Perception of risk of hypertension related complications and adherence to antihypertensive drugs: a primary healthcare based cross-sectional study

Joint Modifiable Risk Factor Control and Incident Stroke in Hypertensive Patients

Recent guidelines have recognized several factors, including blood pressure (BP), body mass index (BMI), low-density lipoprotein cholesterol (LDL-C), hemoglobin A1c (HbA1c), smoking, and physical activity, as key contributors to stroke risk. However, the impact of simultaneous management of these risk factors on stroke susceptibility in individuals with hypertension remains ambiguous. This study involved 238 388 participants from the UK Biobank, followed up from their recruitment date until April 1, 2023. Cox proportional hazard models with hazard ratios (HRs) and 95% confidence intervals (CIs) were used to illustrate the correlation between the joint modifiable risk factor control and the stroke risk. As the degree of risk factor control increased, a gradual reduction in stroke risk was observed. Hypertensive patients who had the optimal risk factor control (≥5 risk factor controls) had a 14.6% lower stroke risk than those who controlled 2 or fewer (HR: 0.854; 95% CI: 804-0.908; p < 0.001). The excess risk of stroke linked to hypertension slowly diminished as the number of controlled risk factors increased. However, the risk was still 25.1% higher for hypertensive patients with optimal risk factor control as compared to the non-hypertensive population (HR: 1.251; 95% CI: 1.100-1.422; p < 0.001). The protective effect of joint risk factor control against the stroke risk due to hypertension was stronger in medicated hypertensive patients than in those not medicated. This finding leads to the conclusion that joint risk factor control combined with pharmacological treatment could potentially eliminate the excess risk of stroke associated with hypertension.

Socio-demographic and genetic risk factors for drug adherence and persistence across 5 common medication classes

Low drug adherence is a major obstacle to the benefits of pharmacotherapies and it is therefore important to identify factors associated with discontinuing or being poorly adherent to a prescribed treatment regimen. Using high-quality nationwide health registry data and genome-wide genotyping, we evaluate the impact of socio-demographic and genetic risk factors on adherence and persistence for 5 common medication classes that require long-term, regular therapy (N = 1,814,591 individuals from Finnish nationwide registries, 217,005 with genetic data from Finland and Estonia). Need for social assistance and immigration status show a notable negative effect on persistence and adherence across the examined medications (odd ratios between 0.48 and 0.82 for persistence and between 1.1% to 4.3% decrease in adherence) while demographic and health factors show comparably modest or inconsistent effects. A genome-wide scan does not identify genetic variants associated with the two phenotypes, while some pharmacogenes (i.e. CYP2C9 and SLCO1B1) are modestly associated with persistence, but not with adherence. We observe significant genetic correlations between medication adherence and participation in research studies. Overall, our findings suggest that socio-economically disadvantaged groups would benefit from targeted interventions to improve the dispensing and uptake of pharmacological treatments.

Prevalence of hypertension and factors associated with the utilization of primary health care services for hypertension among hypertensive population aged 40 years and above in Pyin Oo Lwin Township, Myanmar

BACKGROUND

Utilization of hypertension services at primary health care levels has not been assessed at township level, since launching of PEN interventions in Myanmar. This study aimed to determine the factors associating with the utilization of primary health care services for hypertension among 40 years and above hypertensive population.

METHODS

Community-based cross-sectional study was done in Pyin Oo Lwin Township, 2023. Multi stage sampling was conducted to recruit 40 years and above participants; response rate was 85%. Joint National Committee (JNC7) classification was used to define hypertension. Among hypertensive participants, descriptive analysis, Chi squared test and multiple logistic models were conducted, with a significance level of 0.05.

RESULTS

Out of 1001 screening participants, prevalence of hypertension was 38.6% (386). Among 386 participants, 51.8% (200) utilized primary health care services provided by public health facilities. Rural residents (AOR = 2.79, CI = 1.68, 4.67), known hypertension (AOR = 4.36, CI = 2.39, 8.23), good perception on hypertension (AOR = 0.30, CI = 0.14, 0.62), perceived cost of travel as necessary (AOR = 0.57, CI = 0.35, 0.92) and awareness of available services (AOR = 4.11, CI = 2.55, 6.71) were associated with the utilization of primary health care services for hypertension.

CONCLUSION

This study provided context-specific scientific evidence to tackle existing problems of low utilization of PHC services for hypertension. Strengthening health care infrastructure for quality hypertension care at primary health care level was also recommended.

Visual analysis of acupuncture point selection patterns and related mechanisms in acupuncture for hypertension

BACKGROUND

Hypertension has become one of the most pathogenic diseases in the world.

OBJECTIVE

This paper summarizes and analyzes the acupuncture point combinations and treatment principles of acupuncture for hypertension in a systematic way by means of big data mining.

METHODS

The literature for this paper was obtained from CNKI, Wanfang, VIP, SinoMed and PubMed, Embase, Cochrane Library, Web of Science, and Ovid databases. Thedata were collected to obtain combinations of acupoints with strong associations through association rule analysis, complex networks for screening to obtain core acupoint nuclei, and cluster analysis to derive treatment principles.

RESULTS

A total of 127 acupuncture prescriptions involving 66 acupoints were included in this study. Tai-chong (LR3), Qu-chi (LI11), Zu-san-li (ST36), Feng-chi (GB20), and He-gu (LI4) were the most commonly used acupoints. The large intestine meridian was the preferred meridian, and most of the extremity acupoints, especially the lower extremities, were selected clinically. The association rule reveals that Qu-chi (LI11) and Zu-san-li (ST36) are the dominant combination acupoints. 3 core association points obtained after complex network analysis, the 1st association, Bai-hui (DU20), Tai-xi (KI3), Gan-shu (BL18), Shen-shu (BL23); The 2nd association, Qu-chi (LI11), He-gu (LI4), San-yin-jiao (SP6), Zu-san-li (ST36), Feng-chi (GB20), Tai-chong (LR3); The 3rd association, Qi-hai (RN6), Guan-yuan (RN4), Zhong-wan (RN12), Zhao-hai (KI6), Tai-yang (EX-HN5), Lie-que (LU7), Yang-ling-quan (GB34), Xing-jian (LR2), Yin-ling-quan (SP9). Cluster analysis yielded the treatment principles of nourishing Yin and submerging Yang, pacifying the liver and submerging Yang, tonifying Qi and Blood, and calming the mind and restoring the pulse, improving clinical outcomes.

CONCLUSION

By means of big data mining, we can provide reference for acupuncture point grouping and selection for clinical acupuncture treatment of hypertension.

A cross-sectional study on adherence to treatment and life-style modifications in hypertensive patients attending the urban health centre of a teaching hospital in Hyderabad

Introduction

The burden of hypertension is expected to double by 2025 and adherence to treatment has a key role in disease outcome. The World Health Organization defines adherence as the extent to which a person's behaviour of taking medication, following a diet and/or exceeding life-style changes, corresponds with the agreed recommendations of health care providers. The study tries to assess the level of adherence to medication and life-style modifications in hypertensive patients.

Materials and Methods

It is a cross-sectional study among patients attending urban health centres of a teaching hospital. The study population included all hypertensive patients above 30 years. Based on the prevalence of non-adherence to hypertensive medication, 70% of the sample size is calculated as 182. A Morisky medication adherence scale is used to find adherence to treatment. Life-style modification was also assessed. Scoring was done based on their adherence to treatment and life-style modifications and quantified.

Results

The mean age of the study population was 55 years (38-80 years). In total, 58.33% were illiterate and 21% were retired from work. Around 87.5% had to spend money on medication. Mean weight, height, hip and waist circumference was 66 kg, 157 cm, 108 cm and 100 cm, respectively. Mean BMI was 26.6. Prevalence of good adherence to medication was 129 (70.83%) and that of good life-style modifications was 127 (70.17%).

Conclusion

The adherence to medication and life-style modification was satisfactory. Family physicians have a key role in Non communicable diseases (NCD) management and should focus on ongoing education programmes for treatment adherence and life-style modifications at a community level, and grass-root level workers should conduct regular follow-up activities.

Medication adherence and pharmaceutical design strategies for pediatric patients: An overview

Medication adherence in pediatric patients is a key factor in drug development and dosage form design. High medication adherence is not only important to achieve the expected treatment effects but can also effectively reduce medical costs. It is an ongoing task to accurately identify differences in medication adherence between children and adults and analyze the factors related to pediatric medication adherence. This is necessary to guide the development of pediatric drugs. This review focuses on factors that influence pediatric medication adherence as well as pharmaceutical design strategies to improve adherence. Current new dosage forms, new technologies, and new devices are comprehensively summarized in terms of their advantages and limitations.