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Nagamine Y, Shobugawa Y, Sasaki Y, Takagi D, Fujiwara T, Khin YP, Nozaki I, Shirakura Y, Kay Thi L, Poe Ei Z, Thae Z, Win HH. Associations between socioeconomic status and adherence to hypertension treatment among older adults in urban and rural areas in Myanmar: a cross-sectional study using baseline data from the JAGES in Myanmar prospective cohort study. BMJ Open 2023; 13:e065370. [PMID: 36653052 PMCID: PMC9853216 DOI: 10.1136/bmjopen-2022-065370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES This study aims to investigate whether there is a differential association between socioeconomic status (SES) and adherence to hypertension medication among older adults in rural and urban areas in Myanmar and assess what type of SES is associated with a difference. DESIGN Cross-sectional study using baseline data from the Japan Gerontological Evaluation Study in Myanmar prospective cohort study. A multistage random sampling method was applied in each region. SETTING An urban and a rural area in Myanmar. PARTICIPANTS A total of 1200 older adults over 60 years old in Myanmar were randomly selected in 2018 (600 each from rural and urban areas). Of them, 573 had hypertension and were eligible for the analysis (urban: 317, rural: 256). OUTCOME Adherence to hypertension medication (yes/no) is the outcome of interest. Three types of SES (wealth, education and current employment status) were the independent variables. RESULTS We found that 21.5% of urban residents and 48.4% of rural residents were non-adherent in the study population. Poisson regression modelling stratified by area was performed to estimate the prevalence ratios (PRs) of not following treatment instructions. Demographic information and complications of hypertension were adjusted for in all models as possible confounders. In terms of SES, middle level of wealth compared with low level was significantly associated with poor adherence (PR 2.68, 95% CI 1.28 to 5.59) in the urban area, but education and employment status did not show similar associations. Lower education compared with middle/high school or higher was significantly associated with poor adherence in the rural area (no school: PR 3.22, 1.37-7.58; monastic: 3.42, 1.16-5.07; primary school: 2.41, 1.18-4.95), but wealth and income did not show similar associations. CONCLUSIONS SES and adherence to hypertension medication were differently associated among older adults in rural and urban areas in Myanmar. To ensure healthcare access to hypertension treatment for every citizen, the differential association between SES and adherence in urban/rural areas needs to be recognised.
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Affiliation(s)
- Yuiko Nagamine
- Department of Global Health Promotion, Tokyo Medical and Dental University, Bunkyo-ku, Japan
- Department of Social Preventive Medical Sciences, Chiba University Center for Preventive Medical Sciences, Chiba, Japan
| | - Yugo Shobugawa
- Department of Active Ageing, Niigata University, Niigata, Japan
| | - Yuri Sasaki
- Department of International Health and Collaboration, National Institute of Public Health, Wako, Japan
| | - Daisuke Takagi
- Department of Health and Social Behavior, The University of Tokyo, Bunkyo-ku, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Yu Par Khin
- Department of Global Health Promotion, Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Ikuma Nozaki
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yuki Shirakura
- Department of Active Ageing, Niigata University, Niigata, Japan
| | - Lwin Kay Thi
- Department of Preventive and Social Medicine, University of Medicine, Magway, Myanmar
| | - Zin Poe Ei
- Department of Preventive and Social Medicine, University of Medicine 1, Yangon, Yangon, Myanmar
| | - Zarchibo Thae
- Department of Preventive and Social Medicine, University of Medicine 1, Yangon, Yangon, Myanmar
| | - Hla Hla Win
- Department of Preventive and Social Medicine, University of Medicine 1, Yangon, Yangon, Myanmar
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Abrahamowicz M, Beauchamp ME, Moura CS, Bernatsky S, Ferreira Guerra S, Danieli C. Adapting SIMEX to correct for bias due to interval-censored outcomes in survival analysis with time-varying exposure. Biom J 2022; 64:1467-1485. [PMID: 36065586 DOI: 10.1002/bimj.202100013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 05/16/2022] [Accepted: 05/28/2022] [Indexed: 12/14/2022]
Abstract
Many clinical and epidemiological applications of survival analysis focus on interval-censored events that can be ascertained only at discrete times of clinic visits. This implies that the values of time-varying covariates are not correctly aligned with the true, unknown event times, inducing a bias in the estimated associations. To address this issue, we adapted the simulation-extrapolation (SIMEX) methodology, based on assessing how the estimates change with the artificially increased time between clinic visits. We propose diagnostics to choose the extrapolating function. In simulations, the SIMEX-corrected estimates reduced considerably the bias to the null and generally yielded a better bias/variance trade-off than conventional estimates. In a real-life pharmacoepidemiological application, the proposed method increased by 27% the excess hazard of the estimated association between a time-varying exposure, representing the 2-year cumulative duration of past use of a hypertensive medication, and the hazard of nonmelanoma skin cancer (interval-censored events). These simulation-based and real-life results suggest that the proposed SIMEX-based correction may help improve the accuracy of estimated associations between time-varying exposures and the hazard of interval-censored events in large cohort studies where the events are recorded only at relatively sparse times of clinic visits/assessments. However, these advantages may be less certain for smaller studies and/or weak associations.
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Affiliation(s)
- Michal Abrahamowicz
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Marie-Eve Beauchamp
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Cristiano Soares Moura
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Sasha Bernatsky
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Steve Ferreira Guerra
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Coraline Danieli
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
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Torres JL, Neri AL, Ferrioli E, Lourenço RA, Lustosa LP. Difficulty in taking medication and stroke among older adults with systemic arterial hypertension: the Fibra Study. CIENCIA & SAUDE COLETIVA 2021; 26:5089-5098. [PMID: 34787201 DOI: 10.1590/1413-812320212611.3.29292019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/29/2019] [Indexed: 11/22/2022] Open
Abstract
This article aims to investigate whether difficulty in taking medication is associated with stroke among older adults with Systemic Arterial Hypertension (SAH) and to explore their association with living arrangements. Cross-sectional study was based on 3,502 older adults with SAH from the four universities pole of Frailty in Brazilian Older People (Fibra) Study, Brazil, including 14 municipalities of the five Brazilian regions. We used the medical diagnosis of stroke and difficulty in taking medications (self-reported difficulty and financial difficulty affording prescribed medications). Multivariate analysis was performed using logistic regression. Differently from women, older men with SAH, which report difficulty in taking medication (unintentional non-adherence), have higher odds of stroke. When stratified by living arrangements, those living with a partner have even higher odds of stroke compared to those without difficulty in taking medication and living alone. None association was found for difficulty affording prescribed medication for both men and women. Unintentional difficulty in taking medication plays a role in SAH treatment among men. Primary care strategies for controlling blood pressure should not be focus only on patients but targeting spouses as well.
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Affiliation(s)
- Juliana Lustosa Torres
- Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais. Av. Prof. Alfredo Balena 190, sala 803. 30130-100 Belo Horizonte MG Brasil.
| | | | - Eduardo Ferrioli
- Faculdade de Medicina, Universidade de São Paulo, Ribeirão Preto. Ribeirão Preto SP Brasil
| | - Roberto Alves Lourenço
- Departamento de Medicina Interna, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro. Rio de Janeiro RJ Brasil
| | - Lygia Paccini Lustosa
- Departamento de Fisioterapia, Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas. Belo Horizonte MG Brasil
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Mohammadian Khonsari N, Shahrestanaki E, Ejtahed HS, Djalalinia S, Sheidaei A, Hakak-Zargar B, Heshmati J, Mahdavi-Gorabi A, Qorbani M. Long-term Trends in Hypertension Prevalence, Awareness, Treatment, and Control Rate in the Middle East and North Africa: a Systematic Review and Meta-analysis of 178 Population-Based Studies. Curr Hypertens Rep 2021; 23:41. [PMID: 34625888 DOI: 10.1007/s11906-021-01159-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW This study investigated and pooled the long-term trends in prevalence, awareness, treatment, and control of hypertension (HTN) in the Middle East and North Africa (MENA) region. In this systematic review and meta-analysis, we searched MEDLINE/PubMed, Web of Science, Google Scholar, EMBASE, and Scopus between database inception and November 2020. All cross-sectional studies that investigated the prevalence of pre-HTN, HTN, awareness, treatment, and control in the MENA counties were included. The selection study, data extraction, and quality assessment were conducted by two investigators independently. Heterogeneity between studies was assessed using Cochran's Q test and I-squared, and due to sever heterogeneity between studies, the random effect model was used to pool the estimates. Sensitivity analysis was performed to estimate the long-term trends in prevalence, awareness, treatment, and control rates of HTN according to definition of HTN as systolic blood pressure of 140 mm Hg or more, or diastolic blood pressure of 90 mm Hg or more, or being on pharmacological treatment for HTN. RECENT FINDINGS Overall, 178 studies met the inclusion criteria. Studies comprised 2,262,797 participants with a mean age of 45.72 ± 8.84 years. According to random effect model, the pooled prevalence of pre-HTN and HTN was 33% (95% CI 28, 39) and 26% (25, 27), respectively. Over the past three decades, prevalence of hypertension increased significantly in the region. The pooled awareness, treatment, and control rates were 50% (48, 53), 41% (38, 44), and 19% (17, 21), receptively. The pooled awareness, treatment, and control rates of HTN were lower significantly in men than women. According to definition of HTN as blood pressures above 140/90 mm Hg, over the past three decades, although the awareness and treatment rates did not change significantly, the control rates improved significantly in the region. The findings showed that HTN is a significant public health problem in the MENA region. Although there are low levels of pooled awareness, treatment, and control rates, the control rates improved over the past three decades in the region.
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Affiliation(s)
| | - Ehsan Shahrestanaki
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Hanieh-Sadat Ejtahed
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Djalalinia
- Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran.,Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Sheidaei
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Javad Heshmati
- Songhor Healthcare Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Armita Mahdavi-Gorabi
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mostafa Qorbani
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran. .,Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Pakhare A, Joshi A, Anwar R, Dubey K, Kumar S, Atal S, Tiwari IR, Mayank V, Shrivastava N, Joshi R. Linkage to primary-care public health facilities for cardiovascular disease prevention: a community-based cohort study from urban slums in India. BMJ Open 2021; 11:e045997. [PMID: 34362799 PMCID: PMC8351514 DOI: 10.1136/bmjopen-2020-045997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 07/23/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Hypertension and diabetes mellitus are important risk factors for cardiovascular diseases (CVDs). Once identified with these conditions, individuals need to be linked to primary healthcare system for initiation of lifestyle modifications, pharmacotherapy and maintenance of therapies to achieve optimal blood pressure and glycaemic control. In the current study, we evaluated predictors and barriers for non-linkage to primary-care public health facilities for CVD risk reduction. METHODS We conducted a community-based longitudinal study in 16 urban slum clusters in central India. Community health workers (CHWs) in each urban slum cluster screened all adults, aged 30 years or more for hypertension and diabetes, and those positively screened were sought to be linked to urban primary health centres (UPHCs). We performed univariate and multivariate analysis to identify independent predictors for non-linkage to primary-care providers. We conducted in-depth assessment in 10% of all positively screened, to identify key barriers that potentially prevented linkages to primary-care facilities. RESULTS Of 6174 individuals screened, 1451 (23.5%; 95% CI 22.5 to 24.6) were identified as high risk and required linkage to primary-care facilities. Out of these, 544 (37.5%) were linked to public primary-care facilities and 259 (17.8%) to private providers. Of the remaining, 506 (34.9%) did not get linked to any provider and 142 (9.8%) defaulted after initial linkages (treatment interrupters). On multivariate analysis, as compared with those linked to public primary-care facilities, those who were not linked had age less than 45 years (OR 2.2 (95% CI 1.3 to 3.5)), were in lowest wealth quintile (OR 1.8 (95% CI 1.1 to 2.9), resided beyond a kilometre from UPHC (OR 1.7 (95% CI 1.2 to 2.4) and were engaged late by CHWs (OR 2.6 (95% CI 1.8 to 3.7)). Despite having comparable knowledge level, denial about their risk status and lack of family support were key barriers in this group. CONCLUSIONS This study demonstrates feasibility of CHW-based strategy in promoting linkages to primary-care facilities.
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Affiliation(s)
- Abhijit Pakhare
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Ankur Joshi
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Rasha Anwar
- NCD Urban Project, Department of Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Khushbu Dubey
- NCD Urban Project, Department of Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Sanjeev Kumar
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Shubham Atal
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | | | - Vipul Mayank
- All India Institute of Medical Sciences, Bhopal, India
| | - Neelesh Shrivastava
- NCD Urban Project, Department of Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Rajnish Joshi
- Department of Medicine, All India Institute of Medical Sciences, Bhopal, India
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Halling T, Akkermann S, Löffler F, Groh A, Heitland I, Haefeli WE, Bauersachs J, Kahl KG, Westhoff-Bleck M. Factors That Influence Adherence to Medication in Adults With Congenital Heart Disease (ACHD). Front Psychiatry 2021; 12:788013. [PMID: 34899440 PMCID: PMC8660073 DOI: 10.3389/fpsyt.2021.788013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Innovative operative and interventional procedures have improved survival in congenital heart disease (CHD), and today more than 90% of these children reach adulthood. Consequently, adherence and psychosocial issues are becoming increasingly important because non-adherence to treatment recommendations worsens morbidity and mortality. This study aimed to identify factors modifying adherence to medication in adult congenital heart disease (ACHD). Methods: This cross-sectional study included 451 outpatients (female 47.9%, average age ± SD: 37.9 ± 12 years) from the ACHD department, who completed a questionnaire assessing medication non-adherence and individual barriers to treatment. Further assessments included psychological well-being (Hospital Anxiety and Depression scale; HADS), childhood traumatization, sociodemographic, and clinical data. Binary logistic regression analysis calculated the impact of these factors on drug adherence. Results: Of the 451 patients 162 participants (35.9%) reported to be non-adherent. In univariate analysis non-adherence to treatment was associated with smoking (P = < 0.001) and internet addiction (P = 0.005). Further factors negatively influencing adherence were the presence of depressive symptoms (P = 0.002), anxiety (P = 0.004), and childhood traumatization (p = 0.002). Factors positively associated with adherence were older age (P = 0.003) and more advanced heart disease as indicated by NYHA class (P = 0.01), elevated NT-proBNP (P = 0.02), device therapy (P = 0.002) and intermittent arrhythmias (P = 0.01). In multivariate analysis especially psychopathological factors such as depression (P = 0.009), anxiety (P = 0.032) and childhood traumatization (P = 0.006) predicted non-adherence. Conclusion: Adherence is a critical issue in the long-term management of ACHD. Identifying modifiable factors that worsen adherence offers the opportunity for targeted interventions. Depressive symptoms, anxiety, and adverse childhood experiences are amenable to psychosocial interventions, as well as cigarette smoking. Our study suggests that a multimodal and interdisciplinary treatment concept for the long-term management of adults with congenital heart disease could be beneficial. Whether it will further improve morbidity and mortality, should be assessed in prospective interventions.
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Affiliation(s)
- Tim Halling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Steffen Akkermann
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Friederike Löffler
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Adrian Groh
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Ivo Heitland
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Walter Emil Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
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Amoud R, Grindrod K, Cooke M, Alsabbagh MW. The Impact of Prescription Medication Cost Coverage on Oral Medication Use for Hypertension and Type 2 Diabetes Mellitus. Healthc Policy 2020; 16:82-100. [PMID: 33337316 PMCID: PMC7710965 DOI: 10.12927/hcpol.2020.26351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND No previous study, to the best of our knowledge, has examined both the time trend and impact of not having insurance or prescription medication cost coverage (PMCC) on the usage of type 2 diabetes and hypertension oral medications in Ontario and New Brunswick, Canada. METHODS We used data from the Canadian Community Health Survey (CCHS) from 2007 to 2014 to examine the time trend and impact of PMCC. A multivariable-adjusted logistic regression model was fitted. RESULTS The pseudo-cohort included 23,215 individuals representing a population of approximately 8.7 million people. Overall, 20.0% of respondents reported absence of PMCC. This proportion increased slightly from 19.6% (95% confidence interval [CI] 95% CI [17.5, 22.5]) to 20.7% (95% CI [16.9, 23.1]). Adjusted odds ratios (OR) showed that uninsured individuals were 23% less likely to use their medications (OR = 0.77, 95% CI [0.657, 0.911]). CONCLUSION There was a slight decline in PMCC over time and this decline was associated with reduced use of medications for type 2 diabetes and hypertension.
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Affiliation(s)
- Razan Amoud
- School of Pharmacy, Faculty of Science, University of Waterloo, Waterloo, ON
| | - Kelly Grindrod
- Associate Professor, School of Pharmacy, Faculty of Science, University of Waterloo, Waterloo, ON
| | - Martin Cooke
- Associate Professor, School of Public Health and Health Systems, Faculty of Applied Health Sciences, Department of Sociology and Legal Studies, Faculty of Arts, University of Waterloo, Waterloo, ON
| | - Mhd Wasem Alsabbagh
- Assistant Professor, School of Pharmacy, Faculty of Science, University of Waterloo, Waterloo, ON
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Badin YV. [Tactical approaches to the treatment of arterial hypertension in the European part of the Russian Federation. EPOHA study 2017]. ACTA ACUST UNITED AC 2019; 59:77-84. [PMID: 31884944 DOI: 10.18087/cardio.n408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/21/2019] [Indexed: 11/18/2022]
Abstract
AIM Analysis of antihypertensive treatment among different groups of patients with arterial hypertension from "EPOCHA" study 2017. MATERIALS AND METHODS EPOCHA study is a representative sample of the European part of the Russian Federation was created in 2002 and re-examined in 2017. RESULTS 34.6% of the effectively treated (ET) patients had one antihypertensive drug and 32,2% of the ineffective treatment (IT) patients, p=0.16. Two-component antihypertensive therapy was 45.9% and 44.9%, respectively, p=0.56. Three antihypertensive drugs had 17.9% of the ET patients and 20.7% of the IT patients, p=0.05. Four antihypertensive drugs had 1.6% of the ET patients and 2.2% of the IT patients. The frequency of use of renin-angiotensin-aldosterone system blockers in the group of ET patients was 85.0%, which was significantly lower than 91.6% in the group of IT patients, р<0.0001. CONCLUSION EPOCHA study shows that structure of antihypertensive therapy does not differ between ET and IT patients what is caused lack of medical supervision for patients with hypertension in real clinical practice.
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Su M, Haldane V, Upshur R, Sullivan F, Légaré F, Greiver M, Wei X. The Impact of Treatment Adherence for Patients With Diabetes and Hypertension on Cardiovascular Disease Risk: Protocol for a Retrospective Cohort Study, 2008-2018. JMIR Res Protoc 2019; 8:e13571. [PMID: 31152529 PMCID: PMC6658229 DOI: 10.2196/13571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/31/2019] [Accepted: 04/02/2019] [Indexed: 01/02/2023] Open
Abstract
Background Cardiovascular disease (CVD) is the leading cause of death globally and in Canada. Diabetes and hypertension are major risk factors for CVD events. Despite the increasing availability of effective treatments, the majority of diabetic and hypertensive patients do not have adequate blood pressure and glycemic control. One of the major contributors is poor treatment adherence. Objective This study aims to evaluate the impact of treatment adherence for patients with both diabetes and hypertension on acute severe CVD events and intermediate clinical outcomes in Canadian primary care settings. Methods We will conduct a population-based retrospective cohort study of patients living with both diabetes and hypertension in Ontario, Canada, between January 1, 2008, and March 31, 2018. The Social Cognitive Theory will be used as a conceptual framework by which to frame the reciprocal relationship between treatment adherence, personal factors, and environmental determinants and how this interplay impacts CVD events and clinical outcomes. Data will be derived from the Diabetes Action Canada National Data Repository. A time-varying Cox proportional hazards model will be used to estimate the impacts of treatment adherence on CVD morbidity and mortality. Multivariable linear regression models and hierarchical regression models will be used to estimate the associations between treatment adherence of different medication categories and intermediate clinical outcomes. Our primary outcome is the association between treatment adherence and the risk of acute severe CVD events, including CVD mortality. The secondary outcome is the association between treatment adherence and intermediate clinical outcomes including diastolic and systolic blood pressures, glycated hemoglobin, low-density lipoprotein cholesterol, and total cholesterol. Owing to data limitation, we use medication prescriptions as a proxy to estimate treatment adherence. We assume that a patient adhered to medications if she or he had any prescription record in the 4 preceding quarters and 1 quarter after each quarter of interest. Acute severe CVD events are defined based on the World Health Organization’s Monitoring Trends and Determinants in Cardiovascular Disease Project, including acute coronary heart disease, stroke, and heart failure. As causes of death are not available, the number of CVD deaths will be computed using the most recent systolic blood pressure distributions and the population attributable risks related to systolic blood pressure level. Results The project was funded by Diabetes Action Canada (reference number: 503854) and approved by the University of Toronto Research Ethics Board (reference number: 36065). The project started in June 2018 and is expected to be finished by September 2019. Conclusions The findings will be helpful in identifying the challenges of treatment adherence for diabetic and hypertensive patients in primary care settings. This will also help to develop intervention strategies to promote treatment adherence for patients with multi-morbidities. International Registered Report Identifier (IRRID) DERR1-10.2196/13571
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Affiliation(s)
- Min Su
- School of Public Administration, Inner Mongolia University, Hohhot, China.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Victoria Haldane
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ross Upshur
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Lunenfeld Tanenbaum Research Institute, Sinai Health Systems, Toronto, ON, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Frank Sullivan
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,School of Medicine, University of St Andrews, North Haugh, United Kingdom
| | - France Légaré
- Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Michelle Greiver
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,North York General Hospital, Toronto, ON, Canada
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Sex differences in the awareness, treatment, and control of hypertension in China: a systematic review with meta-analyses. Hypertens Res 2018; 42:273-283. [PMID: 30518984 DOI: 10.1038/s41440-018-0154-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/28/2018] [Accepted: 08/01/2018] [Indexed: 01/13/2023]
Abstract
Hypertension is the major cause of preventable disease burden in China. However, limited evidence is available on sex differences in the awareness, treatment, and control of hypertension. We assessed sex differences in the awareness, treatment, and control of hypertension in China. A systematic search of four English language and four Chinese-language databases was conducted to identify studies conducted from 2005 that reported sex-specific data on the awareness, treatment, and control of hypertension in China. Random-effects meta-analysis weighted by the inverse of the variances were used to obtain pooled sex-specific rates and women-minus-men differences, and their 95% confidence intervals (CI). Overall, 57 studies comprising 2,155,829 individuals (55% women) were included. Awareness (53% in women vs. 47% in men), treatment among all (44% vs. 38%), treatment among aware (65% vs. 60%), control among all (17% vs. 14%), and control among treated (27% vs. 27%) were low for both sexes, but more favourable in women than men. The corresponding women-minus men difference was 7% (95% CI: 6; 8%) for awareness, 6% (5; 8%) for treatment among all, 6% (2; 9%) for treatment among aware, 3% (2; 3%) for control among all, and 0% (-2; 1%) for control among treated. Awareness, treatment, and control of hypertension in China is low in both sexes, but greater in women than men. Sex-specific interventions may be needed to efficiently combat the burden of hypertension.
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Al-Daken LI, Eshah NF. Self-reported adherence to therapeutic regimens among patients with hypertension. Clin Exp Hypertens 2017; 39:264-270. [PMID: 28448187 DOI: 10.1080/10641963.2016.1247164] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To assess Jordanian hypertensive patients' adherence rate to hypertension therapeutic regimen (HTR) and to identify the strongest predictors of adherence rate among such patients. DESIGN AND SAMPLE A descriptive comparison design and convenience sampling were used. The sample comprised 192 participants who came to their regular appointments in a public healthcare center. MEASUREMENT The Hill-Bone Compliance to High Blood Pressure Therapy Scale and the Hypertension Knowledge-Level Scale were used to assess adherence to HTR and knowledge of hypertension, respectively. RESULTS The mean total score for adherence to HTR was 87.3, and 82.8% of participants reported good adherence overall. Adherence scores were significantly higher among women, less educated, unemployed participants, those with comorbidities, those with a negative family history of hypertension, and those who visited their physicians regularly. To identify the most significant predictors of adherence to HTR, multiple linear regression analysis was performed. Results indicated that good adherence to HTR was predicted by greater knowledge about hypertension and regularly visiting a physician. CONCLUSIONS Adherence to taking antihypertensive medications was good overall among the study participants; these participants, however, were less interested in adherence to reduced sodium intake and keeping up with medical appointments. Hypertensive patients appear to follow instructions related to pharmacological management and are less likely to comply with other elements of HTR.
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Affiliation(s)
| | - Nidal F Eshah
- a Faculty of Nursing, Zarqa University , Zarqa, Jordan
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Palafox B, McKee M, Balabanova D, AlHabib KF, Avezum AJ, Bahonar A, Ismail N, Chifamba J, Chow CK, Corsi DJ, Dagenais GR, Diaz R, Gupta R, Iqbal R, Kaur M, Khatib R, Kruger A, Kruger IM, Lanas F, Lopez-Jaramillo P, Minfan F, Mohan V, Mony PK, Oguz A, Palileo-Villanueva LM, Perel P, Poirier P, Rangarajan S, Rensheng L, Rosengren A, Soman B, Stuckler D, Subramanian SV, Teo K, Tsolekile LP, Wielgosz A, Yaguang P, Yeates K, Yongzhen M, Yusoff K, Yusuf R, Yusufali A, Zatońska K, Yusuf S. Wealth and cardiovascular health: a cross-sectional study of wealth-related inequalities in the awareness, treatment and control of hypertension in high-, middle- and low-income countries. Int J Equity Health 2016; 15:199. [PMID: 27931255 PMCID: PMC5146857 DOI: 10.1186/s12939-016-0478-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 11/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Effective policies to control hypertension require an understanding of its distribution in the population and the barriers people face along the pathway from detection through to treatment and control. One key factor is household wealth, which may enable or limit a household's ability to access health care services and adequately control such a chronic condition. This study aims to describe the scale and patterns of wealth-related inequalities in the awareness, treatment and control of hypertension in 21 countries using baseline data from the Prospective Urban and Rural Epidemiology study. METHODS A cross-section of 163,397 adults aged 35 to 70 years were recruited from 661 urban and rural communities in selected low-, middle- and high-income countries (complete data for this analysis from 151,619 participants). Using blood pressure measurements, self-reported health and household data, concentration indices adjusted for age, sex and urban-rural location, we estimate the magnitude of wealth-related inequalities in the levels of hypertension awareness, treatment, and control in each of the 21 country samples. RESULTS Overall, the magnitude of wealth-related inequalities in hypertension awareness, treatment, and control was observed to be higher in poorer than in richer countries. In poorer countries, levels of hypertension awareness and treatment tended to be higher among wealthier households; while a similar pro-rich distribution was observed for hypertension control in countries at all levels of economic development. In some countries, hypertension awareness was greater among the poor (Sweden, Argentina, Poland), as was treatment (Sweden, Poland) and control (Sweden). CONCLUSION Inequality in hypertension management outcomes decreased as countries became richer, but the considerable variation in patterns of wealth-related inequality - even among countries at similar levels of economic development - underscores the importance of health systems in improving hypertension management for all. These findings show that some, but not all, countries, including those with limited resources, have been able to achieve more equitable management of hypertension; and strategies must be tailored to national contexts to achieve optimal impact at population level.
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Affiliation(s)
- Benjamin Palafox
- ECOHOST - The Centre for Health and Social Change, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Martin McKee
- ECOHOST - The Centre for Health and Social Change, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Dina Balabanova
- ECOHOST - The Centre for Health and Social Change, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Ahmad Bahonar
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Noorhassim Ismail
- Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Jephat Chifamba
- Physiology Department, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Clara K Chow
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | | | | | - Rafael Diaz
- Estudios Clinicos Latinoamerica, Rosario, Santa Fe, Argentina
| | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, Jaipur, Rajasthan, India
| | - Romaina Iqbal
- Departments of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
| | - Manmeet Kaur
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rasha Khatib
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Annamarie Kruger
- Africa Unit for Transdisciplinary Health Research and Medical Research Council Research Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Iolanthe Marike Kruger
- Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | | | - Patricio Lopez-Jaramillo
- Research Institute, Fundacion Oftalmologica de Santander; and Medical School, University of Santander, Floridablanca, Bucaramanga, Colombia
| | - Fu Minfan
- Daxing Health Center, Shenyang City, Liaoning Province, China
| | | | - Prem K Mony
- St John's Medical College & Research Institute, Bangalore, India
| | - Aytekin Oguz
- Department of Internal Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | | | - Pablo Perel
- World Heart Federation, Geneva, Switzerland.,The London School of Hygiene & Tropical Medicine, London, UK
| | - Paul Poirier
- Faculté de Pharmacie, Université Laval Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Lei Rensheng
- Center for Disease Control & Prevention, Nanchang City, Jiangxi Province, China
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden
| | - Biju Soman
- Health Action by People, Thiruvananthapuram, and Achutha Menon Centre for Health Science Studies, Sree Chitra Institute for Medical Sciences & Technology, Trivandrum, Kerala, India
| | - David Stuckler
- Department of Sociology, University of Oxford, Oxford, UK
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard University, Boston, MA, USA
| | - Koon Teo
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Peng Yaguang
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, FuWai Hospital, Beijing, China
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, Canada
| | - Mo Yongzhen
- Institute of Geriatrics, Nanjing City, Jiangsu Province, China
| | - Khalid Yusoff
- UCSI University, Kuala Lumpur, Malaysia.,Universiti Teknologi MARA, Selayang, Selangor, Malaysia
| | - Rita Yusuf
- Independent University, Dhaka, Bangladesh
| | | | - Katarzyna Zatońska
- Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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13
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The persisting gender gap in hypertension management and control in Germany: 1998 and 2008-2011. Hypertens Res 2016; 39:457-66. [PMID: 26818655 DOI: 10.1038/hr.2016.5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/11/2015] [Accepted: 12/17/2015] [Indexed: 01/13/2023]
Abstract
Hypertension is a major risk factor for cardiovascular morbidity; therefore, its control is very important. International Guidelines recommend the same hypertension management in men and women; however, studies suggest that management of hypertension differs. This study explores gender-age disparities in the management and control of hypertension in Germany in 1998 and 2008-2011. Data from the German Health Examination Surveys (GNHIES98 1998, n=7124 and DEGS1 2008-2011, n=7988, age 18-79 years), including standardized blood pressure measurements and Anatomical Therapeutic Chemical medication codes, were analyzed by gender and two age groups. For 1998 and 2008-2011 in Germany, the gender gap in hypertension management persisted without significant changes. Hypertensive men in 2008-2011 had lower awareness of their condition (78.3 vs. 86.8%), less treatment for hypertension (65.3 vs. 79.2%), less control of hypertension (45.4 vs. 57.5%) and less treatment among those aware of their condition (83.9 vs. 91.5%) than did women. These gender differences were greater in younger compared with older adults (18-54 years vs. 55-79 years). No gender differences were observed in control of hypertension among those treated in 1998; however, subsequent improvement was less in younger men compared with the other age-gender groups, leading to a new gender gap in 18-54-year olds (women 84.8%, men 63.9%). Younger women used more β-blockers and less angiotensin-converting enzyme inhibitors (ACEI) than younger men. Factors positively associated with control among those treated for hypertension in the younger group were being a woman, using β-blockers or using ACEI, or angiotensin-receptor blockers. In the older group, diabetes was negatively associated with control of hypertension, whereas having cardiovascular comorbidities was positively associated. Gender disparities in hypertension management and control still exist in Germany but may be masked because they are age-dependent.
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Magrin ME, D'Addario M, Greco A, Miglioretti M, Sarini M, Scrignaro M, Steca P, Vecchio L, Crocetti E. Social support and adherence to treatment in hypertensive patients: a meta-analysis. Ann Behav Med 2016; 49:307-18. [PMID: 25341642 DOI: 10.1007/s12160-014-9663-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND It is important to examine factors associated with patient adherence to hypertension control strategies. PURPOSE A meta-analysis was conducted to examine whether social support was related to adherence to healthy lifestyle and treatment medication in hypertensive patients. METHODS Journal articles were searched in medical (CINAHL, MEDLINE), psychological (PsycINFO, PsycARTICLES), and educational (ERIC) electronic databases; in reference lists of selected papers; and in the reference list of a previous review. RESULTS Findings of a set of meta-analyses indicated that (a) structural social support was not significantly related to overall adherence, (b) functional social support was significantly and positively related to overall adherence, (c) these findings were further confirmed in meta-analyses conducted on specific types of adherence, and (d) most results were characterized by heterogeneity across studies that was partially explained by moderator analyses. CONCLUSIONS Functional social support, but not structural social support, was associated with adherence in hypertensive patients.
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Contemporary Management and Control of Uncomplicated Hypertension in Canada: Insight From the Primary Care Audit of Global Risk Management (PARADIGM) Study. Can J Cardiol 2015; 31:664-70. [DOI: 10.1016/j.cjca.2015.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 03/10/2015] [Accepted: 03/10/2015] [Indexed: 11/19/2022] Open
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Tu K, Anderson LN, Butt DA, Quan H, Hemmelgarn BR, Campbell NR, McAlister FA. Antihypertensive drug prescribing and persistence among new elderly users: implications for persistence improvement interventions. Can J Cardiol 2014; 30:647-52. [PMID: 24882536 DOI: 10.1016/j.cjca.2014.03.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 03/07/2014] [Accepted: 03/09/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The objective of this study was to examine persistence rates and factors influencing persistence for new elderly users of antihypertensive drugs. METHODS We conducted a population-based cohort study in Ontario of adults aged 66 years or older to identify new users of antihypertensive medications between 1999 and 2010. Two-year therapy and class persistence were defined as persistence on any antihypertensive medication and persistence only on the same antihypertensive medication class, respectively. RESULTS From 1999-2010, the prevalence of antihypertensive drug use increased from 47.8%-60.5% (P < 0.0001). Persistence was evaluated in 420,148 new users of antihypertensive drugs. After 2 years, therapy persistence was 58.9% and varied according to initial class prescribed, from 52.3% for diuretics to 64.1% for angiotensin-converting enzyme inhibitors. Class persistence ranged from 25.3% for diuretics to 35.8% for angiotensin II receptor blockers. Therapy persistence rates were greater in new users from more recent years (adjusted odds ratio [aOR], 1.24; 95% confidence interval [CI], 1.21-1.27). Subgroups that demonstrated poorer persistence included patients older than 75 years (aOR, 0.95; 95% CI, 0.94-0.96), those with lowest neighbourhood income quintile (aOR, 0.81; 95% CI, 0.80-0.83 compared with the highest quintile), those from urban vs rural areas (aOR, 0.83; 95% CI, 0.81-0.84), and those who started on diuretics as initial monotherapy compared with all other drug classes. CONCLUSIONS Although 2-year therapy and class persistence were low for new users of antihypertensive drugs, improvements have occurred over the past decade. Our data highlight subgroups to target for future persistence improvement interventions.
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Affiliation(s)
- Karen Tu
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; University Health Network-Toronto Western Hospital Family Health Team, Toronto, Ontario, Canada.
| | - Laura N Anderson
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - Debra A Butt
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Brenda R Hemmelgarn
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Norm R Campbell
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Finlay A McAlister
- Division of General Internal Medicine, University of Alberta, Edmonton, Canada
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Blais C, Rochette L, Hamel D, Poirier P. Prevalence, incidence, awareness and control of hypertension in the province of Quebec: perspective from administrative and survey data. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2014; 105:e79-85. [PMID: 24735701 PMCID: PMC6972276 DOI: 10.17269/cjph.105.4123] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 02/12/2014] [Accepted: 01/24/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Hypertension is a major risk factor for cardiovascular diseases. Nearly one adult in four was diagnosed with hypertension in 2007-2008 in Canada. One of the objectives of this study was to determine whether the prevalence of hypertension in Quebec as assessed using administrative data is comparable to that specifically measured, especially for the elderly population. METHODS Trends in prevalence, incidence and mortality were examined using the Quebec Integrated Chronic Disease Surveillance System built from grouping numerous administrative databases from 1996-1997 to 2009-2010. Blood pressure measurements, hypertension prevalence, awareness and control were obtained in 1,706 Quebecers in the combined cycles of the Canadian Health Measures Survey. RESULTS Using administrative databases, 23.6% [95% confidence interval, 23.5-23.6] of the Quebec population (n=1,433,400) aged ≥20 years was diagnosed with hypertension in 2009-2010, an increase of 32.1% compared to 2000 2001. The incidence decreased by 27.3%. Among people aged ≥65 years, the prevalence rose to 69.0% [95% CI: 68.8 69.2] in women and 61.7% [95% CI: 61.5-61.9] in men. For people aged 20-79 years, the prevalence of hypertension was lower with the administrative data compared to the survey (20.2% and 23.1%, respectively). The level of awareness, treatment and control were 84.3%, 83.1% and 67.9%, respectively. CONCLUSION The prevalence of hypertension derived from administrative data is comparable to that obtained with a health measured survey. Elderly women (≥65 years) are a very high-risk subgroup. The levels of awareness, treatment and control of hypertension in Quebec are very high.
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Affiliation(s)
- Claudia Blais
- Associate professor, Laval University, Institut national de santé publique du Québec.
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Patient and healthcare provider barriers to hypertension awareness, treatment and follow up: a systematic review and meta-analysis of qualitative and quantitative studies. PLoS One 2014; 9:e84238. [PMID: 24454721 PMCID: PMC3893097 DOI: 10.1371/journal.pone.0084238] [Citation(s) in RCA: 245] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 11/12/2013] [Indexed: 01/13/2023] Open
Abstract
Background Although the importance of detecting, treating, and controlling hypertension has been recognized for decades, the majority of patients with hypertension remain uncontrolled. The path from evidence to practice contains many potential barriers, but their role has not been reviewed systematically. This review aimed to synthesize and identify important barriers to hypertension control as reported by patients and healthcare providers. Methods Electronic databases MEDLINE, EMBASE and Global Health were searched systematically up to February 2013. Two reviewers independently selected eligible studies. Two reviewers categorized barriers based on a theoretical framework of behavior change. The theoretical framework suggests that a change in behavior requires a strong commitment to change [intention], the necessary skills and abilities to adopt the behavior [capability], and an absence of health system and support constraints. Findings Twenty-five qualitative studies and 44 quantitative studies met the inclusion criteria. In qualitative studies, health system barriers were most commonly discussed in studies of patients and health care providers. Quantitative studies identified disagreement with clinical recommendations as the most common barrier among health care providers. Quantitative studies of patients yielded different results: lack of knowledge was the most common barrier to hypertension awareness. Stress, anxiety and depression were most commonly reported as barriers that hindered or delayed adoption of a healthier lifestyle. In terms of hypertension treatment adherence, patients mostly reported forgetting to take their medication. Finally, priority setting barriers were most commonly reported by patients in terms of following up with their health care providers. Conclusions This review identified a wide range of barriers facing patients and health care providers pursuing hypertension control, indicating the need for targeted multi-faceted interventions. More methodologically rigorous studies that encompass the range of barriers and that include low- and middle-income countries are required in order to inform policies to improve hypertension control.
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Mozheyko M, Eregin S, Vigdorchik A, Tobe S, Campbell N, Riahi F, Hughes D. Changes in hypertension treatment in the yaroslavl region of Russia: improvements observed between 2 cross-sectional surveys. J Clin Hypertens (Greenwich) 2013; 15:918-24. [PMID: 24118731 PMCID: PMC4255293 DOI: 10.1111/jch.12214] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 08/21/2013] [Accepted: 09/13/2013] [Indexed: 11/29/2022]
Abstract
This prospective before-and-after survey of hypertensive patients visiting government-run outpatient health facilities in the Yaroslavl Region of Russia assessed blood pressure (BP)-related endpoints following initiation of a comprehensive health system improvement program for hypertension. Two cross-sectional surveys, one at baseline and the other approximately 1 year after program initiation, evaluated the primary measure of BP control rate. Secondary measures included mean BP levels and distribution, cardiovascular risk factors, and associated conditions, heart rate levels, and antihypertensive therapy. From the 2011 survey (n=1794) to the 2012 survey (n=2992), BP control rate (<140/90 mm Hg) significantly increased from 16.8% to 23.0%, reflecting a 37% relative improvement (P<.0001). Mean BP level was significantly reduced from 151/90 mm Hg to 147/88 mm Hg (P<.0001). Severe uncontrolled hypertension (systolic BP ≥180 mm Hg) was reduced from 9.7% to 6.4% (P<.0001). Implementing a guidelines-based treatment protocol with medical and patient education programs resulted in physician behavior change and improved patient BP control.
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Affiliation(s)
- Maria Mozheyko
- Department of CardiologyYaroslavl Regional Clinical Hospital of War VeteransYaroslavlRussia
| | - Sergey Eregin
- Cardiology CenterYaroslavl Regional Clinical HospitalYaroslavlRussia
| | | | - Sheldon Tobe
- Sunnybrook Health Sciences CentreTorontoONCanada
| | - Norman Campbell
- Community Health Sciences and Physiology and PharmacologyLibin Cardiovascular Institute of AlbertaABCanada
| | - Farhad Riahi
- Healthcare SystemsNovartis International AGBaselSwitzerland
| | - David Hughes
- Healthcare SystemsNovartis International AGBaselSwitzerland
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Campbell NRC, McAlister FA, Quan H. Monitoring and evaluating efforts to control hypertension in Canada: why, how, and what it tells us needs to be done about current care gaps. Can J Cardiol 2012; 29:564-70. [PMID: 22809887 DOI: 10.1016/j.cjca.2012.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 05/17/2012] [Accepted: 05/18/2012] [Indexed: 11/30/2022] Open
Abstract
Blood pressure surveillance, monitoring, and evaluation of programs to prevent and control hypertension are critical because increased blood pressure is a leading risk for premature death and disability. Since 2003, the Hypertension Outcomes Research Task Force has existed in Canada, with members who assist in the development and revision of surveys and conduct analyses that help guide hypertension programs. Although the Task Force has tracked a 5-fold increase in the control of hypertension (from 13% in 1985-1992 to 65% in 2007-2009), surveillance data also indicate that many "care gaps" remain. Fifty-four percent of people with diabetes and 34% of those without diabetes have blood pressure readings greater than their target. Treatment rates are high in those who are diagnosed (95%), but 17% of people with hypertension remain undiagnosed. Younger men (more so than women) are too often unaware of having hypertension. Although they are more likely to be aware of their diagnosis, older women are 2 times more likely to have uncontrolled hypertension than men; systolic blood pressure is high in over 80% of those with uncontrolled blood pressure (90% in women); and often people with hypertension are not provided comprehensive advice on healthy behaviours, or assisted in developing plans to control their blood pressure. Many current surveys do not have adequate statistical power to assess vulnerable populations; surveys of Aboriginal populations do not usually assess blood pressure, such that the burden of hypertension in these high risk populations cannot be assessed.
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Affiliation(s)
- Norm R C Campbell
- Department of Medicine, University of Calgary, Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada.
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