Relationship of an adherence score with blood pressure control status among patients with hypertension and their determinants: Findings from a nationwide blood pressure screening program

Association between medication adherence and blood pressure control and factors associated with antihypertensive medication adherence in the Melaka Tengah District: A cross-sectional survey

Introduction

The burden of cardiovascular disease and early morbidity and mortality is exacerbated by hypertension. According to the 2019 National Health and Morbidity Survey, 30% of adults in Malaysia aged over 18 years had hypertension. Our study aimed to investigate the association between medication adherence and blood pressure control and the factors associated with antihypertensive medication adherence.

Methods

This cross-sectional study was conducted among adult patients with hypertension who had been under treatment at public primary health clinics in the Melaka Tengah District. A self-administered questionnaire was used, and blood pressure was measured. Descriptive and multivariate logistic regression analyses were conducted using the Statistical Package for the Social Sciences (version 28).

Results

A total of 1531 patients were recruited in this study. Among them, 74.1% had good antihypertensive medication adherence, and 51.4% had their blood pressure controlled. Medication adherence was significantly associated with blood pressure control (P<0.005). The multivariate analysis showed that the determinants for antihypertensive medication non-adherence were Malay ethnicity, secondary education, farther distance from the clinic, experience of side effects of antihypertensive medications, concern about long-term side effects and usage of alternative medicine (P<0.05). Taking multiple antihypertensive medications was the only factor associated with uncontrolled blood pressure (P<0.05).

Conclusion

Addressing issues on medication adherence is important to ensure blood pressure control. The factors associated with non-adherence should be closely monitored to improve blood pressure control and prevent adverse health outcomes. Single-pill combination antihypertensive medications are encouraged to reduce pill burden and improve blood pressure control.

Analysis of the Effectiveness of Coordinated Care in the Management of Pharmacotherapy of Patients with Hypertension and Comorbidities in Primary Care-Preliminary Reports

Hypertension (HTN) is the dominant cause of cardiovascular disease and premature death worldwide. Also in Poland, the number of people with HTN is steadily increasing. In order to improve care for patients with HTN and other chronic diseases, a pilot of the POZ PLUS coordinated-care model was introduced. The pilot ran from 1 July 2018 to 30 September 2021 at 47 facilities nationwide. The purpose of this study was to conduct a preliminary analysis of the effectiveness of this model of care. The study focused on the management of pharmacotherapy in patients with hypertension and other comorbidities. The study included a group of 90 patients with HTN. Fifty-nine people were in the coordinated-care study group and 31 in the control group. Data were collected from electronic medical records. The analysis showed a trend toward greater blood-pressure reduction in patients under coordinated care (-4 mmHg difference in systolic blood pressure between the second and first visits and -2 mmHg difference in diastolic pressure between the second and first visits, p = 0.180 and p = 0.156). This suggests the preliminary conclusion that coordinated care in the PCP plus model might have positively affected the outcomes of patients with HTN. Further studies on the subject are planned.

Validity and reliability of the Romanian version of the Hill-Bone compliance to high blood pressure therapy scale

Romania is considered a country with high cardiovascular risk, arterial hypertension and its complications accounting for about 60% of total deaths. The management of high blood pressure often involves a combination of both therapeutic regimens as well as lifestyle changes, to which patients have to be adherent. In order to assess patients adherence to professionals' recommendations, validated tools are needed. The aim of our study was to translate, culturally adapt and validate the Hill-Bone Compliance to High Blood Pressure Therapy Scale into Romanian. The study included 215 participants from Iasi, North-Eastern Romania. The internal consistency of the instrument was measured with Cronbach's alpha coefficient, while the construct validity was determined using exploratory factor analysis and principal component extraction with promax rotation. Sampling adequacy and appropriateness of data for factor analysis was measured using Kaiser-Meyer-Olkin (KMO) statistics and Bartlett's test of sphericity. Our statistical analysis revealed a Cronbach's alpha coefficient of 0.733 (73.3%) and a Kaiser-Meyer-Olkin (KMO) Measure of Sampling Adequacy of 0.697. The chi square test demonstrated that the overall perfect adherence was not significantly associated with the number of medications taken per day variable (p = 0.721). The Romanian version of the Hill-Bone Compliance to High Blood Pressure Therapy Scale demonstrated suitability for its use in evaluating adherence in the intended population.

Risk factors and prevalence of hypertension in older adults from south-eastern Poland: an observational study

The aim of this study was to assess the prevalence of hypertension and to investigate risk factors linked to hypertension in older adults. An observational study was conducted in a group of adults between 60 and 85 years of age, living in south-eastern Poland. In line with the specific inclusion criteria, 80 women and 29 men were enrolled for the study (109 adults). Participants' body weight, height, and body fat percentage (BFP) were assessed using a bioelectrical impedance analysis, blood pressure was measured using automated oscillometric sphygmomanometer, moderate-to-vigorous physical activity (MVPA) and sedentary time were assessed using a tri-axial accelerometer, whereas data related to socio-economic and lifestyle factors were collected using a self-report technique. Arterial hypertension was found at a rate of 16% in participants with normal body weight, 22% in those with overweight and 85% in those with obesity. Body mass index (BMI) and BFP correlated significantly with systolic blood pressure (SBP) and diastolic blood pressure (DBP). The highest median SBP and DBP values were found in the group of participants with obesity, and the lowest values were identified in those with normal body weight. Out of all the investigated socio-economic risk factors linked to hypertension, education level was the only one that showed significant associations. A logistic regression analysis was performed to check which factors were most strongly associated with hypertension in the study group. The stepwise method showed that hypertension was more common in participants with a higher BMI, and BFP and in those who did not meet MVPA recommendation.

Predictors of non-adherence to antihypertensive medications: A cross-sectional study from a regional hospital in Afghanistan

BACKGROUND

Non-adherence to antihypertensive medications (AHMs) is a widespread problem. Cardiovascular morbidity and mortality reduction is possible via better adherence rates among hypertensive patients.

OBJECTIVES

This study aimed to assess the prevalence of non-adherence to AHMs and its predictors among hypertensive patients who attended Mirwais Regional Hospital in Kandahar, Afghanistan.

METHODS

A cross-sectional study using random sampling method was conducted among hypertensive patients, aged ≥18 years in Mirwais Regional Hospital at a 6-month follow-up between October and December 2022. To assess non-adherence to AHMs, we employed the Hill-Bone Medication Adherence scale. A value below or equal to 80% of the total score was used to signify non-adherence. A multivariable binary logistic regression model was used to identify predictors of non-adherence to AHMs.

RESULTS

We used data from 669 patients and found that 47.9% (95%CI: 44.1-51.8%) of them were non-adherent to AHMs. The majority (71.2%) of patients had poorly controlled blood pressure (BP). The likelihood of non-adherence to AHMs was significantly higher among patients from low monthly-income households [Adjusted odds ratio (AOR) 1.70 (95%CI: 1.13-2.55)], those with daily intake of multiple AHMs [AOR 2.02 (1.29-3.16)], presence of comorbid medical conditions [AOR 1.68 (1.05-2.67), lack of awareness of hypertension-related complications [AOR 2.40 (1.59-3.63)], and presence of depressive symptoms [AOR 1.65 (1.14-2.38)].

CONCLUSION

Non-adherence to AHMs was high. Non-adherence to AHMs is a potential risk factor for uncontrolled hypertension and subsequent cardiovascular complications. Policymakers and clinicians should implement evidence-based interventions to address factors undermining AHMs adherence in Afghanistan.

Adherence Behaviors and Related Factors Among Elderly Hypertensive Patients in China: Evidence from the China Health and Retirement Longitudinal Study

Background

Non-adherence or partial adherence is the main reason for poor therapeutic effect of hypertension. This paper aims to assess adherence behaviors and related factors among elderly hypertensive patients in China.

Methods

Participants aged ≥60 years, with hypertension, and with complete data in 2018 interviews of the China Health and Retirement Longitudinal Study (CHARLS) were included. The adherence behaviors included medication, blood pressure monitoring and the combined adherence behaviors. Referring to the social-ecological theory, correlates of adherence behaviors were divided into three layers, namely demographic characteristics, health behaviors, living environment and retirement. Univariate and multivariable logistic regression models were performed to identify factors of adherence behaviors.

Results

The prevalence of medication adherence (76.58%) was higher than that of blood pressure monitoring adherence (20.08%), and the full adherence rate was 18.53%. Self-rated health status, smoking status, living area, and health education status were detected to be associated with medication adherence and blood pressure monitoring adherence (all p < 0.05). Gender, sleep duration, health examination, and physical exercise were also detected to be associated with blood pressure monitoring adherence (all p < 0.05). Self-rated health status and health education status were detected to be associated with partially and fully adherence, while age, living area, and life satisfaction were detected to be associated with partially adherence, smoking status, sleep duration, health examination, and pension reliance were detected to be associated with fully adherence (all p < 0.05).

Conclusion

Our study reveals the poor adherence behaviors of elderly hypertensive patients in China. This is most evident among those who were male, 60-69 years old, living in rural areas, self-reported being healthier, those without health examination and health education. Targeting these vulnerable populations, we suggest to strengthen health education, increase the publicity of basic public health services and enhance the self-management ability of hypertensive patients.

High Prevalence of Uncontrolled Hypertension Among Afghan Hypertensive Patients: A Multicenter Cross-Sectional Study

Background

Despite striking advances in the management of hypertension, blood pressure (BP) control remains suboptimal worldwide. Sustainable Development Goals (SDGs) call for 80% control rates by 2030, highlighting the urgency for improvements in hypertension control.

Objective

We aimed to determine the prevalence of uncontrolled hypertension (≥140/90 mmHg) and assess its associated factors in Afghan hypertensive patients.

Methods

We conducted this multicenter cross-sectional study at three Afghan public hospitals in Afghanistan. We recruited hypertensive patients (n=950) on antihypertensive medications (AHMs) from August to December 2022. We analyzed only complete datasets (853). We employed the 14-item Hill-Bone compliance scale to assess compliance with AHMs. We performed multivariable logistic regression analyses to determine factors associated with uncontrolled hypertension.

Results

The mean age (±SD) of the patients was 47.5 (± 9.5) years and males constituted 50.5% (431) of the study sample. The prevalence of uncontrolled hypertension in this study was 77.3% (95% CI: 74.2-79.9%). Factors associated with uncontrolled hypertension and their adjusted OR (95% CI) were physical inactivity: 3.45 (1.87-6.35), current smoking: 3.04 (1.50-6.15), high salt intake: 3.57 (1.9-6.7), presence of comorbid medical disease: 2.22 (1.20-4.08), higher BMI: 3.32 (1.12-9.88), poor compliance to AHMs: 8.50 (4.62-15.6), and presence of depressive symptoms: 1.99 (1.2-3.27).

Conclusion

The prevalence of uncontrolled hypertension was high in the present study. Factors associated with uncontrolled hypertension may epitomize potential targets for public/individual health interventions in Afghanistan.

Does negative affectivity have an association with achieving target values in hypertensive patients: primary care perspective

OBJECTIVES

The current study aimed to seek the relationship between demographic characteristics, treatment compliance status, and type D personality characteristics to achieve target BP values.

METHODS

This cross-sectional research was conducted on HT patients at three family medicine health-care services in Ankara, Turkey, between 1 February 2021, and 31 January 2022. The sociodemographic questionnaire survey, Hill-Bone Compliance to High Blood Pressure Therapy Scale (HBCHBPTS), and Type D Scale-14 (DS-14) were applied to 317 patients. HBCHBPTS consists of 14 items with three domains. DS-14 consists of 14 items assessing negative affectivity (NA) and social inhibition (SI).

RESULTS

Patients with NA were less likely to achieve the SBP target values (62.20% vs 47.50, p = 0.011). NA scores were correlated with HBCHBPTS total scores and HBCHBPTS medication-taking domain scores. Living in a city center (β = -0.157, p = 0.017), not smoking (β = -0.114, p = 0.042), knowing the names of HT drugs (β = - 0.152, p = 0.005), having a Mediterranean-style diet (β = -0.182, p = 0.002), starting treatment immediately after diagnosis (β = -0.121, p = 0.029), older age (β = -0.164, p = 0.028), having less NA scores (β = 0.171, p = 0.029) were effective on better treatment adherence. Variables affecting the failure to achieve the SBP target values were not being in the extended family (p = 0.022, OR: 0.337), anti-HT drug side effects (p = 0.029, OR: 2.566), higher HBCHBPTS total scores (p = 0.001, OR: 1.178), higher DBP values (p < 0.001, OR: 1.141).

CONCLUSION

HBCHBPTS total and HBCHBPTS medication-taking domain indicators worsened as the NA and SI characteristics increased. Predictors, including those not living in an extended family, being affected by the side effects of anti-HT drugs, high HBCHBPTS total score, and high DBP values, were effective in failure to achieve the SBP target values.

2022 Malaysian Working Group Consensus Statement on Renal Denervation for management of arterial hypertension

Hypertension is highly prevalent and a major contributor to cardiovascular mortality and morbidity. In spite of the availability of efficacious, safe and affordable anti-hypertensive drugs, hypertension remains poorly controlled in the majority of hypertensive patients. Various reasons including non-adherence to the anti-hypertensive drugs, account for the poor control. Resistant hypertension is also one of the reasons for poor control of blood pressure (BP). The sympathetic nervous system (SNS) has long been recognized as one of the determinants in the pathophysiology of a raised BP. Overactivity of the SNS is a contributor to sustained arterial hypertension. Renal denervation (RDN) is increasingly recognized as a safe and effective adjunctive therapy to control BP with or without pharmacotherapy. Hence for patients who remain uncontrolled despite all efforts, renal denervation (RDN) is a novel treatment that can potentially improve BP control, hence reducing the major adverse cardiovascular events (MACE). More recent randomized, sham control trials of RDN have shown that RDN produces a sustained lowering of BP. To date, this lowering of BP through RDN is maintained for at least 3 years. Furthermore, this procedure has been found to be safe. Hence this consensus summarises the science behind RDN and the available clinical data to support the use of this therapy. It is hoped that this consensus will offer guidance on the importance of identifying patients who will benefit most from this therapy. A multidisciplinary team approach in the management of the patient undergoing RDN is recommended.