Hypertension and health-related quality of life: an epidemiological study in patients attending hospital clinics in China

Development and validation of a disease-specific quality of life measure QLICD-HY (V2.0) for patients with hypertension

The purpose of the present study is to develop and validate the hypertension scale of the Quality of Life Instruments (QoL) for Chronic Diseases system, QLICD-HY (V2.0). The QLICD-HY (V2.0) was developed via a programmed decision method with several focus groups, nominal discussions and pilot testing. The data was collected from 370 hypertensive inpatients and measured their QoL three times before and after treatment. Using correlation, factor analyses, as well as t-tests, the psychometric properties of the scale were assessed with regard to validity, reliability and responsiveness. Correlation and factor analysis supported good construct validity and criterion-related validity when using Short Form 36 as a criterion. Test-retest reliability coefficients for the overall scale score and all domains, with the exception of the psychological and social domain (0.77, 0.78), were greater than 0.80, with a range of 0.77-0.92. The internal consistency for all domains was higher than 0.70. With the exception of the psychological domain and social domain, the overall score and scores for the majority of aspects within each domain underwent statistically significant changes (t-tests) after the treatment. The QLICD-HY (V2.0) has good validity, reliability and responsiveness and can be used as a QoL measure for hypertensive patients.

Assessment of health-related quality of life and its determinants in the pre-dialysis patients with chronic kidney disease

PURPOSE

Health-related quality of life (HRQoL) is increasingly being considered as a critical parameter to measure how the disease affects patients' health status, especially for long-term ailments like chronic kidney disease (CKD). This study aimed to assess the HRQoL and its determinants in pre-dialysis patients with CKD.

METHODS

This cross-sectional study recruited patients with CKD stages one to four. Data were collected using the HRQoL Questionnaire (15D). Descriptive statistics were used to summarize patients' characteristics. Chi-square test or Fisher's exact test was used to explore the association between independent variables and the HRQoL. Multivariate logistic regression analyses were employed to investigate the determinants of HRQoL. A P value of less than 0.05 was considered statistically significant.

RESULTS

Two hundred and twenty patients were enrolled in the study (average age 52.7 ± 12.4 years, 61.8% females, and 69.1% with CKD stage 4). The average multidimensional utility score of the study population was 0.82 ± 0.13, while the single-attribute utility scores ranged from 0.73 to 0.89. The speech, and discomfort and symptoms dimensions had the highest (0.89) and lowest (0.73) single-attribute utility scores, respectively. The patients who were uneducated [Adjusted Odds Ratio (AOR) 0.34, 95% CI (0.12-0.97)] were significantly less likely to have poor HRQoL compared to those with tertiary education level. Additionally, unemployed [AOR 4.69, 95% CI (1.69-13.02)], and self-employed patients [AOR 4.25, 95% CI (1.26-14.38)] were significantly more likely to have poor HRQoL compared to the retirees CONCLUSIONS: This study shows that the overall HRQoL of the participants was high, though a considerable proportion of them had poor HRQoL, while the discomfort and symptoms dimension was the most impacted. Being educated, unemployed, and self-employed were significantly and independently associated with poor overall HRQoL.

Self-rated health and psychological health among hypertensive patients in Palestine

The study has investigated the self-rated psychological health of hypertensive patients in Palestine. To that end, a stratified random sample of 502 hypertensive patients (aged ⩾ 18 years) was asked to complete a validated Arabic version of the General Health Questionnaire (GHQ-28). After collection, the data were analyzed using descriptive statistics, Mann-Whitney U test and logistic regression. In this study, it was found the mean scores for GHQ were statistically higher for females than males (p < 0.05). The females were found to be 1.701 (95% CI = 1.025-2.823) times more at risk of psychological disorders compared to males. In conclusion, improvement of social determinants of hypertensive patients can make a difference in their psychological/mental health.

A Smartphone App (mDASHNa-CC) to Support Healthy Diet and Hypertension Control for Chinese Canadian Seniors: Protocol for Design, Usability and Feasibility Testing

BACKGROUND

This proposed study aims to translate the Dietary Approach to Stop Hypertension with Sodium (Na) Reduction for Chinese Canadians (DASHNa-CC), a classroom-based, antihypertensive, dietary educational intervention, to an innovative smartphone app (mDASHNa-CC). This study will enable Chinese Canadian seniors to access antihypertensive dietary interventions anytime, regardless of where they are. It is hypothesized that senior Chinese Canadians will be satisfied with their experiences using the mDASHNa-CC app and that the use of this app could lead to a decrease in their blood pressure and improvement in their health-related quality of life.

OBJECTIVE

The goal of this study is to design and test the usability and feasibility of a smartphone-based dietary educational app to support a healthy diet and hypertension control for Chinese Canadian seniors.

METHODS

A mixed-method two-phase design will be used. The study will be conducted in a Chinese immigrant community in Toronto, Ontario, Canada. Chinese Canadian seniors, who are at least 65 years old, self-identified as Chinese, living in Canada, and with elevated blood pressure, will be recruited. In Phase I, we will design and test the usability of the app using a user-centered approach. In Phase II, we will test the feasibility of the app, including implementation (primary outcomes of accrual and attrition rates, technical issues, acceptability of the app, and adherence to the intervention) and preliminary effectiveness (secondary outcomes of systolic and diastolic blood pressure, weight, waist circumference, health-related quality of life, and health service utilization), using a pilot, two-group, randomized controlled trial with a sample size of 60 participants in a Chinese Canadian community.

RESULTS

The study is supported by the Startup Research Grant from Nipissing University, Canada. The research ethics application is under review by a university research ethics review board.

CONCLUSIONS

The study results will make several contributions to the existing literature, including illustrating the rigorous design and testing of smartphone app technology for hypertension self-management in the community, exploring an approach to incorporating traditional medicine into chronic illness management in minority communities and promoting equal access to current technology among minority immigrant senior groups.

TRIAL REGISTRATION

Clinicaltrials.gov NCT03988894; https://clinicaltrials.gov/ct2/show/NCT03988894.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/15545.

Health-Related Quality of Life of Hypertension Patients: A Population-Based Cross-Sectional Study in Chongqing, China

Purpose: Hypertension is a major risk factor for cardiovascular diseases and stroke, and it requires lifelong medication. This study aimed to investigate the factors impacting on Health-Related Quality of Life (HRQoL) among hypertensive patients in Chongqing, China, and to provide evidence-based strategies to improve their HRQoL. Methods: This cross-sectional survey was conducted in Chongqing, China. Of 600 randomly selected patients, 586 patients agreed to participate and 567 patients completed the survey. A SF-36 (Medical Outcomes Study (MOS) Short Form Health Survey questionnaire) that included eight domains: physical functioning, role limitations due to physical problems, body pain, general health, vitality, social function, role limitations due to emotional problems, and mental health was used to measure HRQoL. Linear regressions were used; each domain of HRQoL was measured in the stratification of sex. Results: Self-perceived relatively low economic burden caused by hypertension and regular physical activity had a positive impact on HRQoL (p < 0.05) for both men and women. For women, younger age was associated with higher scores of measuring physical functioning and body pain. Living with more than three family members had a positive impact on domains, including physical functioning. Emotional self-regulation had a positive association with women’s mental health. Alcohol use for men was associated with higher scores in physical and mental health measures, and emotional self-regulation showed some positive impact on general health. Conclusion: Perceived economic burden caused by hypertension was the most common factor impacting on patients’ HRQoL. Female patients were more susceptible when compared to male patients. Health intervention strategies need to be further explored and adapted to the context of improving HRQoL for patients who suffer from hypertension and other chronic non-communicable diseases.

Quality of life among patients with moderate to advanced chronic kidney disease in Ghana - a single centre study

Background

The prevalence of chronic kidney disease (CKD) is increasing worldwide and in Africa. Health related quality of life (QOL) has become an essential outcome measure for patients with CKD and end stage renal disease (ESRD). There is growing interest worldwide in QOL of CKD patients but paucity of data in Ghana. This study sought to assess QOL in patients with moderate to advanced CKD (not on dialysis) and establish its determinants.

Methods

We conducted a cross sectional observational study at the renal outpatient clinic at Komfo Anokye Teaching Hospital (KATH). We collected demographic, clinical and laboratory data. A pretested self-administered Research and Development corporation (RAND®) 36-Item Health Survey questionnaire was administered and QOL scores in physical component summary (PCS) and mental component summary (MCS) were computed. Determinants of QOL were established by simple and multiple linear regression. P value of < 0.05 was considered statistically significant.

Results

The study included 202 patients with CKD not on dialysis. There were 118(58.5%) males. Mean age was 46.7 ± 16.2 years. The majority, 165(81.7%) of patients were on monthly salaries of less than GHS 500 (~USD 125). Chronic glomerulonephritis was the most common cause of CKD in 118 (58.5%) patients followed by diabetes mellitus in 40 (19.8%) patients and hypertension in 19 (9.4%) patients. The median serum creatinine was 634.2 μmol/L (IQR 333–1248) and the median eGFR was 7 ml/min/1.73m² (IQR 3–16). The most common stage was CKD stage 5 accounting for 143 (71.1%), followed by CKD stage 4 with 45 (22.4%) of cases and 13 (6.5%) of CKD stage 3. The overall mean QOL score was 40.3 ± 15.4. MCS score was significantly lower than PCS score (37.3 ± 10.8 versus 43.3 ± 21.6, P < 0.001). Multiple linear regression showed that low monthly income (p = 0.002) and low haemoglobin levels (p = 0.003) were predictive of overall mean QOL.

Conclusion

Patients with moderate to advanced CKD had low-income status, presented with advanced disease and had poor QOL. Anaemia and low-income status were significantly associated with poor QOL.

Quality of life in adults with sickle cell disease: an integrative review of the literature

OBJECTIVE

To identify the available evidence in the literature on health-related quality of life in adults with sickle cell disease.

METHOD

integrative review of MEDLINE, CUMED, LILACS and SciELO databases, from articles developed in this area, published between 2005 and 2015, in English, Portuguese or Spanish.

RESULTS

22 articles were included, six scales were used to evaluate health-related quality of life scores: three generic and three specific. No specific scale for adults with sickle cell disease has been adapted to Brazilian Portuguese so far. Patients affected by frequent painful crises, with low adherence to treatment, had a compromised quality of life.

CONCLUSION

Selected studies have shown that patients with sickle cell disease have worse scores than the general population. These indicators should be instrumental to the nurse in the proposal of interventions and strategies of assistance and socio-educational, with a view to improving the quality of life of this clientele.

Quantile regression analysis of modifiable and non-modifiable drivers' of blood pressure among urban and rural women in Ghana

High blood pressure is an increasingly problematic public health concern in many developing countries due to the associated cardiovascular and renal complications. This study set out to investigate the drivers of blood pressure among urban and rural women using the 2014 Ghana Demographic and Health Survey data. Diastolic blood pressure (DBP) and systolic blood pressure (SBP) were the outcomes of interest. Our findings showed that body mass index (BMI) had a significant positive effect on DBP and SBP in both urban and rural settings, with the largest effect occurring among women in the 75^th quantile. Arm circumference also had a positive effect on DBP and SBP across all quantiles in both settings. Age had an increasing positive effect along the entire conditional DBP and SBP distribution in both settings. Women who were pregnant had lower DBP and SBP relative to those who were not pregnant in both settings. These results highlight the important drivers of DBP and SBP, and the differential effects of these drivers on blood pressure (BP) among women in urban and rural settings. To increase their effectiveness, interventions to address high BP should take into account these differential effects.

Health-promoting behaviors and quality of life in older adults with hypertension as compared to a community control group

Hypertension (HTN) related to health-promoting behaviors (HPB) and quality of life (QOL) in older Chinese has not been clearly identified. We sought to compare the HPB and QOL of elderly adults (aged ≥60) living with HTN in China to a community normotensive control group. Using multistage stratified cluster sampling, a sample of 543 elderly people with HTN and 550 with normotension were randomly selected and asked to complete questionnaires. The Chinese version of the Health Promoting Lifestyle Profile (HPLP-IICR) and The World Health Organization Quality of life-BREF instrument (WHOQOL-BREF) were used to evaluate the HPB and QOL of elderly adults. As compared to the normotensive elderly, the hypertensive elderly showed significantly lower scores in their spiritual growth and health management (both P < 0.05), but not in the other three domains. Also, the participants with HTN showed significantly lower scores in the QOL overall and physical health (both P < 0.05), but not in other factors, as compared to the participants without HTN. Each HPLP-IICR domain score among the elderly with or without HTN were significantly correlated with their QOL scores (all P < 0.01). It is suggested that more attention should be paid to improving the spiritual growth and health management of HBP, and thus the overall quality of life among hypertensive patients.

Diet and Blood Pressure Control in Chinese Canadians: Cultural Considerations

Hypertension is highly prevalent in Chinese Canadians and diet has been identified as an important modifiable risk factor for hypertension. The current anti-hypertensive dietary recommendations in hypertension care guidelines lack examination of cultural factors, are not culturally sensitive to ethnic populations, and cannot be translated to Chinese Canadian populations without cultural considerations. Guided by Leininger's Sunrise Model of culture care theory, this paper investigates how cultural factors impact Chinese Canadians' dietary practice. It is proposed that English language proficiency, health literacy, traditional Chinese diet, migration and acculturation, and Traditional Chinese Medicine influence Chinese Canadians' dietary practices. A culturally congruent nursing intervention should be established and tailored according to related cultural factors to facilitate Chinese Canadians' blood pressure control. In addition, further study is needed to test the model adapted from Sunrise Model and understand its mechanism.

The influence of quality of life on the level of adherence to therapeutic recommendations among elderly hypertensive patients

BACKGROUND

Hypertension is one of the most important risk factors for cardiovascular disease, which contributes to lowering the quality of life (QOL), especially in elderly patients. Recent data show that almost half of the hypertensive patients and one-third of patients with comorbidities were nonadherent to medication.

OBJECTIVE

To assess the association of QOL with the level of adherence and to examine the association with selected variables on the level of adherence.

DESIGN

A prospective, cross-sectional, and analytical study.

METHODS

This study involved 186 hypertensive elderly patients (mean age: 71.05±7.47 years). An analysis of medical records based on sociodemographic and clinical data was conducted. The World Health Organization Quality of Life Scale Brief version (WHOQOL-BREF) was used to assess the level of QOL, and the Hill-Bone Compliance to High Blood Pressure Therapy Scale (HBQ) was used to examine the level of adherence to therapeutic recommendations in hypertensive patients.

RESULTS

The average assessment of the QOL measured by the WHOQOL-BREF questionnaire was 3.36±0.84 points, which indicates a QOL at a level between average and good. The patients' average score on the HBQ questionnaire was 20.39±4.31 points. In the "reduced sodium intake" subscale, patients had an average of 4.75±1.33 points. In the "appointment keeping" subscale, the patients scored an average of 3.45±1.07 points. In the "medication taking" subscale, the patients had an average of 12.19±3.46 points. It was shown that the total score of the HBQ questionnaire was negatively correlated with all domains of QOL assessed with the WHOQOL-BREF questionnaire (P<0.05).

CONCLUSION

There is an association between QOL and adherence to therapeutic recommendations among hypertensive elderly patients. It has been concluded that with an increasing QOL, the level of adherence to therapeutic recommendations increases. The level of adherence is also negatively affected by: older age, longer duration of disease, worse marital status, lower education, living alone, and using polytherapy.

Health-related quality of life among adults with and without hypertension: A population-based survey using EQ-5D in Shandong, China

Previous studies have focused on health-related quality of life (HRQoL) in hypertensive individuals, but few studies have attempted to compare HRQoL between hypertensive and normotensive individuals using the EQ-5D in China. Based on a survey of 3509 adults aged 18 + years, we compared HRQoL between hypertensive and normotensive individuals using a chi-square test, t-test and multi-linear regression model. The results indicated that HRQoL in hypertensive individuals was poorer than that of normotensive individuals in all domains of the EQ-5D and its utility index. In addition, education, complications, household income, and family history of HBP were associated with HRQoL among the hypertensive patients. Factors including age, education, household income, health expenditure, place of residence, and family history of high blood pressure (HBP) were found to be associated with HRQoL in normotensive individuals. Interventions targeting at-risk subgroups, such as modifying existing health insurance schemes to improve them for poor individuals, might be helpful to improve HRQoL.

The effect of health literacy and self-management efficacy on the health-related quality of life of hypertensive patients in a western rural area of China: a cross-sectional study

Background

Hypertension is a common and frequently occurring chronic disease of the cardiovascular system. Besides the pathological factors, the occurrence and exacerbation of hypertension are also associated with many factors of lifestyle and behaviors. Thus hypertensive patients’ Health-related quality of life (HRQL) is not only influenced by the disease itself but also by many subjective factors such as health literacy and self-management efficacy, especially in the deeper part of southwestern China and thus is less developed compared to the other places. The purpose of this study was to examine the association between the HRQL of hypertensive patients and health literacy and self-management efficacy as well as how they affect the HRQL, so as to provide a theoretical reference for improving the HRQL of patients with hypertension in less developed areas.

Methods

This was a cross-sectional study of baseline data from a clustered randomized controlled trial. The study design had passed a cross-national peer review and accepted grants by the China Medical Board. It was also registered in the Chinese Clinical Trial Registry (ChiCTR-OOR-14005563).

A standardized questionnaire adapted from a previous validated WHO questionnaire was used for the survey which included detailed questions about patient’s socio-demographic characteristics and self-reported information.

Patients’ HRQL was measured by the Mandarin version of the 36-item Short Form. We used the validated Mandarin version of the Self-Efficacy for Managing Chronic Disease 6-Item Scale to assess patients’ self-management efficacy. The validated three-item Brief Health Literacy Screening (BHLS) was used to measure the patients’ health literacy.

A structural equation model was constructed, and p ≤ 0.05 was taken as significant.

Results

Demographic characteristics, health literacy and self-management efficacy have all significant effects on HRQL. Age, education level, self-management efficacy and health literacy were significantly related to the HRQL. The constructed model had a good fit for the data according to the model fit indices. Based on the model, health literacy (r = 0.604, p = 0.029) and Self-management efficacy (r = 0.714, p = 0.018) have a significant impact on HRQL. Demographic characteristics were inversely related to HRQL (r = −0.419, p = 0.007), but have a significant impact on health literacy (r = 0.675, p = 0.029) and self-management efficacy (r = 0.379, p = 0.029). At the same time, self-management efficacy was positively correlated to health literacy (r = 0.413, p < 0.01).

Conclusions

Age, education level, self-management efficacy and health literacy were all related to the HRQL of patient with hypertension, which means that patients who are more elderly and have lower education level, low self-management efficacy and poor health literacy get worse HRQL. This may imply the necessary to introduce routine assessment of health literacy and self-management efficacy into assessment procedures for hypertensive patients’ health management. Such assessment can help professionals to identify the population at greatest risk for poor health outcomes and low well-being in the future. In clinical practice, effective interventions such as direct guidance and education to raise the self-management efficacy and enhance health literacy might improve the HRQL of patients with hypertension.

Trial registration

Retrospectively registered Chinese Clinical Trial Registry (ChiCTR-OOR-14005563).

Name of registry: Effects of the integrated delivery system and payment system of community-based intervention on rural patients of chronic diseases in Qianjiang District, China

Date of registration: Retrospectively registered 23 November 2014.

Date of enrolment of the first participant to the trial: 5 July 2012

Hypertension Impact on Health-Related Quality of Life: A Cross-Sectional Survey among Middle-Aged Adults in Chongqing, China

Hypertension is a major risk factor of cardiovascular disease in China, and yet little is known about health-related quality of life (HRQOL) and its associations with demographic and social-economic characteristics in middle-aged patients with hypertension. A cross-sectional survey was undertaken in Chongqing, China, using a multistage stratified random sampling methodology. Data was collected on 1,224 eligible adults, aged between 45 and 53 years, including the Medical Outcomes Survey Short Form-36 to measure HRQOL. Hypertension was associated with poor state of physical functioning, role-physical, bodily pain, general health, vitality, and social function (p < 0.05 for all). In multivariable analyses, education level, job conditions, average monthly income, smoking status, sleep quality, perception of relationship with family, childhood breastfeeding history, and body mass index were associated with domains of SF36 among those with hypertension (p < 0.05 for all). Hypertensive respondents with high education, marital status, breastfeeding, higher incomes, good quality of sleep, positive relationship with family, and higher body mass index have better HRQOL in middle-aged people with hypertension. Those unemployed had a better state of general health and had a poorer state of social function. Nonsmokers had a poorer state of bodily pain than smokers. This study provides detailed information of the implications for health care providers to gain a more complete picture of their hypertension patients' health.

[Influence of socioeconomic factors on the quality of life of elderly hypertensive individuals]

This study sought to evaluate the association between socioeconomic variables and the quality of life of elderly hypertensive patients treated under the Family Health Program in the city of Montes Claros, Minas Gerais, Brazil. An analytical cross study was conducted in a representative sample of 294 elderly hypertensive patients. Data were collected using a questionnaire on socioeconomic characteristics and quality of life (MINICHAL). The data were analyzed using the nonparametric Mann-Whitney and Kuskall-Wallis tests. The results showed that marital status, religion and education affect the quality of life of elderly hypertensive patients in a statistically significant way. Elderly hypertensive patients who were single/divorced/widowed, evangelical, spiritualist and belonging to other religious bodies, illiterate achieved lower scores in terms of quality of life. For the remaining variables, there was no statistical association. The conclusion, drawn is that socioeconomic factors such as marital status, education and religion influence the quality of life of elderly hypertensive patients.

Association of frail index and quality of life among community-dwelling older adults

AIMS AND OBJECTIVES

To examine the independent effect of frailty on quality of life.

BACKGROUND

The World Health Organisation has proposed that frailty be used to indicate a lack of successful ageing. However, studies investigating the relationship between frail phenotypes and quality of life are lacking.

DESIGN

This research employed a cross-sectional design.

METHODS

The Study of Osteoporotic Fractures index was used based on the following three criteria: unexpected weight loss, inability to rise from a chair without using the armrests five times, and feeling a lack of energy. Participants who fulfilled more than two, one or zero criteria were considered as frail, prefrail or robust respectively. Moreover, this study used the Taiwanese version of the World Health Organisation Quality of Life-BREF to assess the quality of life of older people. A multiple linear regression was performed to investigate the independent effect of frail status on each quality of life subscale.

RESULTS

A total of 239 older people [average age = 74·77 years; standard deviation = 7·02 years; 104 males (43·5%) and 135 females (56·5%)] participated in this study. The multiple linear regression analysis showed that the older people who were more advanced in age and had been diagnosed with a greater number of chronic diseases had a lower comprehensive quality of life. The Study of Osteoporotic Fractures index was associated only with the environmental domain of the World Health Organisation Quality of Life-BREF.

CONCLUSIONS

Compared with robust and prefrail older people, frail older people have worse biomarkers, health statuses, and quality of life. The Study of Osteoporotic Fractures index was correlated only with the quality of life environmental domain.

RELEVANCE TO CLINICAL PRACTICE

Professional nurses must understand the differences among frail, prefrail and robust older people with regard to their biomarkers, health status, and quality of life. In addition, a comprehensive nursing intervention programme must be developed to improve the quality of life of older people.

Health-related quality of life and risk of hypertension in the community: prospective results from the Western New York Health Study

OBJECTIVES

Measures of health-related quality of life (HRQL) are strong predictors of health outcomes including cardiovascular disease (CVD). However, prospective evidence on the potential impact of these measures on hypertension risk is scant. We therefore examined the independent role of HRQL on the risk of hypertension in a 6-year longitudinal investigation among 979 women and men (mean age 54.3 years) from the community, who were free of hypertension, CVD and diabetes at the baseline examination.

METHODS

Baseline variables included socio-demographics, anthropometrics, blood pressure, behavioural risk factors and measures of HRQL, such as the physical and mental health component summaries of the short form-36 questionnaire (SF-36). Incident hypertension was defined as blood pressure at least 140/90  mmHg or on antihypertensive medication at the follow-up visit.

RESULTS

The cumulative 6-year incidence of hypertension was 21.9% (214/979). In bivariate analyses, there were several baseline correlates of incident hypertension, including age, abdominal height, BMI and baseline blood pressure levels in both sexes, whereas impaired fasting glucose, family history of hypertension and the SF-36 physical score were all significantly associated with hypertension among women only. After multivariate adjustment, the SF-36 physical scores [odds ratio (OR) 0.97, 0.94-0.99 for unit change] were still significant predictors of hypertension in women only, independent of age, anthropometrics, baseline SBP levels, behavioural risk factors and other covariates.

CONCLUSION

Measures of HRQL may represent independent predictors of hypertension risk, at least among women, above and beyond the role of traditional risk factors, such as age, anthropometrics and genetic predisposition.

Quality of Life in Treatment-Resistant Hypertension

Treatment-resistant hypertension (TRH) is an increasingly common and clinically challenging hypertension phenotype associated with adverse impact on cardiovascular events and death. Recent evidence, although limited, suggests that TRH may also adversely affect health-related quality of life (HrQoL) and other patient-reported outcomes. However, the precise mechanisms for this link remain unknown. A number of recent studies focusing on both the general hypertensive population and those with TRH suggest that patient awareness of difficult-to-control blood pressure, chronically elevated blood pressure levels, and the use of aggressive medication regimens with attendant cumulative adverse effects may play significant roles. This review summarizes the existing literature on HrQoL in persons with TRH, highlights literature from the general hypertensive population with relevance to TRH, and discusses important remaining questions regarding HrQoL in persons with TRH.

SOCIAL ENGAGEMENT AND USE OF HYPERTENSIVE MEDICATION AMONG ADULTS IN CHINA

This study’s objectives were, first, to examine the association between social engagement and the odds of taking hypertensive medications and treatment among adults in China; and second, to explore the lifestyle and psychological mechanisms underlying this association. Data were from the WHO Study on Global AGEing and Adult Health (WHO-SAGE), a national survey of 11,046 participants aged 18 to 69 conducted in China in 2010. The key outcome was a dichotomous indicator of whether the respondent was taking hypertensive medication or other treatment. A series of logistic regression models were fitted to examine the research questions. Higher levels of social engagement were found to be associated with a lower odds of taking hypertensive medication or treatment, and the association was stronger for women than for men. Lifestyle factors (i.e. smoking and BMI) and perceived overall life satisfaction were significant covariates. Life satisfaction helped explain some of the social engagement benefit for both men and women and BMI only appeared to be a mediator for men. Being married was not significantly associated with lower odds of taking hypertensive medication or treatment in either men or women. Social engagement seems to be protective against hypertension for adult men and women in China, although causation could not be determined in this cross-sectional study. Psychosocial mechanisms are probably at work, but these vary by gender.

Relationship of treatment satisfaction to health-related quality of life: findings from a cross-sectional survey among hypertensive patients in Palestine

BACKGROUND

Evaluation of the association between treatment satisfaction and health-related quality of life (HRQoL) may enable health-care providers to understand the issues that influence quality of life and to recognize the aspects of hypertension treatment that need improvement to enhance the long-term treatment outcomes.

OBJECTIVE

The aim of this study was to determine the relationship between HRQoL and treatment satisfaction in a sample of Palestinian hypertensive patients.

METHODS

A cross-sectional study was conducted, adopting the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4) for the assessment of treatment satisfaction and using the European Quality of Life scale (EQ-5D-5L) for the assessment of HRQoL. Descriptive and comparative statistics were used to describe socio-demographic and disease-related characteristics of the patients. All analyses were performed using SPSS v 15.0.

RESULTS

Four hundred and ten hypertensive patients were enrolled in the study. This study findings indicate a positive correlation between all satisfaction domains and HRQoL. Significant differences were observed between this study variables (P < 0.001). After adjustment for covariates using multiple linear regression, an increase of one point in the global satisfaction scale was associated with a 0.16 increase in EQ-5D index scores (r = 0.16; P < 0.001).

CONCLUSIONS

Patients with reportedly higher satisfaction scores have reported relatively higher EQ-5D-5L index values. These study findings could be helpful in clinical practice, mainly in the early treatment of hypertensive patients, at a point where improving treatment satisfaction and HRQoL is still possible.

Utilities of Patients with Hypertension in Northern Vietnam

Objectives

The study aims to inform potential cost-effectiveness analysis of hypertension management in Vietnam by providing utilities and predictors of utilities in patients with hypertension.

Methods

Hypertensive patients up to 80 years old visiting the hospital were invited to participate in a survey using Quality Metric’s Short-form 36v2^TM translated into Vietnamese. Health-state utilities were estimated by applying a previously published algorithm.

Results

The mean utility of the 691 patients interviewed was 0.73. Controlling for age, sex, blood pressure (BP) stage, and history of stroke, the utilities in older patients were lower than those in younger ones, and statistically significantly different between the extremes of youngest and oldest groups (p = 0.03). Utility in males was higher than in females (p = 0.002). As expected, patients with a history of stroke appeared to exhibit lower utilities than patients without such history, but the difference was not statistically significant (p = 0.73). Patients with more than three comorbidities did have lower utilities than patients without comorbidity (p = 0.01).

Conclusions

Health-state utilities found among hypertensive patients in Vietnam were similar to those found in other international studies. It is suggested that lower of health-state utilities exist among those patients who were older, female or had more than three comorbidities in comparison with respective reference groups. However, further research for confirmation is required. The data from this study provide a potential reference on health-state utilities of hypertensive patients in Vietnam as an input for future cost-effectiveness analysis of interventions. Also, it may serve as a reference for other similar populations, especially in the context of similar environments in low income countries.

Comparative assessment of determinants of health-related quality of life in hypertensive patients and normal population in south-west Nigeria

Objective: Health-related quality of life (HRQOL) in hypertensive patients may be influenced by the presence and the knowledge of disease, beliefs associated with the disease, blood pressure (BP) control, and drug utilization. The impact of hypertension on HRQOL in hypertensive patients compared to the normal population has not been assessed in Nigeria, the most populous country in sub-Saharan Africa. This study compares HRQOL in hypertensive patients and the normal population; the effect of BP control and medication on HRQOL of hypertensive patients is also assessed. Materials and methods: A prospective cross-sectional study of 713 individuals, 606 were hypertensive patients attending the University College Hospital in Oyo State, Nigeria, while 107 were normal persons residing in Ibadan. Data on sociodemographic status, clinical variables, and drug utilization were collected. World health organization-quality of life short version (WHO-QOL-BREF) questionnaires were used to assess HRQOL of participants. Results: Hypertensive patients had poorer HRQOL compared with normal individuals in the physical health (p < 0.05), psychological (p < 0.01), and total quality of life domains. Blood pressure control had no effect on HRQOL in domain (p > 0.05). Drug use significantly worsened HRQOL of hypertensive patients in the psychological (p ˂ 0.01), social relationship (p < 0.01), and the total quality of life domains (p < 0.01). Multiple regression analysis showed that while income per month was positively predictive of physical, psychological, and total quality of life domains (r² = 1.988, p=0.001; r² = 3.710, p < 0.001; r² = 2.748, p < 0.001), symptom count was negatively predictive of the same (r² = –0.746, p = 0.005; r² = 1.869, p < 0.001; and r² = –1.094; p < 0.001), respectively. Reduced symptoms and higher income improved quality of life in hypertensive patients. Conclusion: The presence of hypertension and antihypertensive medication reduced HRQOL of hypertensive patients, although BP control surprisingly did not impact HRQOL. However, lower symptom count and higher income improved quality of life.

Association Between Awareness of Hypertension and Health-Related Quality of Life in a Cross-Sectional Population-Based Study in Rural Area of Northwest China

Hypertensive patients have more complex health care needs and are more likely to have poorer health-related quality of life than normotensive people. The awareness of hypertension could be related to reduce health-related quality of life. We propose the use of quantile regression to explore more detailed relationships between awareness of hypertension and health-related quality of life. In a cross-sectional, population-based study, 2737 participants (including 1035 hypertensive patients and 1702 normotensive participants) completed the Short-Form Health Survey. A quantile regression model was employed to investigate the association of physical component summary scores and mental component summary scores with awareness of hypertension and to evaluate the associated factors. Patients who were aware of hypertension (N = 554) had lower scores than patients who were unaware of hypertension (N = 481). The median (IQR) of physical component summary scores: 48.20 (13.88) versus 53.27 (10.79), P < 0.01; the mental component summary scores: 50.68 (15.09) versus 51.70 (10.65), P = 0.03. adjusting for covariates, the quantile regression results suggest awareness of hypertension was associated with most physical component summary scores quantiles (P < 0.05 except 10th and 20th quantiles) in which the β-estimates from -2.14 (95% CI: -3.80 to -0.48) to -1.45 (95% CI: -2.42 to -0.47), as the same significant trend with some poorer mental component summary scores quantiles in which the β-estimates from -3.47 (95% CI: -6.65 to -0.39) to -2.18 (95% CI: -4.30 to -0.06). The awareness of hypertension has a greater effect on those with intermediate physical component summary status: the β-estimates were equal to -2.04 (95% CI: -3.51 to -0.57, P < 0.05) at the 40th and decreased further to -1.45 (95% CI: -2.42 to -0.47, P < 0.01) at the 90th quantile. Awareness of hypertension was negatively related to health-related quality of life in hypertensive patients in rural western China, which has a greater effect on mental component summary scores with the poorer status and on physical component summary scores with the intermediate status.

Health-related quality of life in persons with apparent treatment-resistant hypertension on at least four antihypertensives

Little is known about the impact of treatment-resistant hypertension (TRH) on health-related quality of life (HrQoL). We aimed to compare HrQoL measures in adults with apparent TRH (aTRH) and non-resistant hypertension among nationally representative US Medical Expenditure Panel Survey data pooled from 2000 to 2011. Cohorts compared were adults with aTRH (⩾2 unique fills from ⩾4 antihypertensive classes during a year) versus non-resistant hypertension (those with hypertension not meeting the aTRH definition). Key outcomes were cohort differences in SF-12v2 physical component summary (PCS) and mental component summary (MCS) scores and disease-state utility using the SF-6D. Of 57 150 adults with hypertension, 2501 (4.4%) met criteria for aTRH. Persons with aTRH, compared with non-resistant hypertension, were older (mean, 68 vs 61 years), had a higher BMI (30.9 vs 29.7 kg m(-)(2)) and were more likely to be Black (20% vs 14%), but less likely to be female (46% vs 54%). Persons with aTRH, compared with non-resistant hypertension, had lower mean PCS scores (35.8 vs 43.2; P<0.0001), and utility (0.68 vs 0.74; P<0.0001), but similar MCS scores (49.1 vs 50.4). In multivariable-adjusted analyses, aTRH was associated with a 2.37 (95% CI 1.71 to 3.02) lower PCS score and 0.02 (95% CI 0.01 to 0.03) lower utility, compared with non-resistant hypertension. In conclusion, aTRH was associated with substantially lower HrQoL in physical functioning and health utility, but not in mental functioning, compared with non-resistant hypertension. The multivariable-adjusted reduction in physical functioning was similar in magnitude to previous observations comparing hypertension with no hypertension.

Hypertension in the Lebanese adults: impact on health related quality of life

Cardiovascular disease is a major cause of morbidity and mortality worldwide, hypertension being one of their most prevalent risk factors. Information on health related quality of life (QOL) of hypertensive individuals in Lebanon is lacking. Our objectives were to evaluate QOL of hypertensive patients compared with non-hypertensive subjects and to suggest possible predictors of QOL in Lebanon. We conducted a case control study among individuals visiting outpatient clinics. Quality of life was assessed using the eight item (SF-8) questionnaire administered face to face to the study population, applied to hypertensive (N=224) and non-hypertensive control (N=448) groups. Hypertensive patients presented lower QOL scores in all domains, particularly in case of high administration frequency and occurrence of drug related side effects. Among hypertensive patients, QOL was significantly decreased with the presence of comorbidities (β=-13.865, p=0.054), daily frequency of antihypertensive medications (β=-8.196, p<0.001), presence of drug side-effects (β=-19.262, p=0.031), older age (β=-0.548, p<0.001), female gender (β=-21.363, p=0.05), lower education (β=-22.949, p=0.006), and cigarettes smoked daily (β=-0.726, p<0.001); regular sport activity (β=23.15, p<0.001) significantly increased quality of life. These findings indicate the necessity for health professionals to take these factors into account when treating hypertensive patients, and to tackle special subgroups with attention to their deteriorated QOL.

Clinical use of azelnidipine in the treatment of hypertension in Chinese patients

Background

Hypertension is the most common chronic disease and the calcium channel antagonist is the most popularly used antihypertensive drug in Chinese patients. Azelnidipine is a third generation and long-acting dihydropyridine calcium channel antagonist. A series of research has demonstrated that azelnidipine produced an effective antihypertensive effect in patients with essential hypertension. Now it is need to summarize clinical use of azelnidipine in the treatment of hypertension in Chinese patients.

Methods

Relevant literature was identified by performing searches in PubMed and CNKI (China National Knowledge Infrastructure), covering the period from January 2003 (the year azelnidipine was launched) to July 2014. We included studies that described pharmacology of azelnidipine, especially the pharmacokinetics, clinical efficacy, and safety and tolerability of azelnidipine in a Chinese population. The full text of each article was strictly reviewed, and data interpretation was performed.

Results

In Chinese healthy volunteers, a single-dose oral administration of azelnidipine 8–16 mg had a peak plasma concentration of 1.66–23.06 ng/mL and time to peak plasma concentration was 2.6–4.0 hours and the area under the plasma concentration versus time curve from time 0 hour to 96 hours was 17.9–429 ng/mL·h and elimination half-life was 16.0–28.0 hours. A number of clinical trials have demonstrated that azelnidipine produced a significant reduction in blood pressure in Chinese patients with mild-to-moderate hypertension, which was similar to that of other effective antihypertensive drugs such as amlodipine, zofenopril, and nifedipine. In addition to its antihypertensive effect, azelnidipine had other cardiovascular protective effects as well, like anti-oxidative action, decreasing heart rate, and improving systolic and diastolic function. Azelnidipine was generally well tolerated in Chinese patients and no severe adverse events were observed.

Conclusion

Azelnidipine is effective and safe in the treatment of hypertension in Chinese patients.

Pharmacist intervention in improving hypertension-related knowledge, treatment medication adherence and health-related quality of life: a non-clinical randomized controlled trial

OBJECTIVE

The study evaluated whether a pharmaceutical care intervention can result in better understanding about hypertension, increase medication adherence to antihypertensive therapy and improve overall health-related quality of life.

METHODS

A non-clinical randomized control trial was conducted whereby participants received an educational intervention through hospital pharmacists. Hypertension knowledge, medication adherence and health-related quality of life were measured by means of self-administered questionnaires. Descriptive statistics were used to describe the demographic and disease characteristics of the patients. Inferential statistics were used for inter- and intragroup comparisons. SPSS 17 was used for data analysis.

RESULTS

Three hundred and eighty-five hypertensive patients were randomly assigned (192 in the control group and 193 in the intervention group) to the study. No significant differences were observed in either group for age, gender, income, locality, education, occupation or duration of disease. There was, however, a significant increase in the participants' levels of knowledge about hypertension and medication adherence among the interventional group after completing the intervention. Significantly lower systolic and diastolic blood pressure levels were also observed among the interventional group after completion of the intervention. The interventional group, however, reported decreased yet significant health-related quality of life at the end of the interventional programme.

CONCLUSION

Pharmacist intervention can significantly increase disease-related knowledge, blood pressure control and medication adherence in patients with hypertension. However, further research is needed to address the decreased health-related quality of life after completion of the study.

Association of elevated blood pressure with low distress and good quality of life: results from the nationwide representative German Health Interview and Examination Survey for Children and Adolescents

OBJECTIVE

Quality of life is often impaired in patients with known hypertension, but it is less or not at all reduced in people unaware of their elevated blood pressure. Some studies have even shown less self-rated distress in adults with elevated blood pressure. In this substudy of the nationwide German Health Interview and Examination Survey for Children and Adolescents (KIGGS), we addressed the question whether, also in adolescents, hypertensive blood pressure is linked to levels of distress and quality of life.

METHODS

Study participants aged 11 to 17 years (N = 7688) received standardized measurements of blood pressure, quality of life (using the Children's Quality of Life Questionnaire), and distress (Strengths and Difficulties Questionnaire).

RESULTS

Elevated blood pressure was twice as frequent as expected, with 10.7% (n = 825) above published age-, sex- and height-adjusted 95th percentiles. Hypertensive participants were more likely to be obese and to report on adverse health behaviors, but they showed better academic success than did normotensive participants. Elevated blood pressure was significantly and positively associated with higher self- and parent-rated quality of life (for both, p ≤ .006), less hyperactivity (for both, p < .005), and lower parent-rated emotional (p < .001), conduct (p = .021), and overall problems (p = .001). Multiple regression analyses confirmed these findings.

CONCLUSIONS

Our observation linking elevated blood pressure to better well-being and low distress can partly be explained by the absence of confounding physical comorbidity and the unawareness of being hypertensive. It also corresponds to earlier research suggesting a bidirectional relationship with repressed emotions leading to elevated blood pressure and, furthermore, elevated blood pressure serving as a potential stress buffer.

Are there consequences of labeling patients with prehypertension? An experimental study of effects on blood pressure and quality of life

OBJECTIVE

The prehypertension classification was introduced to facilitate prevention efforts among patients at increased risk for hypertension. Although patients who have been told that they have hypertension report worse outcomes than unaware hypertensives, little is known about whether or not prehypertension labeling has negative effects. We evaluated the effects of labeling individuals with prehypertension on blood pressure and health-related quality of life three months later.

METHODS

One hundred adults (aged 19 to 82 [mean=40.0] years; 54% women; 64% racial/ethnic minorities) with screening blood pressure in the prehypertensive range (120-139/80-89 mmHg) and no history of diagnosis or treatment of elevated blood pressure were randomly assigned to either a "Labeled" group in which they were informed of their prehypertension, or an "Unlabeled" group in which they were not informed. Subjects underwent office blood pressure measurement, 24-hour ambulatory blood pressure monitoring and completed self-report questionnaires at baseline and at three months.

RESULTS

Multilevel mixed effects regression analyses indicated that changes in the white coat effect, office blood pressure, mean daytime ambulatory blood pressure, and physical and mental health did not differ significantly between the two groups. Adjusting for age, sex, race/ethnicity and body mass index did not affect the results.

CONCLUSION

These findings suggest that labeling patients with prehypertension does not have negative effects on blood pressure or quality of life. Additional research is needed to develop approaches to communicating with patients about their blood pressure that will maximize the clinical and public health impact of the prehypertension classification.

Prevalence of sexual activity and associated factors in hypertensive males and females in China: a cross-sectional study

Background

Hypertension is an important factor contributing to sexual dysfunction. The number of people with hypertension is increasing in China, but research into sexual life, which has implications for quality of life, is limited. We aimed to compare sexual activity and the influence of daily behaviors and sexual domain of hypertensive males and females in south China.

Methods

A cross-sectional study was conducted at the health care center of a university-affiliated hospital from 2007 to 2008. We enrolled 502 subjects with hypertension (225 males, 48.79 ± 7.39 years old; 277 females, 48.26 ± 6.93 years old) and 173 with normotension (82 males, 45.69 ± 6.58 years old; 91 females, 46.14 ± 7.03 years old), all sexually active. All subjects completed a self-administered questionnaire on sexual activity before a routine physical check-up. Data were collected on sociodemographic and clinical characteristics, use of cigarettes and intake of beverages (including alcohol).

Results

Hypertensive and normotensive subjects differed in frequency of orgasms and of sexual satisfaction, as well as duration of sexual activity. For hypertensive men, low frequency of sexual activity, orgasms and satisfaction were associated with unemployed or retired status than physical labor work (odds ratio [OR] 0.28 [95% confidence interval (95% CI) 0.12–0.69], 0.32 [0.12–0.86], 0.33 [0.19–0.88], respectively; p < 0.05), and long sexual duration was associated with never drinking alcohol than heavy drinking (OR 4.49 [1.28–6.41]). For hypertensive women, low frequency and duration of sexual activity and low satisfaction were associated with never drinking tea than heavy tea drinking (OR 0.42 [0.18–0.96], 0.49 [0.24–0.98], 0.29 [0.14–0.64], respectively; p < 0.05). Medication use and electrocardiography results were not associated with sexual activity for hypertensive patients.

Conclusions

For hypertensive people in China, lifestyle factors are associated with sexual dysfunction, which differs by the sex of the person. Further research needs to examine serum hormone levels to validate the result.

Influência do treinamento resistido na qualidade de vida de idosas com hipertensão arterial sistêmica

INTRODUÇÃO: A hipertensão arterial sistêmica (HAS) é um dos principais problemas de saúde pública em todo o mundo, afetando principalmente mulheres idosas. O hipertenso pode ter sua qualidade de vida (QV) prejudicada em função das comorbidades inerentes à doença em questão. Dessa forma, o treinamento resistido (TR) vem sendo cada vez mais recomendado como terapêutica não-farmacológica dessa moléstia, uma vez que contribui para redução de incapacidades em indivíduos com e sem doenças cardiovasculares. OBJETIVO: Avaliar a QV, dada pelos questionários genérico (SF-36) e específico (MINICHAL), em idosas hipertensas controladas submetidas a programa de treinamento resistido. MÉTODOS: O TR foi realizado durante oito semanas, três vezes por semana, em dias alternados. A intensidade do treinamento foi periodizada ao longo do treinamento. Para avaliação da QV, utilizaram-se os questionários SF-36 e MINICHAL, antes e após o programa de TR. Na análise estatística utilizaram-se os testes Kolmogorov-Smirnov para verificar a normalidade dos dados, bem como o t de Student, considerando significativo p < 0,05. RESULTADOS: A análise do SF-36 mostrou um aumento no valor médio de quase todas as variáveis analisadas, contrapondo-se apenas aos domínios aspectos sociais e saúde mental. Houve diferença significativa com relação ao estado geral de saúde (EGS) (p = 0,02). Para o MINICHAL não foi observada diferença significativa nos domínios analisados, embora tenha apresentado redução do valor médio de todos os quesitos analisados. CONCLUSÃO: Nossos dados sugerem que o TR mostrou-se eficaz com relação ao domínio EGS pertencente ao SF-36. Em contrapartida, não foram evidenciadas alterações na QV das idosas quando avaliadas com o questionário específico MINICHAL.

The hypertension scale of the system of Quality of Life Instruments for Chronic Diseases, QLICD-HY: a development and validation study

AIMS

This paper is aimed to develop and validate the hypertension scale of the system of Quality of Life Instruments for Chronic Diseases, QLICD-HY.

METHODS

The QLICD-HY instrument was developed based on programmed decision procedures with multiple nominal and focus group discussions and pilot testing. A total of 157 inpatients with hypertension were used to provide the data measuring QOL three times before and after treatment. The psychometric properties of the scale were evaluated with respect to validity, reliability and responsiveness employing correlation and factor analyses, and t-tests.

RESULTS

Correlation and factor analyses confirmed good construct validity and criterion-related validity when using Short Form (36) Health Survey (SF-36) as a criterion. Test-retest reliability coefficients (Pearson r and intra-class correlation (ICC)) for the overall instrument score and all domains except for the hypertension-specific domain (SPD) (0.75) were higher than 0.80 with a range of 0.75-0.91; the internal consistency α for all domains except for the hypertension-specific domain (0.66) was higher than 0.70. The overall score and scores for most facets within each domain except for the social domain (SOD) had statistically significant changes (t-tests) after treatment with moderate effect sizes.

CONCLUSION

QLICD-HY has good validity, reliability, responsiveness and can be used as the quality-of-life instrument for patients with hypertension.

Impact of Hypertension-Related Comorbidity on Health-Related Quality of Life

The aim of this study was to examine the impact of the most prevalent comorbid chronic diseases in hypertensives on health-related quality of life (HRQOL) in the general representative Korean population using the EuroQOL-5D (EQ-5D) and to assess this impact by sex and after controlling for sociodemographic factors. The effects of hypertension and comorbidity on HRQOL were examined using multiple linear regression models with Fourth Korean National Health and Nutrition Examination Survey data. In a total of 5736 adults, the prevalence of hypertension alone was 20.8%, and the prevalence rates of hypertension comorbid with diabetes mellitus (DM), cardiovascular disease (CVD), and musculoskeletal (MS) disease were 9.5%, 3.8%, and 33.5%, respectively. Females with hypertension and other comorbidity showed worse HRQOL scores, with the exception of hypertension and CVD, where males scored worse for HRQOL. After adjustment, subjects with comorbid DM, CVD, or MS experienced EQ-5D scores decreasing by 0.01, 0.09, and 0.05, respectively. Since comorbidity impairs HRQOL in hypertensives, health providers should consider comorbid diseases in hypertensives when developing methods of intervention to effectively manage hypertension.

Psychometric performance of the brazilian version of the Mini-cuestionario de calidad de vida en la hipertensión arterial (MINICHAL)

This study aimed to evaluate the feasibility, acceptability, ceiling and floor effects, reliability, and convergent construct validity of the Brazilian version of the Mini Cuestionario de Calidad de Vida en la Hipertensión Arterial (MINICHAL). The study included 200 hypertensive outpatients in a university hospital and a primary healthcare unit. The MINICHAL was applied in 3.0 (± 1.0) minutes with 100% of the items answered. A "ceiling effect" was observed in both dimensions and in the total score, as well as evidence of measurement stability (ICC=0.74). The convergent validity was confirmed by significant positive correlations between similar dimensions of the MINICHAL and the SF-36, and significant negative correlations with the Minnesota Living with Heart Failure Questionnaire - MLHFQ, however, correlations between dissimilar constructs were also observed. It was concluded that the Brazilian version of the MINICHAL presents evidence of reliability and validity when applied to hypertensive outpatients.

Health-related quality of life is worse in individuals with hypertension under drug treatment: results of population-based study

Patients with hypertension usually report lower health-related quality of life (HRQoL), but it is unclear whether this is secondary to high blood pressure (BP) per se, drug treatment or awareness of disease. In a cross-sectional study using a multistage population-based sample, participants were interviewed and examined at home. Hypertension was defined by BP ≥140/90 mm Hg or use of BP-lowering drugs. HRQoL was assessed through the Short-Form Health Survey (SF-12) and presented as the physical component summary (PCS), mental component summary (MCS) and the SF-12 eight-domain scale. In total, 1858 individuals were evaluated, being 60.1% women, aged 52.5 ± 4.1 years old, and 39.9% men, aged 47.2 ± 9.1 years old. Prevalence of hypertension was 34.2% (95% CI 31.5-36.9). The PCS scores for hypertensive and normotensive participants were 49.4 (CI 48.6-50.2) and 51.06 (CI 50.4-51.7) (P=0.01), respectively, and the MCS scores were 49.1 (CI 47.9-50.3) and 50.5 (CI 49.6-51.2) (P=0.06), respectively. Participants with hypertension and not using BP drugs had higher HRQoL scores (PCS 49.6; MCS 51.9) than those using BP drugs either with uncontrolled (PCS 45.3; MCS 49.4) or controlled BP (PCS 46.2; MCS 47.7; P<0.05). We concluded that individuals with hypertension have worse quality of life, particularly when their BP is controlled by drugs. This perception may lead to lower rates of adherence to treatment.

Health-related quality of life and hypertension: a systematic review and meta-analysis of observational studies

OBJECTIVE

Most, but not all cross-sectional surveys have identified lower quality of life among patients with hypertension. We summarized the estimates for this association in a systematic review and in a meta-analysis of cross-sectional studies.

METHODS

Studies that used the Short-Form Health Survey (SF) to compare the quality of life of normotensive and hypertensive individuals were searched in Embase, MEDLINE/PubMed, LILACS, Ovid, ScienceDirect, SciELO and Cochrane databases using 'hypertension' and 'quality of life' medical subject heading (MeSH) terms and the words 'health survey, SF-12, SF-36 and their spelling variations (SF12, SF 12, SF36 and SF 36)'. Data extraction was conducted by two researchers. Data were analyzed with MIX 1.7 using random effects model. Results of the meta-analysis were expressed as differences of mean scores between hypertensive and normotensive individuals.

RESULTS

Most of the 20 studies selected for the systematic review identified lower quality of life in patients with hypertension, but they were very heterogeneous in regard to selection criteria and comparison groups, limiting their external validity. The meta-analysis identified lower scores in hypertensive patients for physical [-2.43; 95% confidence interval (CI) -4.77 to -0.08] and mental (-1.68; 95% CI -2.14 to -1.23) components. Quality of life was lower in the eight domains of the SF-36: physical and functional functioning, role physical and emotional, bodily pain, general health, vitality and mental health.

CONCLUSION

Quality of life of individuals with hypertension is slightly worse than that of normotensive individuals. The influence of high blood pressure and of the awareness to have hypertension requires further investigation.

The effect of Chinese food therapy on community dwelling Chinese hypertensive patients with Yin-deficiency

OBJECTIVES

The objectives of this study are to evaluate the effectiveness of Chinese food therapy in correcting the Yin-deficiency and to examine its impact on the patients' quality of life and hypertension control.

BACKGROUND

Epidemiological studies have shown 14-50% of people with hypertension have Yin-deficiency. Whether restoring the Yin-Yang balance by means of Chinese food therapy can help to better manage patients with hypertension has yet to be examined.

DESIGN

Two groups randomised controlled trial.

METHODS

Eighty-five hypertensive patients recruited from two community health service centre were divided into two groups. The intervention group (n = 48) received specific dietary instructions and corresponding management of their antihypertensive medication if indicated and brief health education, whilst the control group (n = 37) received routine support involving only brief health education. Data were collected at baseline, after intervention at four, eight, 12 and 16 weeks follow-up. Comparisons were made to examine the effects of Chinese food therapy on Yin-deficiency symptoms, blood pressure and quality of life of hypertensive patients.

RESULTS

The intervention group had reduction in the numbers of antihypertensive medication taken as well as improvement in most of the Yin-deficiency symptoms after 12 weeks of Chinese food therapy and mean scores of several SF-36 dimensions were higher than that of in the control group after 12 and 16 weeks follow-up. Significant difference was found in systolic blood pressure in the intervention group when it was compared from baseline to after four and eight weeks respectively.

CONCLUSION

Chinese Food Therapy can restore body constitution with Yin-Yang imbalance and may potentially improve hypertensive patients' quality of life. It is also beneficial in controlling blood pressure in hypertensive patients.

RELEVANCE TO CLINICAL PRACTICE

Chinese food therapy may become a complementary therapy in health care and it should be a component of nursing education and health education.

Quality of life, dyspnea and ventricular function in patients with hypertension

AIM

This paper is a report of an investigation of the relationship between health-related quality of life and left ventricular function among patients with hypertension who did not fulfil the criteria for heart failure.

BACKGROUND

Heart failure is a common consequence of hypertension, with Doppler echocardiography being the gold-standard tool to evaluate left ventricular function, mainly hypertension-induced left ventricular damage. Echocardiographic data indicating poorer ventricular function have been related to lower levels of health-related quality of life in patients with systolic and/or diastolic heart failure. However, data are still lacking regarding the correlation between health-related quality of life and left ventricular function and structure in patients with hypertension who do not fulfil the criteria for heart failure.

METHOD

Between September 2005 and February 2007, 98 patients with hypertension without systolic or diastolic heart failure were evaluated. Health-related quality of life was assessed using the Medical Outcomes Study Short Form-36. Left ventricular function was evaluated through Tissue Doppler echocardiography.

RESULTS

Statistically significant but weak correlations (varying from r = -0.22 to 0.35) were observed between some of the Short Form-36 domains and echo data. To consider the potential effect of dyspnoea in this relationship, patients were split according to the presence or absence of the symptom. In the subgroup without dyspnoea, similar patterns of correlation were observed (varying from r = 0.26 to 0.32). In the subgroup with dyspnoea, however, more and stronger correlations were observed between echo data and health-related quality of life domains, varying from r = -0.40 to 0.50.

CONCLUSION

Nurses should be aware of the relevance of evaluating the functional echocardiographic data of patients who not fulfil heart failure criteria, but who experience dyspnoea in order to implement appropriate action plans.

Nondipping phenomenon and quality of life: are they related in essential hypertensive patients?

Hypertensive patients report lower general well-being, more severe psychological distress, poorer perceived health status, more physical symptoms, and functional disability when compared to normotensive patients. Nondipping of blood pressure (BP) is related to increased target organ damage in essential hypertension. However, the specific relationship between nocturnal nondipping and quality of life has not been extensively investigated. Patients with essential hypertension underwent the following procedures: anamnesis, office BP measurement, physical examination, routine biochemistry, and 24-hour ambulatory BP monitoring. To determine renal function, 24-hour urine specimens were collected. Quality of life was assessed by a short form of medical outcomes study (SF-36). Totally, 132 patients (male/female: 55/75) were included. Fifty-five of the patients were nondippers. The dippers and nondippers were not statistically different in terms of socio-demographic parameters. Dippers had higher physical functioning (P- 0.004), bodily pain (P- 0.008), and PCS (P - 0.003) than nondippers. PCS of SF-36 was independently associated with age (P - 0.029), body mass index (P - 0.022), presence of coronary artery disease (P - 0.01), gender (P - 0.009), and dipping phenomenon (P - 0.006). A mental component summary score of SF-36 was not associated with dipping phenomenon. Nocturnal nondipping, apart from having important prognostic implications for cardiovascular complications in essential hypertensive patients, is also related to quality of life, especially in its physical aspects.

Health-related quality of life outcomes in chronic kidney disease

PURPOSE OF REVIEW

Patients with chronic kidney disease (CKD) endure compromised health-related quality of life (HRQOL). Although the link between HRQOL and increased mortality in patients with end-stage renal disease (ESRD) is well documented, less is known about the relationship between CKD and HRQOL. This article reviews the recent evidence on HRQOL, its correlates and proposed intervention strategies to improve HRQOL in CKD.

RECENT FINDINGS

A growing body of literature indicates that various comorbid conditions related to CKD play a substantial role in impaired HRQOL in CKD. Hypertension, both a cause and complication of CKD, negatively affects HRQOL due to associated comorbidities, side effects from antihypertensive medications and awareness of the diagnosis. Anemia has been associated with HRQOL, but concerns about the safety of erythropoietin-stimulating agents (ESAs) have led to more conservative anemia treatment. Frailty, symptom burden and depression are also major contributory factors to HRQOL in CKD.

SUMMARY

Certain determinants of HRQOL in CKD, namely anemia and depression, are treatable. Early identification and correction may improve overall well being of patients. Clinical trials are required to demonstrate whether treatment interventions benefit HRQOL in this high-risk population. Furthermore, whether integration of HRQOL assessment into routine clinical practice will improve HRQOL outcomes remains to be determined.

Systolic blood pressure and subjective well-being in patients with coronary artery disease

BACKGROUND

Limited information exists regarding the association between subjective well-being (SWB) and systolic blood pressure (SBP) among hypertensive patients with coronary artery disease (CAD).

HYPOTHESIS

We tested the hypothesis that there is an association between SBP and SWB.

METHODS

We studied 22,576 hypertensive CAD patients > or = 50 years old in the INternational VErapamil SR-Trandolapril Study (INVEST), a randomized, blinded-endpoint trial of antihypertensive therapy in stable CAD patients. At each study visit, patients rated their SWB in the previous 4 weeks as "excellent," "good," "fair," or "poor" prior to SBP recordings. The outcome measure was SWB of "fair" or "poor." A longitudinal analysis using generalized estimating equations was performed to assess the association between SBP and odds of reporting fair/poor SWB, controlling for baseline SWB of fair/poor and angina reported during the study.

RESULTS

Patients with higher SBP had higher odds of reporting fair/poor SWB. Specifically, compared with patients with SBP of < or = 120, patients with SBP 140-150 > 150 - < or = 160 and > 160 had about 90% and 2.5 times greater odds of feeling fair/poor, respectively (adjusted odds ratio [OR]: 1.5990, 95% confidence interval [CI]: 1.81-2.00 and adjusted OR: 2.53, 95% CI: 2.41-2.66). Those who reported angina in the 4 wks prior to a protocol visit had 2.2 times greater odds of reporting fair/poor SWB (adjusted OR: 2.2, 95% CI: 2.13-2.27). Female gender, black race, history of smoking, diabetes, myocardial infarction, stroke, and cancer also increased the odds of reporting fair/poor SWB.

CONCLUSIONS

Among hypertensive CAD patients, higher on-treatment SBP is associated with greater odds of fair/poor SWB during follow-up.

Impact of hypertension on health-related quality of life in a population-based study in Shanghai, China

OBJECTIVES

The purpose of this study was to examine the relationship between hypertension and health-related quality of life (HRQL) in a general representative Chinese population, and to explore the impacts of comorbidity on people with hypertension.

STUDY DESIGN

Population-based cross-sectional survey.

METHODS

A self-administered questionnaire survey including demographic questions and the Mandarin version of 36-item Short Form (SF-36) was conducted in a general population in Shanghai, China. In total, 1034 subjects participated. The SF-36 dimension scores of hypertensive subjects were compared with those of normotensive subjects. Independent association of hypertension with each quality-of-life domain was analysed using a multiple linear regression model, so were the effects of comorbidity on the HRQL of hypertensive subjects.

RESULTS

Nine hundred and nineteen respondents were included in the analysis, and 16.97% reported hypertension. Respondents with hypertension scored lower than those without hypertension in at least five SF-36 dimensions. The dimension of role limitations due to physical problems was the most affected, whereas the mental health dimension was the least affected. Hypertensive subjects with comorbidity experienced lower SF-36 scores than hypertensive subjects without comorbidity.

CONCLUSIONS

Hypertension markedly impairs quality of life in terms of both physical and mental health. Comorbidity further deteriorates HRQL among people with hypertension. The findings suggest that people with hypertension represent a vulnerable population, and it is important to prevent and treat comorbidity of hypertension.

Profile and predictor of health-related quality of life among hypertensive patients in south-western Nigeria

Background

The health-related quality of life (HRQOL) of hypertensives may be influenced by blood pressure, adverse effects of drugs used to treat hypertension, or other factors, such as the labelling effect, or beliefs and attitudes about illness and treatment. There is paucity of information on the determinants of HRQOL among black hypertensives especially in the developing countries such as Nigeria. This study describes the HRQOL and its determinants among black patients diagnosed and treated for Hypertension in Nigeria.

Methods

The study was a cross sectional in design that involved 265 hypertensive patients receiving treatment at the medical outpatient unit of the Federal Medical Centre Abeokuta, Nigeria. They were all consecutive patients that presented at the hospital during the period of the study who meet the inclusion criteria and consented to participate in the study. Demographic data, disease characteristics such as symptoms and signs and recent drug history were obtained from the patients and their hospital records as documented by the physician. The SF-36 questionnaire was administered once by interview to the participants to measure their HRQOL. Descriptive statistics was used in summarizing the demographic data and hypertension related histories of the participants. Multiple linear regression was used to model for the influence of socio demographic and clinical variables of the hypertensives on their HRQOL.

Results

Physical functioning domain mean score was far below average (33.53 ± 29.65). Role physical and role emotional domains were a little above average (54.7 ± 40.4, 51.1 ± 40.6 respectively). Role Physical (p = 0.043), Role Emotional (p = 0.003), Vitality (p = 0.014) and Mental Health (p = 0.034) domain mean scores for patients with controlled BP were significantly higher than patients with uncontrolled BP. The overall HRQOL was significantly better in the group of hypertensives with controlled blood pressure (p = 0.014). Increasing blood pressure (p = 0.005) and symptom count (p < 0.001), the presence of stroke (p = 0.008) and visual impairment (p = 0.015) were significant negative predictors of the overall HRQOL.

Conclusion

This study provides evidence for a model that links patients' status with regard to biology (blood pressure), symptoms, and functionality (HRQOL) and may prove useful in guiding follow-up of patients who receive treatment for hypertension. Identification of patient's symptoms, blood pressure, complication/comorbidity and changes in functioning may help clinicians increase their effectiveness in helping patients maintain adherent behaviour with drug and non drug interventions in chronic diseases such as hypertension.

A tailored target intervention on influence factors of quality of life in Chinese patients with hypertension

Studies suggested that hypertension was associated with impaired health-related quality of life and it is important to find a proper and feasible management of hypertension in the community. This study evaluates the effect of a tailored target intervention on influence factors of quality of life in Chinese patients with hypertension. A cross-sectional survey was carried out to investigate 644 patients with hypertension by using the Chinese version of the short form-36, and 195 patients were screened out to participate in the tailored target intervention. Multivariate linear regression analyses showed that age, gender, educational level, high intake of fried food, household income, attitude, knowledge, blood pressure, symptoms, serious events during the past year, duration of hypertension, and number of taking anti-hypertensive medicine were significantly correlated with quality of life. Grade-based management by community physicians and physical exercise had a positive effect on quality of life. After the 6-month intervention, the control rate of hypertension was increased from 32.0% to 39.4%, and the mean systolic and diastolic blood pressure values were significantly decreased to 137.2 and 85.7 mmHg vs. 140.9 and 87.6 mmHg at baseline, respectively. The intervention program resulted in overall improvement on total score of quality of life and mean scores of all the domains except social functioning in patients with hypertension. In view of the influence factors of quality of life, taking the tailored target intervention could not only improve the quality of life of hypertensive patients, but also effectively increase the control rate of hypertension.