[Factors associated with medication non-adherence in uncontrolled hypertensive males and females: ODACE study]

Prevalence and risk factors associated with uncontrolled blood pressure in rural areas in Settat City, Morocco

Introduction

high blood pressure, commonly known as hypertension, is one of the most widespread chronic diseases in the world. It is a serious problem whose management is essential to maintain stable blood pressure levels in the short term, and to prevent neuro-cardio-vascular complications in the long term. This study aims firstly to explore the characteristics of uncontrolled blood pressure among patient´s residents of rural areas in Settat City, and secondly to determine its prevalence and identify associated risk factors.

Methods

this is a cross-sectional, descriptive, and analytical study which took place between March and August 2023, and targeted a population of hypertensive patients following up at primary healthcare facilities in rural areas in Settat City. A questionnaire was developed and evaluated to ensure its reliability before being administered to study participants, anthropometric measurements and blood pressure readings were also taken.

Results

four hundred hypertensive patients were surveyed, 53% (212) of whom had uncontrolled blood pressure, with a mean age of 56.94 (±13.10 years), and a marked female preponderance, illustrated by 72.3% (289) were female. The risk factors associated with uncontrolled blood pressure were: male gender (aOR: 2.53, 95% CI 1.13-5.65), monthly income (aOR: 5.64, 95% CI 3.04-10.46), diabetes (aOR: 3.16, 95% CI 1.77-5.63), monotherapy (aOR: 8.42, 95% CI 2.85-24.90), poor compliance with medication (aOR: 7.48, 95% CI 4.21-13.29), and stress (aOR: 2.22, 95% CI 1.14-4.33).

Conclusion

the level of blood pressure control was unsatisfactory in this population, underscoring the imperative of educating hypertensive patients about management measures and reinforcing the quality of primary health services.

Atherosclerosis knowledge - diagnosis and management in primary care

BACKGROUND

Atherosclerosis is the leading cause of death worldwide. Ischaemic stroke, coronary heart disease (CHD), and peripheral artery disease (PAD) are different forms of atherosclerotic disease. Knowledge among general practitioners (GPs) about the three main locations of atherosclerosis has never been conjointly explored in a single study. The aim of this survey was to compare GP awareness on the subject of these three different clinical presentations.

MATERIALS AND METHODS

Between February 2017 and May 2017, a self-administered survey was emailed to 18,500 French GPs. The questionnaire comprised three clinical cases involving cases of transient ischaemic attack (TIA), stable angina (SA), and intermittent claudication (IC). Each case was explored with seven similar questions. The primary endpoint was the number of physicians who correctly answered five questions for each clinical case.

RESULTS

The survey was completed by 1,724 GPs. TIA knowledge (48.2 %) was significantly higher than the SA knowledge (3.0 %) and IC knowledge (0.4 %). We also found a significant difference between SA knowledge and IC knowledge. The percentages of GPs who correctly diagnosed TIA, SA or IC were 96.7, 89.7, and 96.5 %, respectively (p < 0.0001). Poor knowledge ratings for all three locations were observed for inadequate prescription of supplementary investigations and treatments.

CONCLUSIONS

Our study demonstrates that GPs' knowledge about atherosclerosis disease varies significantly depending on disease location. GPs diagnose correctly but need to be backed up for their management of patients with atherosclerosis.

[Use of the EvalObs® adherence scale in an unselected French population of treated subjects with antihypertensive, hypolipemiants or oral antidiabetics medications: The FLAHS 2017 adherence survey]

OBJECTIVE

A Visual Analog Scale (VAS) is useful for diagnosing medication nonadherence and its validity has been evaluated using electronic pillbox as the gold standard. We have developed the EvaLobs^® scale for use on paper or on smartphone and the aim of the study was to administrate the scale among FLAHS 2017 participants treated for an hypertension, a dyslipidemia or diabetes. In subjects treated with antihypertensive medications, participants completed the 6-item Girerd Scale and EvaLobs^®.

METHODS

The French League Against Hypertension Survey (FLAHS) are carried out by self-questionnaire sent by mail to individuals from the French Kantar Health sampling frame (representative panel of the population living in metropolitan France). In 2017, FLAHS was conducted in 4783 subjects aged 35 and over. The EvaLobs^® has a scale from 0 to 15 and the use instruction is "how many days have you taken the drug in the past 15 days". A score>12 indicates a "good compliance". The 6-item Girerd scale was also completed. "Good adherence" was determined for a score of 0 to 2 and "nonadherence" for a score of 3 or more. The agreement between EvaLobs^® and the 6-item Girerd scale was evaluated in treated hypertensives.

RESULTS

The survey included 4783 subjects with 1308 treated hypertensives, 942 subjects treated with lipid-lowering drugs and 405 subjects treated with anti-diabetics. EVALOBS^® indicates "Good adherence" in 96% of subjects and the 6 questions questionnaire indicates "good adherence" in 95% of subjects. An excellent agreement is noted in 93.8%. An EvaLobs^® score indicating nonadherence or an absence of response to EvaLobs^® is observed in 3.6% [CI 95, 2.5-4.7] of hypertensives, in 6.0% [CI 95, 3.9-8.1] of diabetics and in 8.2% [CI 95, 6.5-9.9] of dyslipidemic patients.

CONCLUSION

In the population living in France and in unselected patients treated for metabolic disease or hypertension, non-adherence is lowest for antihypertensive medications and highest for statins. EvaLobs^®, which shows good agreement with an adherence questionnaire, is a quick and simple tool for assessing adherence. The smartphone app EvaLobs^® is available for free on Google play and the Apple store.