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Am J Hypertens. 2012 Mar;25(3):348-53. doi: 10.1038/ajh.2011.252. Epub 2012 Jan 12.

Health literacy associated with blood pressure but not other cardiovascular disease risk factors among dialysis patients.

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  • 1Division of Renal, Electrolyte and Hypertension, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.



Limited health literacy is prevalent and has been linked to adverse patient outcomes. We examined the relationship between health literacy and cardiovascular disease (CVD) risk factors, including blood pressure (BP) parameters, lipids, waist-to-hip ratio (WHR), body mass index (BMI), and tobacco utilization among dialysis patients.


We conducted a cross-sectional study of 72 participants in a prospective cohort study of vascular calcification in newly initiated dialysis patients. Health literacy was assessed using the Short Test of Functional Health Literacy (S-TOFHLA) in Adults. The study population was dichotomized into those with and without adequate literacy. Linear and logistic regression analyses were used to predict continuous and dichotomous cardiovascular risk factor variables, respectively.


Twenty-one percent had limited health literacy. Compared to limited health literacy, adequate health literacy was associated with lower BP parameters in multivariable analyses (systolic blood pressure (SBP): β -16.8, s.e. 6.7, P = 0.01; diastolic blood pressure (DBP): β -13.8, s.e. 4.1, P = 0.001; mean arterial pressure (MAP): β -14.8, s.e. 4.6, P = 0.002). Health literacy was not a statistically significant predictor of low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides, WHR, BMI, or tobacco utilization.


Limited health literacy is common in individuals on dialysis. Individuals with adequate health literacy skills had DBP readings that were on average 13.8 mm Hg lower and MAP that was 14.8 mm Hg lower than those with inadequate health literacy. Prospective studies to elucidate if improvements in health literacy skills will lead to improvement in BP control are needed.

© 2012 American Journal of Hypertension, Ltd.

[PubMed - indexed for MEDLINE]
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