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Abstract: TH-PO527

Health Literacy and Blood Pressure Control in Individuals with CKD

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 307 CKD: Health Services, Disparities, Prevention


  • Kambhampati, Rekha, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Kuczmarski, Marie, University of Delaware, Newark, Delaware, United States
  • McAdams-DeMarco, Mara, Johns Hopkins, Baltimore, Maryland, United States
  • Han, Dingfen, Johns Hopkins, Baltimore, Maryland, United States
  • Zonderman, Alan B., Intramural Research Program, NIA, NIH, Baltimore, Maryland, United States
  • Evans, Michele Kim, National Institutes of Health/National Institute on Aging, Baltimore, Maryland, United States
  • Crews, Deidra C., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Low health literacy is associated with poor clinical outcomes, including worse blood pressure (BP) control. The relation between health literacy and BP control among those with CKD is unknown. We examined this relation among participants in the Baltimore-based Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study.


Cross-sectional analyses were conducted of 276 HANDLS participants with CKD (eGFR <60 mL/min/1.73m2 and/or urine albumin:creatinine ratio (ACR) of ≥30 mg/gm). Health literacy was defined by a Rapid Estimate of Adult Literacy in Medicine (REALM) score of ≤60 (lower) versus >60 (high). Multivariable logistic regression was used to assess the association of health literacy with BP control (systolic BP <140 mm Hg and diastolic BP <90 mm Hg) and linear regression was used to assess health literacy and systolic BP level among persons with self-reported hypertension.


Participants’ mean age was 56.4 years. At baseline, 134 (48.6%) had lower health literacy. Those with lower health literacy were more likely to be female (54.5%), African American (81.3%), and living in poverty (56.0%) than those with high health literacy (p <0.05 for all). Both literacy groups had similar levels of education, smoking status, eGFR, and self-reported hypertension and diabetes. A total of 105 (33.5%) had uncontrolled BP. Results of the multivariable regression models are found in the table.


Lower health literacy is associated with uncontrolled BP among persons with CKD. Addressing health literacy to improve risk factor control among CKD patients is worthy of further investigation.

Association of Lower Health Literacy (versus High Health Literacy) and BP Control
ModelOdds of BP control
(OR (95% CI))
SBP continuous
(B coefficient (95% CI))
1- Unadjusted2.02 (1.26, 3.24)9.70 mm Hg (1.97, 17.44)
2 – Adjustment for age, sex, race, poverty status, education2.07 (1.26, 3.41)9.48 mm Hg (1.23, 17.72)
3 – Model 2 + adjustment for diabetes and smoking status2.15 (1.24, 3.73)11.59 mm Hg (2.28, 20.91)
4 – Model 3 + adjustment for eGFR and ACR category*2.19 (1.24, 3.87)9.17 mm Hg (0.25-18.09)

*ACR categories (mg/gm): <30, ≥30-≤300, >300


  • Other NIH Support