BackgroundHypertension is very poorly controlled in patients on hemodialysis (HD). Demographic and psychosocial predictors of nonadherence with blood pressure (BP) regimens in HD have not been investigated. A study of 118 HD patients from six outpatient HD units was conducted to determine the relationship between demographic/psychosocial factors and adherence with BP-related regimens, ie, fluid restriction, BP medication adherence, and HD treatment adherence.MethodsDescriptive statistics, Pearson correlations, and multiple regressions were conducted to analyze and determine the relationships between variables.ResultsYounger age was related to increased fluid gains (r = −0.37, P < 0.01), decreased medication adherence (r = −0.19, P = 0.04), increased missed HD treatments (r = −0.37, P < 0.01), and diastolic BP (r = −0.60, P < 0.01). Female sex was significantly related to decreased fluid gains (r = −0.28, P < 0.01). Race was related to increased missed HD treatments (r = 0.22, P = 0.02). Increased social support was related to decreased missed HD treatments (r = −0.22, P = 0.02). Depression scores were inversely related to decreased medication adherence scores (r = 0.24, P = 0.01).ConclusionBy identifying risk factors for nonadherence with BP-related regimens (young age, male sex, decreased social support, and depression), health care providers can plan early clinical intervention to minimize the risk of nonadherence.

This study examined the effects of an educative, self-regulation intervention on blood pressure self-efficacy, self-care outcomes, and blood pressure control in adults receiving hemodialysis. Simple randomization was done at the hemodialysis unit level. One hundred eighteen participants were randomized to usual care ( n = 59) or intervention group ( n = 59). The intervention group received blood pressure education sessions and 12 weeks of individual counseling on self-regulation of blood pressure, fluid, and salt intake. There was no significant increase in self-efficacy scores within ( F = .55, p = .46) or between groups at 12 weeks ( F = 2.76, p = .10). Although the intervention was not successful, results from the total sample ( N = 118) revealed that self-efficacy was significantly related to a number of self-care outcomes including decreased salt intake, lower interdialytic weight gain, increased adherence to blood pressure medications, and fewer missed hemodialysis appointments. Increased blood pressure self-efficacy was also associated with lower diastolic blood pressure.

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Given the high prevalence of depression and its association with BP medication nonadherence, patients on chronic HD should be routinely assessed for depression and offered validated treatment regimens. Depression is a modifiable risk factor, and interventions that address depression in conjunction with adherence to BP regimens need to be tested in the HD population.

Background: Hypertension is poorly controlled in hemodialysis (HD). Extracellular fluid volume control, restriction of salt intake and antihypertensive therapy are needed to control blood pressure (BP) in this population. Research on patterns of antihypertensive use on BP has not been extensively studied in the chronic HD population.Methods: A descriptive secondary correlational analysis of n = 118 chronic HD patients was conducted to determine the patterns of antihypertensive medication use and their relationship to BP. Results: Participants were taking an average of three antihypertensive medications. Total number of antihypertensive medications was not correlated with BP. There were no differences in BPs in patients who took or did not take a specific antihypertensive drug class except for ace-inhibitors. Those participants who did take ace-inhibitors had significantly higher BPs.Conclusions: Future studies examining antihypertensive class, optimal dosing and time of administration need to be conducted to determine the best hypertensive management intervention for chronic HD patients.