Quality-of-life questionnaire for patients taking antihypertensive medication

A Health Literacy-Focused Intervention for Latinos with Hypertension

Latinos in the United States are experiencing increasing incidences of uncontrolled high blood pressure (HBP). Health literacy is an important determinant of adequate HBP self-management, yet no community-based intervention has effectively addressed health literacy in the management of HBP in the target community. The purpose of this study was to test the acceptability and preliminary efficacy of a health literacy-focused HBP intervention in Spanish-speaking Latinos with uncontrolled HBP. Using a one-group pre- and post-test study design, the study intervention was delivered to Spanish-speaking Latinos in Baltimore, MD, who had uncontrolled HBP. The intervention consisted of four weekly group sessions for health literacy training combined with disease knowledge education in HBP management, followed by phone counseling and text messages for 3 months. Seventeen participants received the study intervention. Eleven who completed the follow-up assessment at 16 weeks reported high satisfaction with the intervention. Participation in the intervention resulted in improved blood pressure, numeracy, and psychological outcomes. Our findings support health literacy education as a promising avenue in promoting HBP control among inner-city Spanish-speaking Latinos. [HLRP: Health Literacy Research and Practice. 2018;2(1):e21-e25.].

Influence of living arrangements on the management and control of hypertension: a mixed-methods study of Korean American elderly

Elders living alone may experience worse health outcomes than do those living with spouse and/or children. Using baseline data from a randomized trial to promote high blood pressure (HBP) control in Korean elders (N = 440), we examined the relationship between living arrangements and HBP control. We also interviewed a sub-sample to better understand the patterns of social interactions associated with different types of living arrangements. One in five reported living alone; this group tended to be older and female, and resided in senior group housing. Those living alone were twice as likely as those living with a spouse to have controlled BP (OR = 2.08; 95 % CI 1.09-3.97), even after controlling for study covariates. Those in senior group housing had frequent social interactions that involved conversations around health, encouragement concerning medication taking, and health information sharing. In conclusion, Korean elders living independently are neither socially-isolated nor at increased risk for poor BP control.

Correlates of Health-Related Quality of Life Among Korean Immigrant Elders

Health-related quality of life (HRQOL) is a key clinical outcome, particularly for individuals with chronic conditions such as hypertension (HTN). While no previous research has examined contributors to HRQOL among Asian Americans in the United States, this study was conducted to identify correlates of HRQOL in hypertensive Korean immigrant elders (≥ 60 years of age) to address the gap. A total of 440 Korean elders with HTN participated in the study. The hierarchical regression model for HRQOL explained 32.8% of the variance. Female gender (β = .109, p = .036), a greater number of comorbid conditions (β = .183, p = .000), lower social support (β = -.240, p = .000), and greater depressive symptoms (β = .402, p = .000) were associated with poorer HRQOL. Depression was the most potent correlate of HRQOL among elderly Korean Americans (KA) with HTN. Future intervention should consider managing depression as an essential component of comprehensive HTN care for this minority population.

Development and validity testing of the neuropathy total symptom score-6: questionnaire for the study of sensory symptoms of diabetic peripheral neuropathy

OBJECTIVE

The aim of this study was to develop and validate a neuropathy sensory symptom scale, the Neuropathy Total Symptom Score-6 (NTSS-6), which evaluates individual neuropathy sensory symptoms in patients with diabetes mellitus (DM) and diabetic peripheral neuropathy (DPN) in clinical trials, with the intent of distinguishing a response to therapy.

METHODS

The NTSS-6 questionnaire was developed to evaluate the frequency and intensity of individual neuropathy sensory symptoms identified frequently by patients with DPN (ie, numbness and/or insensitivity; prickling and/or tingling sensation; burning sensation; aching pain and/or tightness; sharp, shooting, lancinating pain; and allodynia and/or hyperalgesia). The NTSS-6 was administered 8 times over a 1-year period to DPN patients. The NTSS-6's reliability (determined by internal consistency and test-retest reproducibility), construct validity, convergent validity, and minimally clinically important differences (MCIDs) were determined.

RESULTS

The NTSS-6 was administered to a total of 205 patients at 10 centers in the United States, Canada, Belgium, Germany, Hungary, Croatia, Slovenia, and the United Kingdom. Internal consistency was demonstrated at all 8 visits (Cronbach's alpha > 0.7). Test-retest reproducibility (intraclass correlation coefficient >0.9) was observed during the baseline period and at end point. Construct validity was demonstrated by statistically significant correlations between the NTSS-6 total score and the Neuropathy Symptoms and Change (NSC) score (r = 0.773-0.885, P < 0.001). Convergent validity was demonstrated by statistically significant correlations between the change in NTSS-6 total scores and the following: change in NSC scores (r = 0.519-0.708, P < 0.001); change in Neuropathy Impairment Score of the Lower Limbs and composite nerve function scores (r = 0.188-0.202, P < 0.007), and categories of the Clinical Global Impressions (r = 0.402, P < 0.001). The within- and between-groups MCIDs for the total NTSS-6 total scores were -1.26 and 0.97 points, respectively. The mean (SD) within-group MCID for all patients who improved on the Clinical Global Impression was -2.29 (3.4) points.

CONCLUSIONS

The NTSS-6 provided a valid assessment of neuropathy sensory symptoms in this sample of patients with DM and DPN, which suggests that it may be useful for symptom evaluation in clinical trials and practice. The NTSS-6 showed internal consistency, test-retest reliability, and construct validity. There was also convergent validity of the scores, indicating that the NTSS-6 may be a suitable questionnaire for clinical trials that evaluate symptoms of DPN in this well-defined patient population.

The effects of amlodipine compared to losartan in patients with mild to moderately severe hypertension

The calcium channel blocker amlodipine and angiotensin II receptor blocker losartan, with or without hydrochlorothiazide (HCTZ), were compared for the treatment of mild to moderate hypertension in a multicenter, double-blind, parallel-group clinical trial. Following a 2-week placebo run-in, 440 adults (45-80 years old) were randomized to receive either amlodipine 5 mg once daily or losartan 50 mg once daily. Patients who failed to meet the sitting diastolic blood pressure (BP) reduction goal of <or=90 mm Hg after 6 weeks had their dose increased to 10 mg amlodipine or had 12.5 mg of HCTZ added to the losartan 50 mg. A total of 42.3% of losartan and 43.6% of amlodipine subjects achieved a diastolic BP of <or=90 mm Hg at initial dose (low dose). Of those who completed treatment at the low dose, 71% of the amlodipine- and 81% of the losartan-treated patients met BP goal. This difference was not statistically significant. Of those who received a dosage adjustment, a significantly greater percentage of amlodipine-treated patients (59%) than losartan/HCTZ-treated patients (42%) reached BP goal at the last visit (p=0.009). Including both high- and low-dose subjects, 63.8% of amlodipine and 55.1% of losartan patients achieved a diastolic BP of <or=90 mm Hg at the last maintenance visit; this difference was not significant (p=0.07). Overall, reductions in mean sitting BP from baseline to the end of treatment were significantly greater in the amlodipine group than in the losartan group for both diastolic BP (-12.6 vs. -10.3 mm Hg; p=0.002) and systolic BP (-16.1 vs. -13.7 mm Hg; p=0.018). Additionally, the response rate was significantly greater after treatment with amlodipine than with losartan in African Americans (62.5% vs. 41.4%; p=0.033) and the other mostly Hispanic patients (67.7% vs. 53.5%; p=0.039). Both treatment groups showed significant reductions from baseline in 24-hour ambulatory BP at the end of treatment, with no difference between them. Adverse events were consistent with the safety profile of each drug. It is concluded that, while both amlodipine and losartan demonstrated a significant benefit for the treatment of mild to moderate hypertension, there were greater reductions in most BP measurements following treatment with amlodipine in comparison to losartan with or without HCTZ.

The effectiveness of Watson's Caring Model on the quality of life and blood pressure of patients with hypertension

BACKGROUND

Nurses caring relationships with hypertensive patients can have a positive effect upon their blood pressure and may increase quality of life and prolongation of life. Hypertension affects a large number of people. It is important that those affected receive, in addition to the best available medical treatment, nursing care that best meets their needs and adds to the quality of their lives. Watson's Caring Model is one nursing approach consistent with needs of persons with hypertension, and was used in this study to guide both research and practice.

AIM

To determine the effectiveness of a nurse's caring relationship according to Watson's Caring Model on the blood pressure and the quality of life of patients with hypertension.

METHODS

The design of the study was a one-group pretest and post-test. The study included 52 patients with hypertension in four health care units in Erzurum, Turkey in 2000. These patients had been diagnosed with hypertension and invited to participate in a research project involving nursing care. After acceptance, patients were given questionnaires consisting of demographic characteristics; their blood pressure was measured, and a quality of life scale was administered. Each of the participating nurse researchers was prepared in the use of Watson's Theory and Model of Caring (and the 10 Carative Factors). This training formed the basis of the caring process used by the nurse researchers who then visited the patients and their families once a week for blood pressure measurement for a 3-month period. At the end of care, the quality of life scale was applied to patients, and blood pressures were measured as the post-test.

RESULTS

There were statistically significant differences between mean scores of general well-being (t = 3.097, d.f. = 51, P = 0.003), physical symptoms and activity (t = 2.994, d.f. = 51, P = 0.004), medical interaction (t = 2.127, d.f. = 51, P = 0.035). There were also significant differences between blood pressure (systolic: t = 4.830, d.f. = 51, P = 0.000; and diastolic: t = 3.51, d.f. = 51, P = 0.001) in pre- and post-test.

CONCLUSION

This study demonstrated a relationship between care given according to Watson's Caring model and increased quality of life of the patients with hypertension. Further, in those patients for whom the caring model was practised, there was a relationship between the Caring model and a decrease in patient's blood pressure. The Watson Caring Model is recommended as a guide to nursing patients with hypertension, as one means of decreasing blood pressure and increase in quality of life.

Validation of the short form of the Spanish Hypertension Quality of Life Questionnaire (MINICHAL)

BACKGROUND

The finding that low health-related quality of life (HRQoL) can be a risk factor for future cardiovascular events in patients with hypertension emphasizes the need for disease-specific HRQoL assessment tools in this population.

OBJECTIVE

This study evaluated the feasibility and psychometric properties of the short form of the Spanish Hypertension Quality of Life Questionnaire (MINICHAL).

METHODS

An observational, prospective, multicenter study was carried out among patients with hypertension, stratified by sex and disease stage. The feasibility and validity of the MINICHAL were evaluated at baseline. Two follow-up visits were conducted at 1 and 6 months after the initial visit, during which the test-retest reliability and responsiveness to change of the MINICHAL were assessed, respectively.

RESULTS

A total of 736 consecutive patients with hypertension were included. Mean (SD) administration time for the MINICHAL was 7.2 (6.5) minutes. In the validation process, factor analysis showed 2 dimensions: "State of mind" (StM) and "Somatic manifestations" (SM). The response level was high, with 94.3% of patients answering all items. Patients with a higher disease stage (ie, stage II/III hypertension) had a worse HRQoL than those with a lower disease stage (P < 0.01). Internal consistency was 0.87 for StM and 0.75 for SM. Test-retest reliability was 0.82 and 0.75 for the StM and SM dimensions, respectively. Among patients who reported experiencing a positive change in their overall health status 6 months after treatment initiation or treatment change, responsiveness to change ranged from 0.52 (better) to 1.14 (much better).

CONCLUSIONS

The MINICHAL questionnaire could be administered in a short time with a high response level and was found to have acceptable psychometric properties. The MINICHAL is a potentially useful tool for the evaluation of HRQoL among patients with hypertension in the routine clinical setting.

Quality of life with nonpharmacologic treatment of hypertension

Therapeutic treatment of hypertension has been achieved successfully with both pharmacologic and nonpharmacologic interventions. Clinical trials have shown that various approaches to treatment result in different levels of blood pressure reduction as well as varying effects on quality of life. Standardizing the approach to measuring quality of life would be beneficial to the assessment of treatment outcomes in hypertension trials. This article reviews some of the strengths and weaknesses of both pharmacologic and nonpharmacologic treatments of hypertension, with special emphasis placed on effects of quality of life.