Blood Pressure Treatment Adherence and Control after Participation in the ReHOT

Abstract

BackgroundLack of adherence to pharmacological treatment is one of the main causes of low control rates in hypertension.ObjectiveTo verify treatment adherence and associated factors, as well as blood pressure (BP) control in participants of the Resistant Hypertension Optimal Treatment (ReHOT) clinical trial.MethodCross-sectional study including all 109 patients who had completed the ReHOT for at least 6 months. We excluded those participants who failed to respond to the new recruitment after three phone contact attempts. We evaluated the BP control by ambulatory BP monitoring (ABPM; controlled levels: 24-hour systolic and diastolic BP < 130 x 80 mmHg) and analyzed the patients' treatment adherence using the Morisky Medication Adherence Scale (MMAS) questionnaire validated by Bloch, Melo, and Nogueira (2008). The statistical analysis was performed with the software IBM SPSS statistics 21.0. We tested the normality of the data distribution with kurtosis and skewness. The variables tested in the study are presented with descriptive statistics. Comparisons between treatment adherence and other variables were performed with Student's t test for independent variables and Pearson's chi-square or Fisher's exact test. To conduct analyses among patients considering adherence to treatment and BP control, we created four groups: G0, G1, G2, and G3. We considered a 5% significance level in all tests.ResultsDuring the ReHOT, 80% of the patients had good BP control and treatment adherence. Of 96 patients reevaluated in the present study, only 52.1% had controlled hypertension when assessed by ABPM, while 31.3% were considered adherent by the MMAS. Regarding other ABPM measures, we observed an absence of a nocturnal dip in 64.6% of the patients and a white-coat effect and false BP control in 23% and 12.5%, respectively. Patients' education level showed a trend towards being a determinant factor associated with lack of adherence (p = 0.05). Resistant hypertension and number of medications were significantly associated with BP control assessed by ABPM (p = 0.009 and p = 0.001, respectively). Resistant hypertension was also significantly associated with group G0 (patients with no control or adherence, p = 0.012).ConclusionThere was a decrease in BP control and adherence measured by the MMAS after participation of at least 6 months in the ReHOT clinical trial.

Association between follow-up in health services and antihypertensive medication adherence

“…Lack of medication intake was the main obstacle in the way of adherence for the studied patients, corroborating the results of other studies on hypertensive populations (24)(25) . The discontinuation of antihypertensive medication caused by forgetfulness or incorrect timing leads to pressure oscillations that compromise control and facilitate the occurrence of negative cardiovascular events, such as acute myocardial infarction and angina (26) .…”

Association between Therapeutic Adherence and the Profile of Patients with Resistant Hypertension

“…The number of medications used may also have an impact on the degree of therapeutic adherence, 5,10 which was confirmed in this study, since the group with poor adherence used a significantly higher number of antihypertensive drugs. It is important to consider this finding when making prescriptions, as the use of tablets with drug combinations may be an effective strategy to improve adherence.…”

“…The prevalence of good therapeutic adherence found in this study (83%) was similar to that found in the ReHOT study, 8 which was approximately 80%, and that found by Garg et al, 9 where it was 84%. However, other studies show lower rates of good adherence, such as 31.3% found by Jesus et al, 10 51.0% found by Bloch et al, 11 and 31.2% found by Prado-Jr , et al 12 The relatively high rate of good therapeutic adherence in this study can be explained by the fact that patients are followed up at a reference outpatient clinic for Resistant Arterial Hypertension, so more attention is possibly given to the issue of adherence.…”

“…Original Article follow-up. 5,10 All of these variables were analyzed. However, there was no statistical significance for any of them as contributors to poor adherence, possibly because it is a cohort population with high cardiovascular risk and poorly diversified ethnic profile.…”

Antihypertensive treatment adherence in workers of a General Hospital

“…Although no studies have conducted its translation and crosscultural adaptation, considering all stages of the process, several authors evaluated its properties and did not invalidate its use for this purpose, despite its limitations, mainly its low sensitivity (16)(17) . This can be evidenced by continuous use (18) , including as a gold standard for carrying out the validation of other instruments (19) . More recently, two other adherence methods were compared and it presented good agreement with both (20) .…”