Changes in Adherence to Non-Pharmacological Guidelines for Hypertension

Nutrient-Derived Beneficial for Blood Pressure Dietary Pattern Associated with Hypertension Prevention and Control: Based on China Nutrition and Health Surveillance 2015–2017

Background: Greater adherence of Dietary Approach to Stop Hypertension (DASH) or the Mediterranean dietary pattern were reported to be beneficial for blood pressure. However, both were established based on Western populations. Our current study aimed to explore a dietary pattern which might be suitable for hypertension prevention and control among Chinese adults nationwide. Methods: A total of 61,747 Chinese adults aged over 18 years from China Nutrition and Health Surveillance 2015–2017 was included in this study. Using reduced-rank regression (RRR) method, a dietary pattern with higher intakes of those nutrients which are inversely associated with the risk of hypertension was identified. DASH-score was also calculated for each participant for further validate the dietary pattern derived by RRR method. Multi-adjustment logistic regression was applied to examine the association between above two dietary patterns and hypertension prevention and control. Results: Dietary pattern named Beneficial for Blood Pressure (BBP) diet was characterized by higher fresh vegetables and fruits, mushrooms/edible fungi, dairy products, seaweeds, fresh eggs, nuts and seeds, legumes and related products, aquatic products, coarse cereals, and less refined grains and alcohol consumption. After multiple adjustment, protective effects showed on both hypertension prevention and control (for prevention: Q5 vs. Q1, OR = 0.842, 95% CI = 0.791–0.896; for control: Q5 vs. Q1, OR = 0.762, 95% CI = 0.629–0.924). For the DASH-diet, significant results were also observed (for prevention: Q5 vs. Q1, OR = 0.912, 95% CI = 0.854–0.973; for control: Q5 vs. Q1, OR = 0.76, 95% CI = 0.616–0.938). Conclusions: BBP-diet derived from Chinese adults has high conformity with the DASH-diet, and it might serve as an adjuvant method for both hypertension prevention and control.

The Role of Health Care Quality in Hypertension Self-Management: A Qualitative Study of the Experience of Patients in a Public Hospital, North-West Ethiopia

Purpose

Hypertension is becoming a global epidemic in all population groups. For its effective management and control, patients should have enhanced self-management skills and get adequate support from care providers. Although the quality of health care is critical in enhancing self-management behaviors of patients with hypertension, the issue has not been fully explored in the Ethiopian context. Therefore, the purpose of this study was to explore the experience of hypertensive patients on the quality of health care and the self-management practice in a public hospital in North-west Ethiopia.

Patients and Methods

This qualitative study involves a phenomenological approach. Participants were hypertension patients who are on treatment follow-up. They were recruited purposively with maximum variation approach. Eleven in-depth interviews and two key informant interviews were undertaken using a semi-structured interview guide with hypertensive patients and nurses respectively. Interviews were audio recorded, transcribed verbatim, translated into English, and then analyzed thematically by the investigators.

Results

The analysis identified two main themes and seven sub-themes. The first theme “experience in self-management practice” describes medication adherence, lifestyle modification, and self-monitoring of blood pressure. The second theme “experience in the quality of health care” discusses access to health services, patient-centered care, behavior of health care providers, and time and patient flow management.

Conclusion

The self-management practice of hypertensive patients is sub-optimal. Although several individual patient issues were identified, facility-level problems are mainly responsible for poor self-management practice. The main facility-level barriers, as reported by participants, include shortage of medicines, high cost of medicines, busyness of doctors due to high patient load, lack of appropriate education and counseling services, poor patient-provider interaction, and long waiting times. Intervention areas should focus on providing appropriate training for health care providers to enhance the patient–provider relationship. Improving the supply of hypertensive medications is also paramount for better medication adherence.

Factors associated with dietary adherence to the guidelines for prevention and treatment of hypertension among Korean adults with and without hypertension

Background

Although dietary modification is strongly recommended for prevention and treatment of hypertension, little is known about which factors are associated with adherence to dietary guidelines. We investigated knowledge and attitude, perceived benefits of, barriers to, and self-efficacy of dietary therapy, and identified the factors associated with dietary adherence among adults with and without hypertension.

Methods

We collected information on the knowledge/attitudes and perceived benefits of dietary therapy, as well as barriers to and self-efficacy regarding dietary adherence from 497 middle-aged (34–69 years) adults who participated in the follow-up examination of the Cardiovascular and Metabolic Diseases Etiology Center (CMERC) cohort study during December 2018 and February 2019.

Results

Among people without hypertension, 95.5% (343/359) and 95.8% (344/359) answered that they would limit sodium intake and consume health diet, respectively, if diagnosed hypertension. However, among people with hypertension, only 79.7% (110/138) and 77.5% (107/138) reported they were limiting dietary sodium intake and having healthy diet, respectively. Frequency of diet management was not different between normotensive (34.0%) and hypertensive (35.5%) groups. Compared to normotensives, hypertensive people were more likely to have lower dietary adherence score, think they need to change their diet, think dietary change impossible, and report lower self-efficacy for following diet guidelines. Dietary management was significantly associated with cardiometabolic risk factors (OR: 1.63) and dietary education (OR: 2.19) among normotensives, while it was associated only with awareness that lifestyle modification is necessary regardless of antihypertensive medication (OR: 6.29) among hypertensive people. Good dietary adherence had significant associations with perceived barriers (OR: 0.71), self-efficacy (OR: 3.71), and dietary education (OR: 1.98) among normotensives; and with perceived barriers (OR: 0.54), self-efficacy (OR: 4.06), and dietary management (OR: 4.16) among hypertensive people.

Conclusions

Many Koreans have relatively low adherence to dietary guidelines for hypertension prevention and treatment. Knowledge, dietary practices, and factors affecting dietary adherence were different between adults with and without hypertension. A targeted approach will be needed to improve blood pressure control of the Korean population.

Characteristics of nursing interventions that improve the quality of life of people with chronic diseases. A systematic review with meta-analysis

PURPOSE

The objective of this systematic review was to determine the characteristics of the interventions conducted by nurses that attempt to improve the health related quality of life (HRQoL) of people over 18 years of age with chronic diseases.

METHODS

This systematic review with meta-analysis summarizes 24 studies, conducted in 10 countries, that evaluated HRQoL through the Short-Form Health Survey (SF). Five databases were accessed to find the available studies from December 31st, 2000 to May 22sd, 2017. Selected studies were coded according to the characteristics of the sample and the intervention. A model of random effects was adopted for the overall estimation and to explain the heterogeneity.

RESULTS

Twenty-four studies were included in the systematic review and meta-analysis providing a sample of 4324 chronic patients aged 63.4 years. Among the 8 subscales and two summary measures that comprise the SF-36, only an overall significant effect size (ES) index was found in the Mental Health Component summary score (ES = 0.14; 95% CI:0.03 - 0.26; I2 = 44.6, p = 0.042) and the Mental Health subscale. This improvement on HRQoL was associated to interventions on "Case Management" and "Treatments and Procedures", which were based on a theory, were of shorter duration, and had a follow-up period.

CONCLUSIONS

Interventions targeting people with chronic diseases resulted in a slight increase in the HRQoL that was not always significant, which suggests that there is a need for their continuous improvement.

Older Hypertensive Patients’ Adherence to Healthy Lifestyle Behaviors

Non-pharmacological treatment including diet, body weight reduction, smoking cessation and physical activity, is very important part of hypertension treatment. The objective of this study was to investigate the adherence to healthy lifestyle behavior in the representative sample of the older hypertensive patients, and to investigate factors associated with adherence in the studied older population. The study was conducted on random sample of 362 long term hypertensive (> five years) patients older than 65 years of age, at Health Care Center of Kragujevac. Adherence was assessed using the structured questionnaire for the analysis of the implementation of both hypertension and diabetes guidelines in the primary care. Both bivariate and multivariate analyses were conducted. Nearly 35% of examined patients were highly adherent; they exercised regularly, avoided smoking for at least five years and consumed special healthy diet prescribed for hypertension. Another 35.6% of the cases reported exercising regularly, 39.5% followed the recommended diet for the hypertension, while 23.4% of the patients have still consumed cigarettes. Multivariate logistic regression demonstrated that received counseling on healthy lifestyle behaviors by physicians and lack of education predicted high adherence to healthy lifestyle behavior. In order to improve adherence of elderly hypertensive patients to healthy lifestyle, strengthening patient-physician relationships through efforts to enhance communication may be a promising strategy to enhance patients’ engagement in healthy lifestyle behaviors for hypertension. Such an improvement could be achieved through the education of both the physicians and patients.