"Uncontrolled Hypertension Among Medicare Beneficiaries in Rural South Carolina.".

BACKGROUND: More than one-in-five older adults live in the rural U.S. Adults living in rural U.S. experience significantly higher hypertension prevalence and cardiovascular disease-related mortality compared to their urban counterparts. To extend the literature and provide real-world evidence, the primary objective of this study was to estimate the prevalence of uncontrolled hypertension and to identify factors associated with it among Medicare beneficiaries receiving care in rural South Carolina. METHODS: Data were used from the annual review of Abbeville County Medicare patients diagnosed with hypertension between July 2024 and January 2025. Uncontrolled hypertension was defined as blood pressure ≥130/80 mmHg with or without antihypertensive medications. Generalized linear models with a binomial distribution and logit link were used to examine individual, behavioral, clinical, and area-level contextual factors associated with uncontrolled hypertension. RESULTS: Responses from 813 Medicare beneficiaries with diagnosed hypertension were analyzed: 55.6% females with a mean age (standard deviation) of 73.2±8.48 years. Overall, the prevalence (95% CI) of uncontrolled hypertension was 76.3% (95% CI: 73.2, 79.1). Compared with a healthy weight, being overweight (aOR=2.0; 95% CI: 1.2, 3.3; p =  0.005) or obese (aOR=2.1; 95% CI: 1.1, 2.8; p = 0.010) was associated with higher odds of uncontrolled hypertension. Contrary to previous findings, "most of the time" PA (aOR=1.57; 95% CI: 1.05-2.34; p = 0.027) was associated with a higher likelihood of uncontrolled hypertension compared to no PA. CONCLUSIONS: Our findings highlight a high burden of uncontrolled hypertension in a rural Medicare population, underscore the need for objective measures and further studies into the individual, behavioral, clinical, and contextual factors that may contribute to blood pressure control in rural communities.