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van der Laan DM, Elders PJM, Boons CCLM, Nijpels G, van Dijk L, Hugtenburg JG. Effectiveness of a Patient-Tailored, Pharmacist-Led Intervention Program to Enhance Adherence to Antihypertensive Medication: The CATI Study. Front Pharmacol 2018; 9:1057. [PMID: 30319409 PMCID: PMC6169131 DOI: 10.3389/fphar.2018.01057] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/03/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction: Non-adherence to medication is a complex health care problem. In spite of substantial efforts, up till now little progress has been made to effectively tackle the problem with adherence-enhancing interventions. The aim of this study was to investigate the effectiveness of a patient-tailored, pharmacist-led and theory-driven intervention program aimed to enhance self-reported adherence to antihypertensive medication. Materials and Methods: A parallel-group randomized controlled trial in 20 community pharmacies with nine months follow-up was conducted. Patients (45-75 years) using antihypertensive medication and considered non-adherent based on both pharmacy dispensing data and a self-report questionnaire were eligible to participate. The intervention program consisted of two consultations with the pharmacist to identify participants' barriers to adhere to medication and to counsel participants in overcoming these barriers. The primary outcome was self-reported medication adherence. Secondary outcomes were beliefs about medicines, illness perceptions, quality of life and blood pressure. Mixed-model and generalized estimating equation (GEE) analyses were used to assess overall effects of the intervention program and effects per time point. Results: 170 patients were included. No significant differences between intervention and control groups were found in self-reported adherence, quality of life, illness perceptions, beliefs about medicines (concern scale), and blood pressure. After nine months, intervention participants had significantly stronger beliefs about the necessity of using their medicines as compared to control participants (mean difference 1.25 [95% CI: 0.27 to 2.24], p = 0.012). Discussion: We do not recommend to implement the intervention program in the current form for this study population. Future studies should focus on how to select eligible patient groups with appropriate measures in order to effectively target adherence-enhancing interventions. Trial Register: NTR5017 http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5017.
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Affiliation(s)
- Danielle M. van der Laan
- Department of Clinical Pharmacology and Pharmacy and the Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Petra J. M. Elders
- Department of General Practice and Elderly Care Medicine and the Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Christel C. L. M. Boons
- Department of Clinical Pharmacology and Pharmacy and the Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Giel Nijpels
- Department of General Practice and Elderly Care Medicine and the Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Liset van Dijk
- Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Jacqueline G. Hugtenburg
- Department of Clinical Pharmacology and Pharmacy and the Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
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252
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Ng FL, Warren HR, Caulfield MJ. Hypertension genomics and cardiovascular prevention. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:291. [PMID: 30211179 DOI: 10.21037/atm.2018.06.34] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Hypertension continues to be a major risk factor for global mortality, and recent genome-wide association studies (GWAS) have expanded in size, leading to the identification of further genetic loci influencing blood pressure. In light of the new knowledge from the largest cardiovascular GWAS to date, we review the potential impact of genomics on discovering potential drug targets, risk stratification with genetic risk scores, drug selection with pharmacogenetics, and exploring insights provided by gene-environment interactions.
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Affiliation(s)
- Fu Liang Ng
- William Harvey Research Institute, The NIHR Biomedical Research Centre at Barts, Queen Mary University London, London, UK.,Barts BP Centre of Excellence, Barts Heart Centre, The NIHR Biomedical Research Centre at Barts, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Helen R Warren
- William Harvey Research Institute, The NIHR Biomedical Research Centre at Barts, Queen Mary University London, London, UK
| | - Mark J Caulfield
- William Harvey Research Institute, The NIHR Biomedical Research Centre at Barts, Queen Mary University London, London, UK.,Barts BP Centre of Excellence, Barts Heart Centre, The NIHR Biomedical Research Centre at Barts, St Bartholomew's Hospital, W Smithfield, London, UK
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253
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Adidja NM, Agbor VN, Aminde JA, Ngwasiri CA, Ngu KB, Aminde LN. Non-adherence to antihypertensive pharmacotherapy in Buea, Cameroon: a cross-sectional community-based study. BMC Cardiovasc Disord 2018; 18:150. [PMID: 30041606 PMCID: PMC6056997 DOI: 10.1186/s12872-018-0888-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 07/16/2018] [Indexed: 12/14/2022] Open
Abstract
Background Hypertension is a challenging public health problem with a huge burden in the developing countries. Non-adherence to antihypertensive treatment is a big obstacle in blood pressure (BP) control and favours disease progression to complications. Our objectives were to determine the rate of non-adherence to antihypertensive pharmacotherapy, investigate factors associated with non-adherence, and to assess the association between non-adherence and BP control in the Buea Health District (BHD), Cameroon. Methods A community-based cross-sectional study using stratified cluster sampling was conducted in the BHD from November 2013 – March 2014. Eligible consenting adult participants had their BP measured and classified using the Joint National Committee VII criteria. The Morisky medication adherence scale was used to assess adherence to BP lowering medication. Multivariable logistic regression models were used to predict non-adherence. Results One hundred and eighty-three participants were recruited with mean age of 55.9 years. Overall, 67.7% (95% CI: 59.8–73.6%) of participants were non-adherent to their medications. After adjusting for age, sex and other covariates, forgetfulness (aOR = 7.9, 95%CI: 3.0–20.8), multiple daily doses (aOR = 2.5, 95%CI: 1.2–5.6), financial constraints (aOR = 2.8, 95%CI: 1.1–6.9) and adverse drug effects (aOR = 7.6, 95%CI: 1.7–33.0) independently predicted non-adherence to anti-hypertensive medication. BP was controlled in only 21.3% of participants and was better in those who were adherent to medication (47.5% versus 8.2%, p < 0.01). Conclusion At least two of every three hypertensive patients in the Buea Health District are non-adherent to treatment. Forgetfulness, multiple daily doses of medication, financial constraints and medication adverse effects are the major predictors of non-adherence in hypertensive patients. These factors should be targeted to improve adherence and BP control, which will contribute to stem hypertension-related morbidity and mortality.
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Affiliation(s)
- Nkengla Menka Adidja
- Faculty of Health Sciences, University of Buea, Buea, Cameroon.,Djeleng Sub-divisional Hospital, Bafoussam, Cameroon
| | - Valirie Ndip Agbor
- Ibal Sub-divisional Hospital, Oku, Cameroon.,Faculty of Medicine & Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Jeannine A Aminde
- Faculty of Health Sciences, University of Buea, Buea, Cameroon.,Etoug-Ebe Baptist Hospital, Yaoundé, Cameroon
| | - Calypse A Ngwasiri
- Bamendjou District Hospital, Bamendjou, Cameroon.,Clinical Research Education, Networking & Consultancy (CRENC), Douala, Cameroon
| | - Kathleen Blackett Ngu
- Faculty of Medicine & Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Leopold Ndemnge Aminde
- Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, Australia.
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254
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Rampamba EM, Meyer JC, Godman B, Kurdi A, Helberg E. Evaluation of antihypertensive adherence and its determinants at primary healthcare facilities in rural South Africa. J Comp Eff Res 2018; 7:661-672. [DOI: 10.2217/cer-2018-0004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aim: To evaluate adherence to antihypertensive treatment in rural South Africa and identify potential determinants given concerns with adherence and its impact in this priority disease area. Patients & methods: Face-to-face interviews with hypertensive patients and rating their adherence to treatment using defined categorized responses. Associations between adherence and patient characteristics assessed and sensitivity analyses performed. Results: 54.6% of patients were adherent to treatment. Controlled blood pressure (BP; odds ratios [OR] = 2.1; 95% CI: 1.1, 3.8; p = 0.019), comorbidity (OR = 2.0; 95% CI: 1.1, 3.6; p = 0.032) and smoking (OR = 0.3; 95% CI: 0.1, 0.8; p = 0.018) were associated with adherence. Conclusion: Adherence and BP control were suboptimal, only smoking was an independent risk factor for adherence. Adherent patients were twice as likely to have controlled BP, although results were sensitive to the definition of adherence. Initiatives are in place to improve adherence, which will be monitored.
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Affiliation(s)
- Enos M Rampamba
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa
- Department of Health, Tshilidzini Hospital, Limpopo Province, South Africa
| | - Johanna C Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa
| | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Health Economics Centre, Liverpool University Management School, Liverpool, UK
| | - Amanj Kurdi
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Elvera Helberg
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa
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255
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Indexed plasma drug concentrations for drug adherence screening in hypertensive patients. Ann Cardiol Angeiol (Paris) 2018; 67:119-126. [PMID: 29789122 DOI: 10.1016/j.ancard.2018.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 04/27/2018] [Indexed: 11/20/2022]
Abstract
AIM Due to its high sensitivity, qualitative plasma drug screening by liquid chromatography/tandem mass spectrometry may not be able to distinguish same-day drug intake from drug use on preceding days and cause misclassifications of drug adherence in hypertensive patients. Analysis of plasma drug concentrations may provide more accurate results. PATIENTS AND METHODS We describe dose-dependent indexing of plasma drug concentrations for expected peak concentrations to define individual screening thresholds for same-day drug use. To explore its utility, plasma samples from 9 hypertensive patients without major comorbidity were prospectively analyzed on two occasions. All were on hydrochlorothiazide with either amlodipine (n=7) and/or valsartan (n=6) at different doses. Drugs were quantitated by mass spectrometry. Non-adherence was defined if an indexed drug concentration was below the expected trough level at 24-hour dosing interval. RESULTS All patients were adherent by qualitative plasma screening (spectrometric sensitivity). On the first visit (random sampling time), mean plasma concentrations of the drugs were 102±70, 15.4±6.7 and 2529±1608ng/mL, and mean indexes 84±57%, 85±35% and 60±38%, respectively. Using the study criterion, non-adherence was suspected in three. Intraindividual cross-checking retained two. On the second visit (fixed sampling time), amlodipine concentration was 15.6±8.5ng/mL (88±52% after indexing). Two patients were non-adherent according to the study criterion. CONCLUSION Indexing of plasma drug concentrations appears practicable and useful for drug adherence screening under clinical conditions. With this technique, same-day drug intake can be easily distinguished which reduces the risk of false positive results associated with qualitative drug screening.
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256
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Du LP, Cheng ZW, Zhang YX, Li Y, Mei D. The impact of fixed-dose combination versus free-equivalent combination therapies on adherence for hypertension: a meta-analysis. J Clin Hypertens (Greenwich) 2018; 20:902-907. [PMID: 29700923 DOI: 10.1111/jch.13272] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/01/2018] [Accepted: 02/13/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Li-Ping Du
- Department of Pharmacy; Peking Union Medical College Hospital; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Zhong-Wei Cheng
- Department of Cardiology; Peking Union Medical College Hospital; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Yu-Xuan Zhang
- Department of Pharmacy; Peking Union Medical College Hospital; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Ying Li
- Department of Pharmacy; Peking Union Medical College Hospital; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Dan Mei
- Department of Pharmacy; Peking Union Medical College Hospital; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
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257
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Antihypertensive Effect of Ethanolic Extract from Acanthopanax sessiliflorus Fruits and Quality Control of Active Compounds. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:5158243. [PMID: 29849899 PMCID: PMC5937377 DOI: 10.1155/2018/5158243] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 01/11/2018] [Accepted: 02/27/2018] [Indexed: 02/07/2023]
Abstract
Acanthopanax sessiliflorus (Rupr. & Maxim.) Seem., which belongs to the Araliaceae family, mainly inhabits Korea, China, and Japan. Traditionally, Acanthopanax species have been used as treatment for several diseases such as diabetes, tumors, and rheumatoid arthritis. Especially, its fruits have many biological functions including antitumor, immunostimulating, antithrombosis, and antiplatelet activities. Recently, the extract of A. sessiliflorus fruit has been reported to have antithrombotic and antiplatelet activities related to the alleviation of hypertension. Therefore, we investigated the antihypertensive effect of ethanolic extract from A. sessiliflorus fruits (DHP1501) through in vivo, ex vivo, and in vitro studies. In this study, DHP1501 demonstrated free radical scavenging capacity, enhanced endothelial nitric oxide (NO) production, and inhibited angiotensin-converting enzyme (ACE) activity in spontaneously hypertensive rats (SHRs), resulting in the improvement of vascular relaxation and decrease in blood pressure in the hypertensive animal model. These results suggest that A. sessiliflorus fruit extract may be a promising functional material for the prevention and treatment of hypertension. Furthermore, this study demonstrated the utility of MS-based active compounds for the quality control of DHP1501.
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258
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Hennein R, Hwang SJ, Au R, Levy D, Muntner P, Fox CS, Ma J. Barriers to medication adherence and links to cardiovascular disease risk factor control: the Framingham Heart Study. Intern Med J 2018; 48:414-421. [PMID: 29193523 PMCID: PMC5889324 DOI: 10.1111/imj.13687] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/02/2017] [Accepted: 11/13/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND In the elderly, impaired cognition may weaken medication adherence and compromise treatment for cardiovascular disease (CVD). AIM We examined risk factors for medication adherence and the relationship between adherence and levels of CVD risk factors among older participants with hypertension, dyslipidaemia and diabetes in the Framingham Heart Study. METHODS The four-item Morisky Medication Adherence Scale was administered to 1559 participants, median age 70 years, 53% women. We created an adherence score, ranging from 0 to 4, with low adherence defined as a score ≥2. CVD risk factors were assessed using standard protocols. Cognition was measured using the Mini-Mental State Examination (MMSE) and depressive symptoms were measured using the Center for Epidemiologic Studies of Depression (CES-D) scale. RESULTS Among participants who self-reported taking antihypertensive, lipid-lowering and/or hyperglycaemic medication(s), 12% (n = 191) had low medication adherence. The risk of low adherence increased by 45% (95% confidence interval (CI): 25-68%, P < 0.001) per five-unit increase in CES-D score. In participants taking antihypertensive medication (n = 1017), low adherence was associated with higher mean diastolic blood pressure (73 mmHg, 95% CI: 71-75 vs 71 mmHg, 95% CI: 70-71; P = 0.04) after adjusting for covariates. Among participants taking lipid-lowering medication (n = 937), low adherence was associated with higher mean low-density lipoprotein cholesterol (92 mg/dL, 95% CI: 87-96 vs 86 mg/dL, 95% CI: 84-88; P = 0.03). Low adherence was not associated with fasting plasma glucose (P = 0.10) or haemoglobin A1c (P = 0.68) in the subgroup of participants (n = 192) taking hypoglycaemic medication. CONCLUSIONS Depressive symptoms might act as a barrier for medication adherence, which exacerbates CVD risk factors in older-aged adults.
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Affiliation(s)
- Rachel Hennein
- Framingham Heart Study, Framingham, Massachusetts, USA
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Shih-Jen Hwang
- Framingham Heart Study, Framingham, Massachusetts, USA
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Rhoda Au
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Anatomy & Neurobiology, Boston University School of Medicine and Department of Epidemiology, Boston University School of Public Health
| | - Daniel Levy
- Framingham Heart Study, Framingham, Massachusetts, USA
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Caroline S. Fox
- Framingham Heart Study, Framingham, Massachusetts, USA
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Jiantao Ma
- Framingham Heart Study, Framingham, Massachusetts, USA
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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259
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Agbor VN, Takah NF, Aminde LN. Prevalence and factors associated with medication adherence among patients with hypertension in sub-Saharan Africa: protocol for a systematic review and meta-analysis. BMJ Open 2018; 8:e020715. [PMID: 29549213 PMCID: PMC5857663 DOI: 10.1136/bmjopen-2017-020715] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Hypertension is the leading cardiovascular risk factor globally, associated with a high morbidity and mortality. The high prevalence of hypertension in sub-Saharan Africa (SSA) is associated with contrastingly low awareness, treatment and control rates. Adherence to medication remains a major determinant of optimal blood pressure control. This systematic review aims to determine the prevalence, and factors associated with adherence to antihypertensive pharmacotherapy among patients with hypertension in SSA. METHODS AND ANALYSIS We will include studies published in Africa up to 31 December 2017. The following databases will be searched: PubMed, Embase, SCOPUS and Web of Science to identify potential studies without language restriction. To minimise chances of missing studies, resources specific to African literature such as WHO AFROLIB, African Index Medicus and African Journals Online will also be searched. Two reviewers will independently screen studies, extract data and critically appraise included studies for risk of bias, and a third reviewer will resolve discrepancies. A random-effects meta-analysis is planned to pool study-specific estimates to obtain a summary measure presented in Forest plots. Heterogeneity of included studies will be assessed using the χ2 test on Cochrane's Q statistic and quantified using I2. Publication bias will be assessed using the Egger's test and funnel plots. This protocol has been prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses for Protocols 2015 statement. ETHICAL AND DISSEMINATION An ethical approval is not required for the proposed study, as it will be based on already published data. The end report will be presented at conferences and published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42017079838.
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Affiliation(s)
| | - Noah Fongwen Takah
- Ministry of Public Health, Yaounde, Cameroon
- London School of Hygiene and Tropical Medicine, London, UK
| | - Leopold Ndemnge Aminde
- Non-Communicable Disease Unit, Clinical Research Education, Networking and Consultancy (CRENC), Douala, Cameroon
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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260
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Affiliation(s)
- Fu Liang Ng
- Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, London, UK.,Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University, London, UK
| | - Melvin David Lobo
- Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, London, UK.,Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University, London, UK
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261
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Bharti S, Bharti B. Adherence to Antihypertensive Therapy: A Missing Link Between Treatment and Outcomes. Am J Hypertens 2018; 31:290-292. [PMID: 29253073 DOI: 10.1093/ajh/hpx217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/12/2017] [Indexed: 01/10/2023] Open
Affiliation(s)
- Sahul Bharti
- Build Healthy India Movement (Research based NGO), Chandigarh, India
| | - Bhavneet Bharti
- Build Healthy India Movement (Research based NGO), Chandigarh, India
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262
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Eadon MT, Kanuri SH, Chapman AB. Pharmacogenomic studies of hypertension: paving the way for personalized antihypertensive treatment. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2018; 3:33-47. [PMID: 29888336 DOI: 10.1080/23808993.2018.1420419] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Introduction Increasing clinical evidence supports the implementation of genotyping for anti-hypertensive drug dosing and selection. Despite robust evidence gleaned from clinical trials, the translation of genotype guided therapy into clinical practice faces significant challenges. Challenges to implementation include the small effect size of individual variants and the polygenetic nature of antihypertensive drug response, a lack of expert consensus on dosing guidelines even without genetic information, and proper definition of major antihypertensive drug toxicities. Balancing clinical benefit with cost, while overcoming these challenges, remains crucial. Areas covered This review presents the most impactful clinical trials and cohorts which continue to inform and guide future investigation. Variants were selected from among those identified in the Pharmacogenomic Evaluation of Antihypertensive Responses (PEAR), the Genetic Epidemiology of Responses to Antihypertensives study (GERA), the Genetics of Drug Responsiveness in Essential Hypertension (GENRES) study, the SOPHIA study, the Milan Hypertension Pharmacogenomics of hydro-chlorothiazide (MIHYPHCTZ), the Campania Salute Network, the International Verapamil SR Trandolapril Study (INVEST), the Nordic Diltiazem (NORDIL) Study, GenHAT, and others. Expert Commentary The polygenic nature of antihypertensive drug response is a major barrier to clinical implementation. Further studies examining clinical effectiveness are required to support broad-based implementation of genotype-based prescribing in medical practice.
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Affiliation(s)
- Michael T Eadon
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sri H Kanuri
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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263
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Schneider APH, Gaedke MÂ, Garcez A, Barcellos NT, Paniz VMV. Effect of characteristics of pharmacotherapy on non-adherence in chronic cardiovascular disease: A systematic review and meta-analysis of observational studies. Int J Clin Pract 2018; 72. [PMID: 29193650 DOI: 10.1111/ijcp.13044] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/05/2017] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Cardiovascular medications are effective in prevention of cardiovascular diseases (CVD); however, medication non-adherence contributes to morbidity and mortality. OBJECTIVE This systematic review and meta-analysis aims to summarise the evidence regarding the relationship between characteristics of drug therapy (pharmacotherapy) and medication non-adherence in the CVD population. METHODS Systematic searches in PubMed, LILACS, Academic Search and CINAHL databases for observational studies that enrolled adults with CVD were performed, from January 1960 to December 2015. The meta-analysis tested the association between characteristics of pharmacotherapy and self-reported medication non-adherence outcome, using a random effects model. To investigate heterogeneity, we performed subgroup analysis and sensitivity analysis. RESULTS Twenty-four cross-sectional studies and 7 cohort studies were included in this review. Based on 31 studies including 27 441 participants, we performed meta-analyses for all the characteristics of drug therapy that at least 2 studies evaluated, with a total of fourteen meta-analyses. The pooled results showed that studies which evaluate whether participants have insurance or another program that assists with medication costs, but not full coverage (OR = 0.63; 95% CI: 0.53-0.74; P < .001; I2 = 0%, P = .938), and a dosing frequency of twice or more daily (OR = 1.38; 95% CI: 1.13-1.69; P < .001) were associated with non-adherence. CONCLUSIONS AND RELEVANCE The results of this review suggest that access to insurance or another program that assists with medication costs was a protection factor for non-adherence. On the other hand, a high frequency of dosing was a risk factor for non-adherence. Therefore, these characteristics of pharmacotherapy must be considered to improve medication adherence among CVD patients.
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Affiliation(s)
- Ana Paula Helfer Schneider
- Post-graduate Program in Collective Health, University of Vale do Rio dos Sinos (UNISINOS), São Leopoldo, RS, Brazil
- Department of Biology and Pharmacy, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil
| | - Mari Ângela Gaedke
- Post-graduate Program in Collective Health, University of Vale do Rio dos Sinos (UNISINOS), São Leopoldo, RS, Brazil
- Department of Biology and Pharmacy, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil
| | - Anderson Garcez
- Post-graduate Program in Collective Health, University of Vale do Rio dos Sinos (UNISINOS), São Leopoldo, RS, Brazil
| | - Nêmora Tregnago Barcellos
- Post-graduate Program in Collective Health, University of Vale do Rio dos Sinos (UNISINOS), São Leopoldo, RS, Brazil
| | - Vera Maria Vieira Paniz
- Post-graduate Program in Collective Health, University of Vale do Rio dos Sinos (UNISINOS), São Leopoldo, RS, Brazil
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264
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Lamb SA, Al Hamarneh YN, Houle SKD, Leung AA, Tsuyuki RT. Hypertension Canada's 2017 guidelines for diagnosis, risk assessment, prevention and treatment of hypertension in adults for pharmacists: An update. Can Pharm J (Ott) 2018; 151:33-42. [PMID: 29317935 PMCID: PMC5755821 DOI: 10.1177/1715163517743525] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Sarah A. Lamb
- the Faculty of Pharmacy and Pharmaceutical Sciences (Lamb), Department of Medicine (Al Hamarneh, Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta
- the School of Pharmacy (Houle), University of Waterloo, Ontario
- the Department of Medicine (Leung), University of Calgary, Alberta
| | - Yazid N. Al Hamarneh
- the Faculty of Pharmacy and Pharmaceutical Sciences (Lamb), Department of Medicine (Al Hamarneh, Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta
- the School of Pharmacy (Houle), University of Waterloo, Ontario
- the Department of Medicine (Leung), University of Calgary, Alberta
| | - Sherilyn K. D. Houle
- the Faculty of Pharmacy and Pharmaceutical Sciences (Lamb), Department of Medicine (Al Hamarneh, Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta
- the School of Pharmacy (Houle), University of Waterloo, Ontario
- the Department of Medicine (Leung), University of Calgary, Alberta
| | - Alexander A. Leung
- the Faculty of Pharmacy and Pharmaceutical Sciences (Lamb), Department of Medicine (Al Hamarneh, Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta
- the School of Pharmacy (Houle), University of Waterloo, Ontario
- the Department of Medicine (Leung), University of Calgary, Alberta
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Lomper K, Chabowski M, Chudiak A, Białoszewski A, Dudek K, Jankowska-Polańska B. Psychometric evaluation of the Polish version of the Adherence to Refills and Medications Scale (ARMS) in adults with hypertension. Patient Prefer Adherence 2018; 12:2661-2670. [PMID: 30587938 PMCID: PMC6296194 DOI: 10.2147/ppa.s185305] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Only 50%-75% of chronically ill patients take their medication as prescribed. The patient is found to adhere to treatment correctly and optimally if they accomplish 80% or more of the treatment plan. A questionnaire titled the Adherence to Refills and Medications Scale (ARMS) has been used in studies involving various populations and proved to be a simple instrument for measuring adherence, with good psychometric properties. OBJECTIVE The aim of this study was to develop a Polish version of the ARMS (ARMS-P), an instrument that identifies levels of adherence in the hypertensive population, and evaluate its psychometric properties. METHODS This cross-sectional study included 279 patients, including 166 females (mean age 66.5 years), hospitalized between September 2016 and March 2017 in the Department of Internal Medicine, Occupational Diseases, and Hypertension of Wrocław Medical University, Poland. The 12-item ARMS was translated from English into Polish. The 12 items included in the final questionnaire comprise two subscales: adherence to taking medications (eight items) and adherence to refilling prescriptions (four items). RESULTS Patients in the good-adherence group were younger (P=0.017; P=0.048), more likely to be professionally active (P=0.041), better educated (P=0.037), and more likely to have normal blood pressure (P<0.001). They also measured their blood pressure more often (P<0.001), and took fewer pills in a day (P<0.001). Adherent patients were also more likely to take their medication on their own (P=0.016) and read information leaflets on the medication (P<0.001). The study demonstrated that the ARMS-P questionnaire has good psychometric properties that enable its use for assessing adherence in chronically ill patients, including in particular, patients with hypertension. CONCLUSION The psychometric properties of the questionnaire are satisfactory (reliability measured by means of Cronbach's α). The ARMS-P questionnaire proved to be suitable for use in the Polish population. The use of this screening tool for the assessment of adherence to treatment is recommended in this population of hypertensive patients.
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Affiliation(s)
- Katarzyna Lomper
- Division of Nursing of Internal Diseases, Department of Clinical Nursing, Faculty of Health Science, Wrocław Medical University, Wrocław, Poland
| | - Mariusz Chabowski
- Division of Surgical Procedures, Department of Clinical Nursing, Faculty of Health Science, Wrocław Medical University, Wrocław, Poland,
| | - Anna Chudiak
- Division of Nursing of Internal Diseases, Department of Clinical Nursing, Faculty of Health Science, Wrocław Medical University, Wrocław, Poland
| | - Artur Białoszewski
- Department of Prevention of Environmental Hazards and Allergology, Warsaw Medical University, Warsaw, Poland
| | - Krzysztof Dudek
- Faculty of Mechanical Engineering, Wrocław University of Science and Technology, Wrocław, Poland
| | - Beata Jankowska-Polańska
- Division of Nursing of Internal Diseases, Department of Clinical Nursing, Faculty of Health Science, Wrocław Medical University, Wrocław, Poland
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266
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Tilea I, Petra D, Voidazan S, Ardeleanu E, Varga A. Treatment adherence among adult hypertensive patients: a cross-sectional retrospective study in primary care in Romania. Patient Prefer Adherence 2018; 12:625-635. [PMID: 29731610 PMCID: PMC5923249 DOI: 10.2147/ppa.s162965] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE This study was performed to elucidate the level of adherence to antihypertensive treatment in adult subjects attending a family medicine clinic in a city in central Romania. PATIENTS AND METHODS A cross-sectional, retrospective study was performed on a cohort of hypertensive adults. A total of 525 participants were selected from 1,714 adults attending a single urban family medicine practice. Assessment of adherence to therapy was performed by a chart review of prescription and clinical records over a 4-year study period. RESULTS The results showed that 69.8% of the patients had high adherence (>80% with therapy); 20.3% had medium adherence (20%-79%); and 9.9% had low adherence (<20%). A positive association was found (p = 0.01) between low adherence and male gender. A significant positive association (p = 0.02) was found between total cardiovascular risk and level of adherence. We found that 54.7% of the high adherence subjects had well-controlled blood pressure, and chronic kidney disease was associated with high adherence to therapy (p = 0.03). Antihypertensive regimens administered as fixed-dose combinations were positively associated with high adherence (p = 0.001). Subjects who had their antihypertensive regimen adjusted to a new drug class during the study period showed enhanced adherence compared to subjects treated with an unchanged regimen (p = 0.001). CONCLUSION This is the first published study assessing adherence to antihypertensive therapy in family medicine practice in Romania. It presented data derived from a primarily urban setting and targeted a geographical area where the prevalence of hypertension has increased continuously. Female gender, age, presence of cardiovascular risk factors, defined cardiovascular disease, chronic renal impairment, and good control of hypertension were positively associated with high adherence. The results provide insights to guide further strategies to improve adherence and indirect methods for blood pressure management strategies.
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Affiliation(s)
- Ioan Tilea
- Department M3-Internal Medicine, Family Medicine Discipline, Faculty of Medicine, University of Medicine and Pharmacy, Tirgu Mures, Mures, Romania
| | - Dorina Petra
- Department M3-Internal Medicine, Family Medicine Discipline, Faculty of Medicine, University of Medicine and Pharmacy, Tirgu Mures, Mures, Romania
- Correspondence: Dorina Petra, Department M3-Internal Medicine, Family Medicine Discipline, Faculty of Medicine, University of Medicine and Pharmacy, 38, Gheorghe Marinescu Street, Tirgu Mures 540319, Mures, Romania, Tel +40 740 19 4122, Fax +40 265 21 1011, Email
| | - Septimiu Voidazan
- Department M2-Functional and Complementary Sciences, Epidemiology Discipline, Faculty of Medicine, University of Medicine and Pharmacy, Tirgu Mures, Mures, Romania
| | - Elena Ardeleanu
- Department XVI-Balneology, Medical Rehabilitation and Rheumatology, Family Medicine Discipline, Faculty of Medicine, University of Medicine and Pharmacy, Timisoara, Timis, Romania
| | - Andreea Varga
- Department M3-Internal Medicine, Family Medicine Discipline, Faculty of Medicine, University of Medicine and Pharmacy, Tirgu Mures, Mures, Romania
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267
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Uchmanowicz B, Chudiak A, Mazur G. The influence of quality of life on the level of adherence to therapeutic recommendations among elderly hypertensive patients. Patient Prefer Adherence 2018; 12:2593-2603. [PMID: 30584283 PMCID: PMC6287422 DOI: 10.2147/ppa.s182172] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Hypertension is one of the most important risk factors for cardiovascular disease, which contributes to lowering the quality of life (QOL), especially in elderly patients. Recent data show that almost half of the hypertensive patients and one-third of patients with comorbidities were nonadherent to medication. OBJECTIVE To assess the association of QOL with the level of adherence and to examine the association with selected variables on the level of adherence. DESIGN A prospective, cross-sectional, and analytical study. METHODS This study involved 186 hypertensive elderly patients (mean age: 71.05±7.47 years). An analysis of medical records based on sociodemographic and clinical data was conducted. The World Health Organization Quality of Life Scale Brief version (WHOQOL-BREF) was used to assess the level of QOL, and the Hill-Bone Compliance to High Blood Pressure Therapy Scale (HBQ) was used to examine the level of adherence to therapeutic recommendations in hypertensive patients. RESULTS The average assessment of the QOL measured by the WHOQOL-BREF questionnaire was 3.36±0.84 points, which indicates a QOL at a level between average and good. The patients' average score on the HBQ questionnaire was 20.39±4.31 points. In the "reduced sodium intake" subscale, patients had an average of 4.75±1.33 points. In the "appointment keeping" subscale, the patients scored an average of 3.45±1.07 points. In the "medication taking" subscale, the patients had an average of 12.19±3.46 points. It was shown that the total score of the HBQ questionnaire was negatively correlated with all domains of QOL assessed with the WHOQOL-BREF questionnaire (P<0.05). CONCLUSION There is an association between QOL and adherence to therapeutic recommendations among hypertensive elderly patients. It has been concluded that with an increasing QOL, the level of adherence to therapeutic recommendations increases. The level of adherence is also negatively affected by: older age, longer duration of disease, worse marital status, lower education, living alone, and using polytherapy.
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Affiliation(s)
- Bartosz Uchmanowicz
- Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland,
| | - Anna Chudiak
- Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland,
| | - Grzegorz Mazur
- Department and Clinic of Internal and Occupational Diseases and Hypertension, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
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Meyer JC, Schellack N, Stokes J, Lancaster R, Zeeman H, Defty D, Godman B, Steel G. Ongoing Initiatives to Improve the Quality and Efficiency of Medicine Use within the Public Healthcare System in South Africa; A Preliminary Study. Front Pharmacol 2017; 8:751. [PMID: 29163151 PMCID: PMC5677783 DOI: 10.3389/fphar.2017.00751] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 10/03/2017] [Indexed: 01/01/2023] Open
Abstract
Introduction: South Africa has an appreciable burden of both communicable and non-communicable diseases as well as high maternal, neonatal, and child morbidity. In recent years there have been significant strides with improving the public health system, and addressing current inequalities, with the right to health a constitutional provision in South Africa. Initiatives include the introduction of National Health Insurance, programmes to enhance access to medicines for patients with chronic diseases, as well as activities to improve care in hospitals, including improving pharmacovigilance. Consequently, the objective of this paper is to review ongoing initiatives within the public healthcare sector in South Africa and their influence to provide future direction. Method: Principally a structured review of current and planned activities. Results: There have been a number of major activities and initiatives surrounding the availability and access to medicines in the public system in recent years in South Africa. This includes a National Surveillance Centre and an innovative early warning system for the supply of medicines as well as the development of a National Health Care Pricing Authority and initiatives to improve contracting. There have also been developments to improve the supply chain including instigating Medicine Procurement Units in the provinces and enhancing forecasting capabilities. Access to medicines is improving though the instigation of stable chronic disease management initiatives to increase the number of external pick-up points for medicines. There are also ongoing programmes to enhance adherence to medicines as well as enhance adherence to the Standard Treatment Guidelines and the Essential Medicines List with their increasing availability. In addition, there is a movement to enhance the role of health technology assessment in future decision making. Hospital initiatives include increased focus on reducing antimicrobial resistance through instigating stewardship programmes as well as improving adverse drug reaction reporting and associated activities. Conclusion: Overall, there are an appreciable number of ongoing activities within the public healthcare system in South Africa attempting to ensure and sustain universal healthcare. It is too early to assess their impact, which will be the subject of future research.
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Affiliation(s)
- Johanna C Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
| | - Natalie Schellack
- School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
| | - Jacobus Stokes
- Contract Management, South Africa Directorate: Affordable Medicines, Sector Wide Procurement, National Department of Health, Pretoria, South Africa
| | - Ruth Lancaster
- Essential Drugs Programme, South Africa Directorate: Affordable Medicines, Sector Wide Procurement, National Department of Health, Pretoria, South Africa
| | | | - Douglas Defty
- Mediclinic Southern Africa, Stellenbosch, South Africa
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.,Health Economics Centre, Management School, University of Liverpool, Liverpool, United Kingdom
| | - Gavin Steel
- Sector Wide Procurement, National Department of Health, Pretoria, South Africa
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Poovelikunnel TT, Gethin G, Solanki D, McFadden E, Codd M, Humphreys H. Randomized controlled trial of honey versus mupirocin to decolonize patients with nasal colonization of meticillin-resistant Staphylococcus aureus. J Hosp Infect 2017; 98:141-148. [PMID: 29107078 DOI: 10.1016/j.jhin.2017.10.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 10/20/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Mupirocin is used specifically for the eradication of nasal meticillin-resistant Staphylococcus aureus (MRSA), but increasing mupirocin resistance restricts its repeated use. The antibacterial effects of manuka honey have been established in vitro; antibacterial activity of other honeys has also been reported. AIM To describe the learning experience from a randomized controlled trial (RCT) comparing the efficacy of medical-grade honey (MGH) with mupirocin 2% for the eradication of nasal MRSA. METHODS Patients colonized in the nose with MRSA and age ≥18 years were recruited. Participants received either one or two courses of MGH or mupirocin 2%, three times per day for five consecutive days. FINDINGS The proportion of patients who were decolonized after one or two courses of treatment was not significantly different between MGH [18/42; 42.8%; 95% confidence interval (CI): 27.7-59.0] and mupirocin 2% (25/44; 56.8%; 95% CI: 41.0-71.7). Non-nasal MRSA colonization was significantly associated with persistent nasal colonization (odds ratio: 5.186; 95% CI: 1.736-5.489; P = 0.003). The rate of new acquisition of mupirocin resistance was 9.75%. CONCLUSION Although not significant, a decolonization rate of 42.8% for MGH was impressive. Our findings suggest that this strategy, which has the potential to combat antimicrobial resistance, should be assessed in similar but larger studies.
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Affiliation(s)
- T T Poovelikunnel
- Infection Prevention and Control Department, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland.
| | - G Gethin
- School of Nursing and Midwifery, Áras Moyola, National University of Ireland, Galway, Ireland
| | - D Solanki
- Department of Pharmacy, Beaumont Hospital, Dublin, Ireland
| | - E McFadden
- Microbiology Department, Beaumont Hospital, Dublin, Ireland
| | - M Codd
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - H Humphreys
- Infection Prevention and Control Department, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland
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270
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Njuguna B, Vedanthan R. Find and Plug the Leak: Improving Adherence to Anti-Hypertensive Medicines : Editorial to: "Assessing Adherence to Antihypertensive Therapy in Primary Health Care in Namibia: Findings and Implications" by M.M. Nashilongo et al. Cardiovasc Drugs Ther 2017; 31:485-487. [PMID: 28965235 DOI: 10.1007/s10557-017-6753-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Benson Njuguna
- Moi Teaching and Referral Hospital, Department of Pharmacy, Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Rajesh Vedanthan
- Zena and Michael A. Wiener Cardiovascular Institute, Department of Medicine, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA.
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271
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Šíma M, Vodička M, Marešová V, Šálek T, Čabala R, Slanař O. Adherence with perindopril therapy: a pilot study using therapeutic drug monitoring of perindoprilat and an evaluation of the clearance estimation. Int J Clin Pharm 2017; 39:1095-1100. [DOI: 10.1007/s11096-017-0522-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/02/2017] [Indexed: 11/24/2022]
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272
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Basheti IA, Abu-Gharbieh E. Revealing treatment-related problems for outpatients with alarming health status in the United Arab Emirates. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2017. [DOI: 10.1111/jphs.12186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Iman A. Basheti
- Department of Clinical Pharmacy & Therapeutics; Faculty of Pharmacy; Applied Science Private University; Amman Jordan
| | - Eman Abu-Gharbieh
- Department of Clinical Sciences; Faculty of Medicine; University of Sharjah; Sharjah UAE
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273
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Pan J, Lei T, Hu B, Li Q. Post-discharge evaluation of medication adherence and knowledge of hypertension among hypertensive stroke patients in northwestern China. Patient Prefer Adherence 2017; 11:1915-1922. [PMID: 29200832 PMCID: PMC5700759 DOI: 10.2147/ppa.s147605] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The aims of this study were to assess the knowledge of hypertension (HTN) and investigate risk factors associated with medication adherence among hypertensive stroke patients after discharge in northwestern China. PATIENTS AND METHODS A cross-sectional study involving 440 Chinese hypertensive stroke patients was conducted in a tertiary hospital in Xi'an, China. Data were collected by telephone interviews and patients' medical records. RESULTS It was found that 35.23% of patients were compliant with their antihypertensive drug treatments, and 42.95%, 52.27% and 4.77% of patients had poor, moderate and adequate knowledge of HTN, respectively. Gender, blood pressure (BP) categories, BP monitoring and HTN knowledge were independently associated with antihypertensive medication adherence. CONCLUSION The medication adherence among hypertensive stroke patients in northwestern China was poor. Knowledge of HTN was suboptimal. More attention and effective strategies should be designed to the factors affecting medication adherence. As knowledge positively affects medication adherence, clinical pharmacists should play an important role in patients' medication education.
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Affiliation(s)
- Jingjing Pan
- Department of Pharmacy
- Correspondence: Jingjing Pan, Department of Pharmacy, Xi’an Fourth Hospital, 21 JieFang Road, 710004 Xi’an, People’s Republic of China, Tel +86 029 8748 0635 ext 029, Email
| | - Tao Lei
- Department of Neurology, Xi’an Fourth Hospital, Xi’an, People’s Republic of China
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Abstract
BACKGROUND Hypertension is considered a serious health problem worldwide. Controlling and lowering blood pressure have a significant benefit to the hypertensive patients because hypertension is a risk factor for stroke, heart disease and cardiovascular disease. A tropical plant called Roselle, or Red Sorrel in English-speaking countries, has been used both as a thirst-quenching drink and for medical purposes. OBJECTIVES To explore the effect of Roselle on blood pressure in hypertensive adult patients. SEARCH STRATEGY The following databases were searched (Date of most recent search was September 2009): - Cochrane Database of Systematic Reviews (2nd Quarter 2009) - DARE (2nd Quarter 2009) - Ovid MEDLINE (1950 to Present with Daily Update) - EMBASE (1980 to 2009 Week 22) - AMED (1985 to May 2009) - EBSCO CINAHL - BIOSIS (1969 to 2008) - AGRICOLA (1970 to May 2009) - Food Science and Technology Abstract (1969 to 2009 June Week 1) - International Pharmaceutical Abstracts - International Bibliographic Information on Dietary Supplements - Clinical Trials.gov and Current Controlled Trials - OpenSIGLE - Hand searching of journals - ISI Web of Knowledge SELECTION CRITERIA We sought randomised control trials (RCTs) evaluating use of any forms of Roselle with placebo or no treatment in hypertensive patients. Change in trough and/or peak systolic and diastolic blood pressure were primary outcomes. Secondary outcomes were withdrawals due to adverse effects, change of pulse pressure and change of heart rate. DATA COLLECTION AND ANALYSIS Two review authors (C Ngamjarus, CN and P Pattanittum, PP) independently scanned titles and abstracts, as well as independently screened the full reports of the potentially relevant studies. At each stage, the results were compared and disagreements were solved by discussion. MAIN RESULTS No studies were identified that met the inclusion criteria. However, one abstract of an ongoing study is likely to meet the inclusion criteria, when completed. AUTHORS' CONCLUSIONS There is insufficient evidence to support the benefit of Roselle for either controlling or lowering blood pressure in patients with hypertension. Based on the information of this review, there is a clear need to develop well-designed studies to assess the efficacy of Roselle on hypertensive patients.
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Affiliation(s)
- Chetta Ngamjarus
- Department of Biostatistics and Demography, Faculty of Public Health, Khon Kaen University, 123 Miltraparp Road, Khon Kaen, Thailand, 40002
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