1
|
Andersson U, Nilsson PM, Kjellgren K, Ekholm M, Midlöv P. Associations between daily home blood pressure measurements and self-reports of lifestyle and symptoms in primary care: the PERHIT study. Scand J Prim Health Care 2024:1-9. [PMID: 38529930 DOI: 10.1080/02813432.2024.2332745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 03/13/2024] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVE To explore in a primary care setting the associations between patients' daily self-measured blood pressure (BP) during eight weeks and concurrent self-reported values of wellbeing, lifestyle, symptoms, and medication intake. We also explore these associations for men and women separately. DESIGN AND SETTING The study is a secondary post-hoc analysis of the randomised controlled trial PERson-centeredness in Hypertension management using Information Technology (PERHIT). The trial was conducted in primary health care in four regions in Southern Sweden. PATIENTS Participants (n = 454) in the intervention group in the PERHIT-trial used an interactive web-based system for self-management of hypertension for eight consecutive weeks. Each evening, participants reported in the system their wellbeing, lifestyle, symptoms, and medication adherence as well as their self-measured BP and heart rate. MAIN OUTCOME MEASURES Association between self-reported BP and 10 self-report lifestyle-related variables. RESULTS Self-reported less stress and higher wellbeing were similarly associated with BP, with 1.0 mmHg lower systolic BP and 0.6/0.4 mmHg lower diastolic BP (p < 0.001). Adherence to medication had the greatest impact on BP levels (5.2/2.6 mmHg, p < 0.001). Restlessness and headache were also significantly associated with BP, but to a lesser extent. Physical activity was only significantly associated with BP levels for men, but not for women. CONCLUSION In hypertension management, it may be important to identify patients with high-stress levels and low wellbeing. The association between medication intake and BP was obvious, thus stressing the importance of medication adherence for patients with hypertension.
Collapse
Affiliation(s)
- Ulrika Andersson
- Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Peter M Nilsson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Karin Kjellgren
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Mikael Ekholm
- Wetterhälsan Primary Health Care Centre, Jönköping, Region Jönköping County, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden
| |
Collapse
|
2
|
Youssef G, Mohamed M, Abdel Hamid M, El Remisy D. Reasons behind high rate of non-compliance to scheduled office visits in hypertensive patients: results from the Egyptian registry of specialized hypertension clinics. Egypt Heart J 2022; 74:45. [PMID: 35639186 PMCID: PMC9156586 DOI: 10.1186/s43044-022-00285-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/22/2022] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Hypertensive patients' compliance to the clinic's follow-up visits is associated with a better blood pressure control. The aim of this study was to detect the reasons of non-compliance to office visits in Egyptian hypertensive patients. RESULTS This is an observational, prospective, cross-sectional research study where patients were enrolled from the registry of the specialized hypertension clinics of 9 university hospitals. Those who attended less than 3 office visits, throughout the registry period, were considered non-compliant and were contacted through the phone. A simple questionnaire was prepared, which included questions about the reasons of non-compliance to follow up. There were 3014 patients eligible for inclusion in this study but only 649 patients (21.5%) completed the questionnaire. Patients claimed that the reasons of non-compliance to the follow up visits in the specialized hypertension clinics were as follows: 444 patients (68.4%) preferred to follow up elsewhere mostly in pharmacies, 53 patients (8.2%) claimed that the healthcare service was unsatisfactory, 94 patients (14.5%) were asymptomatic, and 110 patients (16.9%) said that the clinic was far from their homes. Despite non-compliance to office visits, 366 patients (59.2%) were compliant to their antihypertensive medications and 312 (48.1%) patients were compliant to salt restriction. About 34% of patients used herbs, mainly hibiscus, as adjuvant to their antihypertensive medications. CONCLUSIONS Reasons for non-compliance to office visits in hypertensive patients were either patient-related, or healthcare-related. To improve patients' compliance, physicians need to educate their patients about hypertension, patients need to follow their doctors' instructions as regard medications, salt restriction and scheduled office visits, and governments need to provide better and cheaper healthcare services.
Collapse
Affiliation(s)
- Ghada Youssef
- Cardiovascular Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
| | | | - Magdy Abdel Hamid
- Cardiovascular Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Dalia El Remisy
- Cardiovascular Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
| |
Collapse
|
3
|
Taft C, Hallberg I, Bengtsson U, Manhem K, Kjellgren K. Links between blood pressure and medication intake, well-being, stress, physical activity and symptoms reported via a mobile phone-based self-management support system: a cohort study in primary care. BMJ Open 2018; 8:e020849. [PMID: 30139897 PMCID: PMC6112389 DOI: 10.1136/bmjopen-2017-020849] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 06/12/2018] [Accepted: 07/19/2018] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To explore relationships between patients' self-monitoring of blood pressure (BP) and their concurrent self-reports of medication intake, well-being, stress, physical activity and symptoms. DESIGN This study is a secondary analysis of a prospective study exploring the 8-week effectiveness of a mobile phone-based self-management support system for patients with hypertension. SETTING Four primary healthcare centres situated in urban and suburban communities in Sweden. PARTICIPANTS 50 patients undergoing treatment for hypertension. PRIMARY AND SECONDARY OUTCOME MEASURES Associations between systolic (SBP) and diastolic blood pressure (DBP) and 10 self-report lifestyle-related variables were analysed using linear mixed effects modelling. RESULTS Medication intake, better well-being, less stress and greater physical activity were associated variously with lower same-day SBP and DBP. The single strongest association was found between medication intake and SBP, where failure to take medications was associated with an estimated 7.44 mm Hg higher SBP. To a lesser degree, medication intake was also associated with DBP, where DBP was 4.70 mm Hg higher in cases where medications were not taken. Well-being and stress were consistently associated with SBP and DBP, whereas physical activity was associated with only SBP. None of the symptoms-dizziness, headache, restlessness, fatigue or palpitations-were significantly associated with BP. CONCLUSIONS Our findings that BP was associated with patients' BP management behaviours and experiences of well-being and stress, but not symptoms suggest that enabling persons with hypertension to monitor and track their BP in relation to medication intake, physical activity, well-being, stress and symptoms may be a fruitful way to help them gain first-hand understanding of the importance of adherence and persistence to treatment recommendations. TRIAL REGISTRATION NUMBER NCT01510301; Pre-results.
Collapse
Affiliation(s)
- Charles Taft
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Inger Hallberg
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ulrika Bengtsson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Manhem
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Karin Kjellgren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
4
|
Arat S, De Cock D, Moons P, Vandenberghe J, Westhovens R. Modifiable correlates of illness perceptions in adults with chronic somatic conditions: A systematic review. Res Nurs Health 2018; 41:173-184. [PMID: 29315678 DOI: 10.1002/nur.21852] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 12/01/2017] [Indexed: 11/11/2022]
Abstract
When individuals become ill, they want to understand and give meaning to their illness. The interpretation of this illness experience, or illness perception, is influenced by a range of individual, contextual, and cultural factors. Some of these factors may be modifiable by nursing interventions. The purpose of this systematic review was to investigate which modifiable factors were correlated with illness perceptions across studies of adults with different chronic somatic diseases. Using search terms tailored to each of four electronic databases, studies retrieved were reviewed by two independent evaluators, and each relevant article was assessed for methodological quality. Results were standardized by calculating correlation coefficients. Fifteen papers on illness perceptions in a variety of chronic diseases met the inclusion criteria. All used standardized measures of illness perceptions. We identified five groups of modifiable correlates of illness perceptions: illness-related factors, psychosocial factors, medication beliefs, information provision and satisfaction with information received, and quality of care. Our findings add to the knowledge of modifiable factors correlated with illness perceptions, including the importance of illness-related factors and psychosocial factors such as anxiety and depression. Knowledge of these correlates can facilitate understanding of patients' illness perceptions and might be useful in tailoring patient education programs.
Collapse
Affiliation(s)
- Seher Arat
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
| | - Diederik De Cock
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium.,Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Joris Vandenberghe
- Department of Psychiatry, University Hospitals Leuven, Leuven, Belgium.,Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - René Westhovens
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium.,Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
5
|
Granados-Gámez G, Roales-Nieto JG, Gil-Luciano A, Moreno-San Pedro E, Márquez-Hernández VV. A longitudinal study of symptoms beliefs in hypertension. Int J Clin Health Psychol 2015; 15:200-207. [PMID: 30487837 PMCID: PMC6224860 DOI: 10.1016/j.ijchp.2015.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/20/2015] [Indexed: 11/02/2022] Open
Abstract
A longitudinal study was conducted to assess the presence of beliefs about symptoms related to hypertension and the time since diagnosis in which they appear. A randomly selected sample of hypertensive patients (67% women, mean age 53.27 years and range 20-65) was divided into four groups according to the time from diagnosis. All patients (N = 171) were interviewed at the beginning (initial assessment) and 12 months later (final assessment) and the patients (n = 75) who did not report beliefs about symptoms at the initial assessment were interviewed in a follow-up schedule. The results showed that 56% of patients reported beliefs about symptoms at the initial assessment, and this percentage increased to 77% at the final assessment (p < .001) finding significant differences between the two groups with a more recent diagnosis and the two groups of long-standing patients. Longitudinal analysis of the group with the recent diagnosis showed that the critical period for the emergence of beliefs was the first year from diagnosis. This period could be decisive in order to prevent them. Healthcare professionals should pay attention to the emergence of these beliefs, as they could negatively affect treatment adherence.
Collapse
|
6
|
Ledur P, Leiria L, Severo M, Silveira D, Massierer D, Becker A, Aguiar F, Gus M, Schaan B. Perception of uncontrolled blood pressure and non-adherence to anti-hypertensive agents in diabetic hypertensive patients. ACTA ACUST UNITED AC 2013; 7:477-83. [DOI: 10.1016/j.jash.2013.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 07/13/2013] [Accepted: 07/15/2013] [Indexed: 11/29/2022]
|
7
|
Marshall IJ, Wolfe CDA, McKevitt C. Lay perspectives on hypertension and drug adherence: systematic review of qualitative research. BMJ 2012; 345:e3953. [PMID: 22777025 PMCID: PMC3392078 DOI: 10.1136/bmj.e3953] [Citation(s) in RCA: 213] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To synthesise the findings from individual qualitative studies on patients' understanding and experiences of hypertension and drug taking; to investigate whether views differ internationally by culture or ethnic group and whether the research could inform interventions to improve adherence. DESIGN Systematic review and narrative synthesis of qualitative research using the 2006 UK Economic and Social Research Council research methods programme guidance. DATA SOURCES Medline, Embase, the British Nursing Index, Social Policy and Practice, and PsycInfo from inception to October 2011. STUDY SELECTION Qualitative interviews or focus groups among people with uncomplicated hypertension (studies principally in people with diabetes, established cardiovascular disease, or pregnancy related hypertension were excluded). RESULTS 59 papers reporting on 53 qualitative studies were included in the synthesis. These studies came from 16 countries (United States, United Kingdom, Brazil, Sweden, Canada, New Zealand, Denmark, Finland, Ghana, Iran, Israel, Netherlands, South Korea, Spain, Tanzania, and Thailand). A large proportion of participants thought hypertension was principally caused by stress and produced symptoms, particularly headache, dizziness, and sweating. Participants widely intentionally reduced or stopped treatment without consulting their doctor. Participants commonly perceived that their blood pressure improved when symptoms abated or when they were not stressed, and that treatment was not needed at these times. Participants disliked treatment and its side effects and feared addiction. These findings were consistent across countries and ethnic groups. Participants also reported various external factors that prevented adherence, including being unable to find time to take the drugs or to see the doctor; having insufficient money to pay for treatment; the cost of appointments and healthy food; a lack of health insurance; and forgetfulness. CONCLUSIONS Non-adherence to hypertension treatment often resulted from patients' understanding of the causes and effects of hypertension; particularly relying on the presence of stress or symptoms to determine if blood pressure was raised. These beliefs were remarkably similar across ethnic and geographical groups; calls for culturally specific education for individual ethnic groups may therefore not be justified. To improve adherence, clinicians and educational interventions must better understand and engage with patients' ideas about causality, experiences of symptoms, and concerns about drug side effects.
Collapse
Affiliation(s)
- Iain J Marshall
- King's College London, Division of Health and Social Care Research, London SE1 3QD, UK.
| | | | | |
Collapse
|
8
|
Providencia RA. Headache and cardiovascular disease: old symptoms, new proposals. Future Cardiol 2010; 6:703-23. [DOI: 10.2217/fca.10.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Evidence of a link between headache symptoms and cardiovascular disease has rapidly grown in recent years and it is of utmost importance for the cardiologist and neurologist to be aware of this intimate connection. A brief overview of different cardiovascular diseases (namely hypertension, stroke, coronary heart disease, patent foramen ovale, atrial septal defects, atrial septal aneurisms, mitral valve prolapse, and aortic and carotid disease) that may be related to headache is presented in this article. Proposed pathophysiological mechanisms for this association and landmark studies are reviewed and discussed.
Collapse
|
9
|
Muiesan ML, Padovani A, Salvetti M, Monteduro C, Poisa P, Bonzi B, Paini A, Cottini E, Agosti C, Castellano M, Rizzoni D, Vignolo A, Agabiti-Rosei E. Headache: Prevalence and relationship with office or ambulatory blood pressure in a general population sample (the Vobarno Study). Blood Press 2009; 15:14-9. [PMID: 16492611 DOI: 10.1080/08037050500436089] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
UNLABELLED The association of headache and arterial hypertension is still controversial, although headache is usually considered a symptom of hypertension. The aim of this study is to evaluate the prevalence of headache in a general population sample and the relationship with arterial hypertension, as diagnosed by office measurements and ambulatory monitoring of blood pressure (BP). PATIENTS AND METHODS In the randomized sample of the Vobarno population, 301 subjects (126 males, 175 females, age range 35-50 years) underwent a structured standardized headache questionnaire, office and 24-h ambulatory BP monitoring. RESULTS Prevalence of lifetime headache and of migraine was greater in females than in males. Office and 24-h BP values did not differ between subjects without headache and subjects with headache. No differences in headache prevalence (58% vs 55%), migraine prevalence (32% vs 28%) and use of analgesic drugs in the presence of headache (82% vs 78%) were observed between hypertensive patients (93.5% newly diagnosed, 6.5% treated) and normotensive subjects. CONCLUSIONS In a general population sample, hypertension (diagnosed by office and/or 24-h BP) is not associated with headache.
Collapse
Affiliation(s)
- Maria Lorenza Muiesan
- Internal Medicine, Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Okken VS, Niemeijer MG, Dijkstra A, Baars MW, Said S, Hoogenberg K, Orfgen H, Otten S, Cleophas TJ. The effect of physical, social and psychological factors on drug compliance in patients with mild hypertension. Neth Heart J 2008; 16:197-200. [PMID: 18665204 PMCID: PMC2442662 DOI: 10.1007/bf03086145] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND In patients with hypertension noncompliance with drug treatment is between 15 to 54%, and has been recognised as a relevant contributor to the burden of cardiovascular morbidity. Up to 92% of patients experience unpleasant symptoms with their condition and, particularly in these patients, the symptoms experienced may enhance compliance. OBJECTIVE To simultaneously assess the effects of physical, social and psychological factors on noncompliance. METHODS Patients with mild hypertension despite drug treatment, from the departments of cardiology and internal medicine, were requested to answer a self-administered questionnaire addressing the presence of physical symptoms as well as psychosocial factors. The questionnaire was based on previously used test batteries and consisted of two lists of physical complaints and four lists addressing the four domains of planned behaviour regarding medical non-adherence according to Baron and Byrne. These domains mainly assess psychosocial factors. Each list consisted of three or more items and each item was scored on fiveto seven-point scales. Mean scores were used for assessment. The lists were also separately assessed for internal consistency and reliability using Cronbach's alphas. One-way analysis of variance and multivariate analysis of variance (MANOVA) with compliance as outcome variable and the physical, social and psychological variables as indicator variables were used for data analysis. MANOVA was adjusted for multiple testing. RESULTS Many patients experienced physical symptoms due to hypertension, such as tiredness (31%), hot flushes (28%), headache (24%), reduced daily life energy (23%), palpitations (22%), with 95% confidence intervals between 16 to 38%. Scores for physical symptoms and social factors did not differ between self-reported adherers (n=165) and nonadherers (n=11). However, the score for psychological factors was significantly larger in the adherers than in the non-adherers, 5.05 versus 3.06, p<0.018. The MANOVA showed a significant overall difference between the adherers and non-adherers in the data at p<0.012, which was mainly due to the score for psychological factors. Conclusion. The effect of physical symptoms on non-compliance in mildly hypertensive patients is negligible. So is the effect of social factors. Psychological factors such as lacking a sense of guilt, regret and shame are major determinants of non-compliance. Physicians may play an educational role in improving their patients' compliance by addressing these determinants. We should add that the conclusions should be made with reservations, given the small number of non-adherers in our sample. (Neth Heart J 2008;16:197-200.).
Collapse
Affiliation(s)
- V S Okken
- Department of Social and Organisational Psychology, University of Groningen, Groningen, the Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Morecroft C, Cantrill J, Tully MP. Patients' evaluation of the appropriateness of their hypertension management--a qualitative study. Res Social Adm Pharm 2006; 2:186-211. [PMID: 17138508 DOI: 10.1016/j.sapharm.2006.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2005] [Revised: 02/16/2006] [Accepted: 02/16/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND The existing appropriateness measures for prescribing used in the United States and the United Kingdom use clinical attributes. Treatment and care from a patient's perspective need to be evaluated in terms of whether they are more likely to lead to an outcome of a life worth living, in social, psychological, and physical terms. However, it is unclear whether patients specifically evaluate their prescribed medication and treatment. If so, do they use only clinical attributes or a combination of clinical and nonclinical attributes? OBJECTIVES The aim of this study was to explore if patients evaluated their hypertension management, and if they did, investigate what attributes were involved in the evaluation. METHODS Semistructured interviews, which focused on personal experiences of hypertension and its management were undertaken with patients (n=28). The aim of the interviews was to obtain, in a narrative format, the experiences, beliefs, and information that patients considered important when discussing the management of hypertension. Data analysis used a constant comparative method. RESULTS All patients considered their hypertension management regimen appropriate, but were able to mention only 2 categories of attributes to justify their decision (the relationship with their General Practitioner and lowering of their blood pressure). Further series attributes were mentioned by the patient during the course of their interview; these attributes were considered to be involved in their evaluation. These implicit attributes were categorized as anxieties and concerns regarding treatment and diagnosis, explanation of the consequences of treatment, choice of antihypertensives, and the side effects experienced. CONCLUSIONS Patient's evaluation of appropriateness was constructed from both explicit and implicit attributes. Implicit attributes, those not consciously known to the patient still, could be involved in the process of evaluating hypertension, its treatment, and care. Although the nonmedical attributes that are considered by patients can be categorized, it has to be remembered that it is the inherent meaning held by each individual patient involved when an evaluation is made.
Collapse
Affiliation(s)
- Charles Morecroft
- School of Pharmacy and Pharmaceutical Sciences, The University of Manchester, Manchester, UK.
| | | | | |
Collapse
|
12
|
Beune EJAJ, Haafkens JA, Schuster JS, Bindels PJE. 'Under pressure': How Ghanaian, African-Surinamese and Dutch patients explain hypertension. J Hum Hypertens 2006; 20:946-55. [PMID: 17051238 DOI: 10.1038/sj.jhh.1002094] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The aim of this study was to explore and compare explanatory models (EMs) of hypertension in native-Dutch, first-generation Ghanaian and African-Surinamese (Surinamese) hypertensives in Amsterdam, the Netherlands. Through semi-structured interviews, we elicited accounts of the nature, causes and consequences of hypertension in a purposive sample of 46 patients (aged 35-65 years, treated for hypertension in general practice >1 year). All three groups had difficulty in describing hypertension. All groups mentioned culturally specific nutritional habits as possible causes of hypertension (Dutch liquorice; Ghanaians fufu; Surinamese salty diet). Most respondents, particularly those of Ghanaian and Surinamese background, perceived stress as the main cause of hypertension and experienced symptoms of hypertension. Many Ghanaian and Surinamese respondents attributed hypertension to migration-related factors: changes in diet or climate, stress owing to adaptation to the Dutch society or obligations towards family in their homelands. Many immigrants felt a return to their homeland could cure hypertension and were concerned about the consequences of hypertension. Half of the Dutch and almost all Ghanaian and Surinamese respondents believed uncontrolled hypertension could cause immediate damage. Some Ghanaians expressed reservations sharing their concerns with community members because it might cause social stigma. Few respondents associated hypertension with obesity, even though many were overweight. Confirming findings from UK and US studies, this study reveals that EMs of hypertension in patients from three ethnic groups differ from the common medical perspective. These differences are greater for patients from migrant groups. Our findings can be useful in developing patient-centred hypertension interventions, particularly in new migrant populations.
Collapse
Affiliation(s)
- E J A J Beune
- Department of General Practice, Academic Medical Centre, Universiteit van Amsterdam, Amsterdam, The Netherlands.
| | | | | | | |
Collapse
|
13
|
Handler J. Quality of life and antihypertensive drug therapy. J Clin Hypertens (Greenwich) 2005; 7:274-85. [PMID: 15886530 PMCID: PMC8109605 DOI: 10.1111/j.1524-6175.2005.04470.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2005] [Revised: 03/09/2005] [Accepted: 03/10/2005] [Indexed: 11/30/2022]
Abstract
Quality of life on antihypertensive therapy is an important consideration because clinicians are asked to initiate drug therapy and follow mostly asymptomatic patients for long periods of time on agents that are fairly equivalent in both blood-pressure-lowering capacity and the reduction of adverse clinical events. There is, however, evidence to show that hypertension is not always an asymptomatic condition; therefore, the reduction of blood pressure makes people not previously knowledgeable of their hypertensive state feel better. Labeling a patient hypertensive may have negative quality-of-life consequences. Clinicians need to be well informed regarding side-effect profiles as well as anxiety conditions that may lead to subjective complaints that are blamed on medication. Additionally, medication information given to patients may have an important effect on adverse effect reporting. Specific intolerance profiles to the thiazides, angiotensin-converting enzyme inhibitors, beta blockers, calcium channel blockers, and angiotensin receptor blockers are discussed in this review. Medication compliance requires a multi-tiered strategy. Low-dose thiazide is well tolerated.
Collapse
|
14
|
Handler J. Headaches and Hypertension: Primary or Secondary? J Clin Hypertens (Greenwich) 2004; 6:42-4. [PMID: 14724424 PMCID: PMC8109346 DOI: 10.1111/j.1524-6175.2004.02843.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
15
|
Fuchs FD, Gus M, Moreira LB, Moreira WD, Gonçalves SC, Nunes G. Headache is not more frequent among patients with moderate to severe hypertension. J Hum Hypertens 2003; 17:787-90. [PMID: 14578919 DOI: 10.1038/sj.jhh.1001621] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The association between hypertension and headache has been a contentious issue. Most studies have showed that mild hypertension and headache are not associated, but this may not be the case in patients with hypertension classified at more severe stages. We investigated the association between hypertension classified at moderate to severe stages and headache in a cross-sectional study conducted in the hypertension clinic of a tertiary care University hospital. In total, 1763 referred patients with a medical diagnosis of hypertension in most cases (95.7%) were evaluated by an extensive protocol questionnaire, detailed physical examination, laboratory examination, and had their blood pressure classified according to the VI Joint National Committee (JNC-VI) recommendation. Logistic regression models were used to explore the association between severity of hypertension and pulse pressure with the presence of headache, controlling for several potential confounders. The complaint of headache was referred by 903 (51.3% of whole sample), and a total of 378 patients (21.4%) were classified at the moderate to severe stage (stage III of the JNC-VI report). The diagnosis of moderate to severe hypertension was not associated with the complaint of headache (OR 1.02, 95% CI from 0.79 to 1.30). Pulse pressure and headache were inversely associated (OR 0.91, 95% CI from 0.86 to 0.97, for 10 mmHg). We concluded that headache and hypertension classified at moderate to severe stages were not associated in patients attending to a hypertension clinic. The novel finding of an inverse association between pulse pressure and headache should be addressed in further investigations.
Collapse
Affiliation(s)
- F D Fuchs
- Division of Cardiology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil.
| | | | | | | | | | | |
Collapse
|
16
|
Antoniazzi AL, Bigal ME, Bordini CA, Speciali JG. Cefaléia relacionada à hemodiálise: análise dos possíveis fatores desencadeantes e do tratamento empregado. ARQUIVOS DE NEURO-PSIQUIATRIA 2002. [DOI: 10.1590/s0004-282x2002000400018] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Um número crescente de pacientes vêm sendo submetidos a procedimentos dialíticos em todo o mundo. Cerca de 70% deles apresentam cefaléia. A despeito disso, a cefaléia não é sintoma bem estudado nesse grupo de pacientes. Os objetivos desse estudo são: avaliar possíveis fatores desencadeantes da cefaléia relacionada à hemodiálise e avaliar o tratamento analgésico utilizado nessa situação. Foram estudados prospectivamente 50 pacientes com insuficiência renal crônica seguidos em três serviços de hemodiálise da cidade de Ribeirão Preto, Estado de São Paulo, Brasil, entre janeiro de 1998 e dezembro de 1999. Todos apresentavam cefaléia estritamente relacionada às sessões de hemodiálise. Cefaléia ocorreu principalmente na segunda metade das sessões de hemodiálise (86%). Hipertensão arterial (38%), hipotensão arterial (12%) e alterações no peso corporal durante as sessões de hemodiálise (6%) foram os fatores desencadeantes mais frequentemente identificados. Em 28% dos casos não se identificou qualquer fator. Dipirona foi o analgésico mais utilisado (56%). A despeito de ser tão comum é surpreendentemente escassa a literatura disponível a respeito da associação entre cefaléias e insuficiência renal crônica. Esses pacientes, além de suportarem o fardo de conviver com um procedimento doloroso e monótono, porém necessário para mantê-los vivos, têm ainda que conviver com o impacto adicional das cefaléias na maioria das sessões. A identificação dos possíveis fatores desencadeantes e do tratamento disponível pode contribuir para o nosso conhecimento sobre essa associação, com consequente redução do impacto das cefaléias em portadores de insuficiência renal crônica.
Collapse
|