 97
Under 35 l 3 96
35—49 3 4 93
50-64 5 6 89
65 and over 8 4 88
Male 4 3 93
Female 4 4 92
High Blood Pressure
Ever been told 8 5 87
Have n0W’ ll 4 85
Total Current 2 2 fig
White 8 5 87
Black 10 7 83
Under 35 2 .8 90
35—49 7 6 87
50—64 10 7 83
65 and over 11 4 85

115

 

Q.33c
EVER TOLD HAD HEART ATTACK
(Base: Total)
Told Had Not Told Had
Heart ’Attack Heart Attack
2' Z
Total 2 22
White 5 95
Black 5 95
Other 1 99
Told Had
Not high school grad 7 Heart Attack 93
High school grad 3 Male "Female 97
College grad and over 4 Z Z 96
Under 35 * * * 100
35-49 3 3 4 97
50—64 8 ll 5 92
65 and over 11 13 10 89
Male 6 94
Female 4 96
High Blood Pres3ure
Ever been told 10 90
Have now 15 85
Total current lg 88
Under 35 2 * 2 98
35-49 9 8 6 91
50-64 16 4 9 84
65 and over 14 17 10 86
Male 18 82
Female 8 92

Q.33d
HOW MANY HEART ATTACKS HAVE YOU HAD
(Base: Had heart attack = 5% of total)

Ever Been Told

 

Total Had’HEgh Blood Pressure
Z 2
One 53 49
Two 21 23
More than two 23 24

Not sure 3 4

(2.34%

EVER TOLD HAD STROKE
(Base: Total)
Told
Had

Stroke

1
Total 3
Under 35 1
35-49 1
50-64 3
65 and over 7
High Blood Pressure

Ever been told ‘ 7
Have now 8
Total Current §
Under 35 3
35-49 3
50-64 8
65 and over 13

Not Told

Had Stroke

%

116

117

--- Fifteen percent of current hypertensives compared with 8%
of the general public have been told they either have diabetes, high
blood sugar or sugar in their urine.

--- Ten percent of current hypertensives compared with 5% of the
general public report they have had a heart attack (just about half of
each group reporting more than one heart attack).

--- Eight percent of current hypertensives compared with 2% of the

general public report having had a stroke.

JObservation

The fact that hypertensives as a group tend to be somewhat
older than the general public does not fully account for the
above differences. As the above tables indicate, the incidence

of each disease is higher in every age group among hypertensives
than it is in the same age groups in the general public.

2) Time away from work or usual activities -- Over half (56%) of
the general public and of current hypertensives indicated that they were
not forced to be away from work or unable to carry out their usual daily
activities-because of illness, injury or disability or hospitalization at
anytime during the past 12 months. However, among those who were away from
work or their usual activities the average number of days away (see column
labeled "average-excluding none") was reported to be 26 days for the

general public and a far higher 51 days for current hypertensives:

118

Q.3Sa

DAYS AWAY FROM WORK 0R USUAL ACTIVITIES DUE TO ILLNESS, INJURY, DISABILITY
0R HOSPITALIZAIION DURING LAST 12 MONTHS

(Base: Total)

 

 

Days Average Number of Daze
More Not (Excluding (Including
None 1-7 8-14 than 14’ Sure None) None)
Z Z Z Z Z '

_T__ota1 22 .22 _6 19 a a 1.1.
White 54 27 6 11 2 24 11
Black 64 16 5 12 3 46 17
Other 57 29 5 8 1 25 11
Not high school grad 61 17 5 14 3 41 16
High school grad 57 27 7 8 l 20 9
College grad and\over 52 36 4 6 2 15 7
Under 35 47 35 7 10 1 14 7
35—49 54 27 6 11 2 20 9
50—64 60 20 6 11 3 46 18
65 and over 71 9 5 13 2 49 14
Male 60 24 5 9 2 30 12
Female 55 25 7 11 22 10

High Blood Pressure
Ever been told 55 20 7 15 3 42 19
Have now 54 16 7 18 5 60 28
Total Current 5_6_ E l l_6_ 5 fl _2_2_
White 57 16 7 15 5 47 20
Black 56 14 7 18 5 56 25
Under 35 ’43 23 ll 19 4 26 15
35-49 52 23 9 14 2 26 12
50-64 62 12 5 14 7 78 3O
65 and over 63 ll 6 l6 4 59 22
Male 55 16 9 15 5 61 27
Female 62 14 6 14 4 43 16
Not high school grad 59 12 6 18 5 61 25
High school grad 56 18 9 13 3 37 16
College grad and over 51 26 3 14 6 55 27

 

119

Among both the general public and hypertensives the average days
away from work tend to be higher among blacks than whites (although the difference
by race is much smaller for hypertensives than for the general public) and higher

for men than women.

Observation

The most fascinating aspect of the above table can be seen by
examining the dimension of age. The average number of days
away from work (excluding none) rises dramatically with in-
creasing age. For the general public the range is from 14
days for those under 35,to 49 days for the 65 and over group.
Similarly for current hypertensives, the range is from 26 days
for the under 35 group,to 59 days for the 65 and ovér group.

But equally dramatic is the increase with age in the proportion
who say they have had no time away from work on their usual
daily activities. In the general public the range by age is
47% to 71% and among current hypertensives the range is from
43% to 63%.

Obviously this pattern is not a result of health improving with
age but rather of life styles varying with increasing age. As

one moves into middle age there is likely to be greater obligation
and commitment to one's activities and greater reluctance to
skip these activities. As one moves beyond these middle years

the level of activity generally declines -- one has less to give
up and, with increasing number of ailments, becomes more'used t0
functioning when not in perfect health.

Of those who were away from work or their usual activities during the
past 12 months,three in four in the general public (74%) and 85% among hyper-
tensives reported they gotprofessional medical care during this period of

inactivity:

120
Q.35b

DID YOU GET PROFESSIONAL MEDICAL CARE DURING THIS TIME
(Base: Away from work = 44% of total)

 

Got Did Not Get

Professional Professional

Medical Care Medical Care
7, "A,
Total 7_4 E
White 73 27
Black 81 19
Other » 76 24
Not high school grad 80 20
High school grad 74 26
College grad and over 61 39
Under 35 71 29
35 to 49 72 28
50 to 64 75 25
65 and over 88 12
Male 71 29
Female 77 23

High Blood Pressure

Ever been told 80 20
Have now 85 15
Total Current §§ E
White 84 16
Black 92 8
Under 35 76 24
35 to 49 89 11
50 to 64 82 18
65 and over 92 8
Male 79 21
Female 90 10
Not high school grad 89 11
High school grad 81 19

College grad and over 84 16

121

As the next table indicates,just over one in five (21%) current
hypertensives who were away from work or their usual daily activities

indicated that at least part of this time it was because of their high blood

pressure:

Q.35cn

WAS ANY TIME AWAY FROM WORK OR USUAL ACTIVITIES PRIMARILY BECAUSE OF HIGH BLOOD PRESSURE

(Base: Time away from work or usual activities = 45% of ever told had high blood pressure)

 

Primarily Not Primarily

Because of Because of

High Blood High Blood

Pressure PresSure Not Sure
Z Z 2
High Blood Pressure

‘Ever been told 16 82 2
Have now 26 7O 4
Total Current 21 ll 2_
White 15 83 2
Black 45 52 3
Under 35 18 80 2
35-49 21 79 —
50-64 26 70 4
65 and over 16 82 2
Male 21 78 1
Female 20 77 3

122

The proportion of hypertensives away from work or their usual
activities is slightly higher in the 50-64 age group than in other age
groups. The sharpest variation, however, is by race. While only 15% of
white hypertensives away from work or their usual activities attribute
the cause to high blood pressure, among blacks the proportion rises to 45%.

As the next table indicates, the average number of days away
from work or their usual activity is significantly higher for hypertensives
who said the break in their routine was primarily because of high blood

preSsure than among those who said it was caused by something else:

AVERAGE DAYS AWAY FROM WORK OR USUAL ACTIVITIES
(Base: Time away from work or usual activity = 45% of ever
told had high blood pressure)

Average Days
(excluding none)
%

Total 33

Primarily because of high
blood pressure 81

Not primarily because of
high blood pressure 39

123

Overall 17% of the total public and a similar 19% of current
hypertensives report having been a patient* in a hospital during the last
12 months. Just about eight out of ten among both general public patients
and hypertensive patients were in the hospital only once during the year.
The total number of days spent in the hospital averaged 12 days for the

general public and a higher 15 days for current hypertnesives:

Q.35d

WERE YOU A PATIENT IN A HOSPITAL DURING LAST 12 MONTHS
(Base: Total)

Was Not a
Patient Patient
% %
Total 11 fig
Under 35 19 81
35-49 15 85
50-64 17 83
65 and over 16 84
High Blood Pressure

Ever been told 20 80
Have now 21 79
Total Current lg g;
Under 35 29 71
35-49 18' 82
50-64 17 83
65 and over 16 84

 

* "Patient" was defined as having "to stay overnight in the hospital".

124

 

Q.35e
NUMBER OF DIFFERENT TIMES IN HOSPITAL
(Base: In hospital = 17% of total)
Two Three or
Once Times More Times
% % Z
Total §9 12 1
Under 35 82 12 6
35-49 78 16 6
50-64 76 12 12
65 and over 77 15 8
High Blood Pressure
Ever been told 77 17 6
Have now 86 5 9
Total Current 12 14 1
Under 35 72 14 14
35-49 89 7 4‘
50-64 74 14 12

65 and over 79 19 2

125

 

Q.35f
NUMBER OF DAYS IN HOSPITAL
(Base: In hospital = 17% of total)
1 Average Days
1—7 8-14 More Than I in Hospital
Days Days 14 Days 1 (Excluding None)
1 1 2 i #
I
Total 57 22 21 : 12
_____ __ __ __ . __
I
Under 35 74 18 8 : 8
35-49 63 17 20 i 11
50-64 46 25 29 l 17
65 and over 32 32 36 l 16
I
I
High Blood Pressure }
I
I
Ever been told 47 27 26 l 14
Have now 49 27 24 i \ 14
l
I
I
{
Total Current £2 22 2g 3 12
I
Under 35 60 7 33 : 16
35-49 60 27 13 : 11
50-64 40 27 33 i 20
65 and over 31 46 23 i 14
I
I

126

Among the general public, the proportion who report having been a patient
in a hospital does not appear to vary by age -- although the average number
of days in hospitals is twice as long for older patients as it is for younger
patients. However, among current hypertensives a higher proportion (29%) of
patients is found in the under 35 group than among those 35 and over (17%).

As the next table indicates, just under one in five (18%) current
hypertensives who were patients said that they had been hospitalized specifically
for the treatment of high blood pressure, with again a sharp difference by race

(13% white, 40% blacks);

Q.35g

ANY HOSPITALIZATION SPECIFICALLY FOR TREATMENT OF HIGH BLOOD PRESSURE
(Base: Patient in hospital in last 12 months = 20% of
ever told had high blood pressure)

 

Was For Treat- Not For Treat-

ment Of High ment of High Not

Blood Pressure Blood Pressure Sure

Z Z Z
High Blood Pressure

Ever been told 13 86 1
Have now 19 79 2
Current Total fl 8_0 2
White 13 85 2
Black 40 58 2
Under 35 13 87 -
35—49 22 78 -
50—64 15 80
65 and over 18 82 -
Male 22 76 2

Female 15 83 2

127

3) Job situation and Insurance -- Although hypertensives have a
higherprevalenceof diabetes, stroke and heart attacks and longer periods
away from work or their usual activities when sick than does the general
public, there does not appear to have been any significant repercussions
on a job because of their high blood pressure:

--- Only 5% of current hypertensives report having quit a job
because of their high blood pressure.

__- Less than % of 1% said theyhaveeverbeenfired from a job or
refused a promotion because of their high blood pressure.

Similarly the ability of hypertensives to obtain life or health-medical
insurance has been only slightly restricted. Among current hypertensives who
have applied for insurance (76% of the total current group) only 11% said they
have been unable to get the insurance because of their high blood pressure
(the proportions are 8% for the ever told group, 13% for the have now group

and a higher 17% for college graduates):

EVER UNABLE TO GET LIFE 0R HEALTH-MEDICAL
INSURANCE BECAUSE OF HIGH BLOOD PRESSURE
(Base: Ever told had high blood pressure and applied for insurance)

 

 

Unable To Able To
Get Insurance Get Insurance (Applied)

% Z (Z )

Ever Told Had High Blood Pressure § 2g (79!
Have now 13 87 (76)
Total Current _1 §2 (76)
Under 35 6 94 (85)
35-49 , 8 92 (79)
50-64 14 86 (76)
65 and over 11 89 (72)
Male 14 86 (78)
Female 8 92 (76)
Not high school grad 11 89 (77)
High school grad 8 92 (80)

College grad and over 17 83 (84)

Awareness 0f Hypertension

\

128

It is worth closing this chapter on a note which re-emphasizes the

need for an educational campaign on highblood pressure. Although, ashas been

mentioned numerous times, high blood pressure is generally asymptomatic,

nevertheless a significant majority of hypertensives believe they can tell

when their pressure is high:

Q.27a

CAN YOU TELL WHEN YOUR BLOOD PRESSURE IS HIGH
(Base: 'Ever told had high blood pressure‘)

High Blood Pressure

Ever been told
Have now

Total Current

White
Black

Under 35
35—49

50-64

65 and over

Male
Female

Not high school grad
High school grad
College grad and over

 

Cannot Not

Can Tell Tell Sure
Z Z Z
63 32 5
72 26 2
6_9 2_7 i
68 28 4
79 19 2
73 23 4
78 18 4
71 24 5
60 36 4
65 33 2
72 23 5
72 24 4
69 27 4
46 52 2

129

The proportion ranges from 63% of the ever told group through 69%
of the total current group to 72% of the have now group. Among total current
hypertensives blacks more than whites, women more than men,and those with less
education are most likely to feel they can tell when their blood pressure is
high. Only among college graduates does a slim majority (52%) say they cannot
tell when their blood pressure is up.

When asked what these recognizable symptoms were, dizziness, headaches,

feeling nervous and getting flushed or tired were mentioned most often.

W

The last three rows of the table are particulary disturbing. They
present the ansers to the above question based upon responses to an
earlier question on the likelihood of having high blood pressure
without obvious symptoms (p. 58). While it is true that the more
one recognizes that hypertension can exist without overt symptoms
the less likely he is to say he can tell when his blood pressure

is high, nevertheless, even among those hypertensives most
convinced that overt symptoms need not be present (the ”very
likely" group), over half (56%) say they can indeed tell when

their pressure is high.*

Luckily 76% of hypertensives who feel they can recognize the
symptoms and are taking medicine for their blood pressure, say
that they continue to take the medicine even when they don't
feel their pressure is high.

But this is small comfort. The problem of hypertension in our
society is enormously complicated by the quiet, insidious nature
of the disease, and when even a majority of hypertensives do not
recognize its often silent nature it becomes clear that a major
information and education campaign is needed.

* It is possible, of course, that hypertensives may have certain of these symptoms
or a vague awareness of increased blood pressure. More research into the
reliability of these feelings or symptoms as an indication of when an individual's
blood pressure is high is clearly needed.

 

APPENDIX

 

133

Since this study is based on a sample, the percentages shown
in this report may differ from those that would have been obtained if a
complete census had been taken. The standard error is a measure of
sampling variability, that is, of the variations that occur by chance
because a sample rather than the entire population was surveyed. The
chances are about 95 out of 100 that an estimated percentage in a sample
selected,as was the one used in this survey would differ from the
complete census figure by less than twice the standard error.

In general, for a particular sample design, the standard error
of an estimated percentage decreases as the sample size increases. As a
corollary to this, the standard errors for the various analytic groups
vary in relationship to the relative numbers of each analytic group in the
sample; the greater the number of interviews, the smaller the standard
error.

Furthermore the standard errors decrease as the estimated
percentage deviates from the 50 percent level. At the 30 percent or 70
percent level, the standard errors are 92 percent of what they are at the
50 percent level;at the 10 percent or 90 percent level, the standard

errors are only 60 percent of the 50 percent values.

The following table shows the values of two standard errors
(rounded to the nearest full percent) for estimated percentages at three
levels (50 percent; 30 or 70 percent; 10 or 90 percent) for each of the
analytic groups used in this study. To allow for the effect due to having a
clustered random sample rather than a simple random sample of the same
size, a factor of an extra 10 percent has been built into the

.celculations. As mentioned above, in 95 times out of 100, the complete

134

census percentage will fall within the estimated percentage plus or

minus the associated standard error value taken from this table. Hence,
adding and subtracting the values from the estimated percentages found in
the report will give "95 percent confidence limits" on the estimate of

the complete census percentages.

Race

Education

Income

Age

Sex

Size of
Place

Region

1..
2-
3.

SAMPLE ERROR

Total cross-section

White
Black
Other

Not high school graduate, completed
0—11 years of schooling

High school graduate, completed
high school (12 years) and up
to 3 years of college

College graduate and over,
completed 4 or more years of
college

Under $5,000, total household
‘income for 1972 before taxes
$5,000-$9,999, total household
income for 1972 before taxes
$10,000-$14,999, total household
income for 1972 before taxes
$15,000 and over, total household
income for 1972 before taxes

Under 35, ages 17 thru 34
35-49

50-64

65 or older

Male
Female

Cities: central cities in urbanized
areas (generally 50,000 or more)

Suburbs: urbanized areas outside
central cities

Towns: other urban places of
2,500 or more

Rural: anything not included above

East
Midwest
South
West

Percentage Levels

 

 

Number 30% or 10% or

in Sample 50% 70% 90%
3867 2 2 1
2829 2 2 l
895 4 3 2
132 9 9 5
1646 3 3 2
1736 3 2 2
466 5 5 3
1030 4 3 2
1161 3 3 2
794 4 4 2
713 4 4 3
1348 3 3 2
961 4 3 2
819 4 4 2
690 4 4 3
1823 3 2 2
2044 3 2 2
1312 3 3 2
865 4 4 2
552 5 5 3
1138 3 3 2
999 4 4 2
1011 4 3 2
1249 3 3 2
608 5 4 3

135

136

Percentage Levels

 

Number 30% or 10% or
In Sample 50% 70% 90%
High Blood Pressure
Ever been told - respondents who indicated they
had ever been told they had high blood pressure,
whether or not they still felt they had it 1204 3 3 2
1. Have now - respondents who said their blood
pressure was still high 310 7 6 4
2. Total current - respondents who said their
blood pressure was still high 9; who had
been told on more than one occasion that
their blood pressure was high (and were not
pregnant on'at least one of those occasions)
23 who were now taking medication for high
blood pressure 878 4 4 2
a. Total current race - White 551 5 4 3
Black 299 6 6 4
b. Total current age - Under 35 130 10 10 6
35-49 178 9 8 6
50-64 279 7 6 4
65 and over 283 7 6 4
c. Total current sex - Male 332 6 6 4
Female 546 5 5 3
d. Total current education - Not high school
graduate 524 5 5 3
High school grad-
uate 287 7 6 4

College graduate
and over 64 14 13 9

 

 

U.C. BERKELEY LIBRARIES

  \IIIIIIIIIIIIIII“

CDE‘IEBHTEB

DHEW Publication No. (NIH) 74—356
U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
Public Health Service

National Institutes of Health

Bethesda, Md. 20014