The problem of uncontrolled hypertension

Lindholm, Lars

doi:10.1038/sj.jhh.1001433

Cited by 34 publications

(24 citation statements)

References 22 publications

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“…This is why counter-intuitive results demonstrating a non-association between the two factors can be observed. Therefore, it is still appropriate to consider poor adherence as a cause of poor blood pressure control in individual patients, 15 but in attributing cause as to why 50% of people with hypertension remain with blood pressures above target, it is perhaps worth paying greater attention to physician rather than patient factors. 16,17 …”

Section: Relationship Between Adherence and Poor Blood Pressure Controlmentioning

confidence: 99%

Does it matter whether patients take their antihypertensive medication as prescribed? The complex relationship between adherence and blood pressure control

Mant

McManus

2006

J Hum Hypertens

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It is well recognized that blood pressure control is sub-optimal. For example, in the UK, 30% of the adult population are hypertensive, with a blood pressure over 140/90 mm Hg, or on blood pressure lowering medication.1 The 'rule of halves' continues to apply, with over half of hypertensives not on any treatment, and over half of the people who are on treatment having blood pressures over the 140/ 90 mm Hg threshold.1 It is regarded as almost axiomatic that a significant reason that blood pressure remains poorly controlled in people on treatment is their non-adherence with therapy. For example, the World Health Organization estimates that 50-70% of people do not take their antihypertensive medication as prescribed, and describes poor adherence as the 'most important cause of uncontrolled blood pressure'.2 This orthodoxy is challenged by the findings of Schroeder et al.,3 reported in this issue. Schroeder et al. analysed the relationship between adherence over 6 months and achieved blood pressure in patients recruited from primary care who at baseline were on treatment for hypertension, but their blood pressure was over 150/90 mm Hg. Surprisingly, they found no relationship between medication adherence and achieved blood pressure, which suggests that adherence was not an important factor in this general practice population in explaining poor blood pressure control. The other interesting finding from these investigators was that adherence at baseline, measured by the strict method of timing compliancethat is, the percentage of doses taken at the correct time interval -was high, with mean timing compliance at just over 90%.4 Therefore, there are two questions raised by this research that need to be explored: Is adherence to medication in people with hypertension better than had been previously thought? And is it a significant factor in determining poor blood pressure control? Levels of adherence in hypertensionA systematic review of studies looking at compliance with blood pressure medication found overall mean 'taking compliance' of 94% for a once daily regime, and 88% for a twice daily regime.5 'Taking compliance' is a slightly less strict criterion than timing compliance, as it simply reflects the percentage of prescribed doses taken, without specifying whether the dosing interval was correct. Nevertheless, Schroeder et al.'s results are broadly consistent with the findings of this systematic review. Indeed, a recent study set in primary care in Scotland also found over 90% adherence (defined as the number of days with treatment supply divided by the total number of days from the first prescription to the end of the study period). 6 However, there are difficulties in interpretation of studies measuring adherence. Study populations may not be representative, and the measures and definitions of adherence used vary. Schroeder et al.'s 3 study, in common with many others, was performed in the context of a randomized controlled trial. It is likely that adherence is better in patients who are willing to be recruited t...

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Section: Relationship Between Adherence and Poor Blood Pressure Controlmentioning

confidence: 99%

Does it matter whether patients take their antihypertensive medication as prescribed? The complex relationship between adherence and blood pressure control

Mant

McManus

2006

J Hum Hypertens

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“…12 However, clinicians regularly experience difficulties in motivating their patients to comply with antihypertensive drug treatment and to undertake the necessary lifestyle modifications. 13,14 Specifically, adherence rates for exercise were shown to be lower than those for sodium and alcohol consumption reduction with obese patients, showing particularly poor adherence to lifestyle modification recommendations. 15 Reframing this uncomfortable knowledge from a behavioral medicine perspective, the data presented by Park et al actually provide good news for the treating physician and his patient alike.…”

mentioning

confidence: 99%

Accumulation of 30 min of moderately intense physical activity is a clinically meaningful treatment to reduce systolic blood pressure in prehypertension

Känel

2008

J Hum Hypertens

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“…It is estimated that adherence rates are approximately 50% for medications (1). Poor adherence with antihypertensive therapy sufficient to result in loss of antihypertensive control may cause reversal of beneficial effects on stroke, cardiovascular disease, hypertensive neuropathy and retinopathy (21,22). Consistent control of blood pressure requires that patients with hypertension follow medication (23).…”

Section: Discussionmentioning

confidence: 99%

Inflammation is related to unbalanced cardiac autonomic functions in hypertension: an observational study

Hacıhasanoğlu

Gözüm

Çapık

2012

Anadolu Kardiyol Derg

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Objective: Study purpose was to examine the validity of a 13-item short form of the Medication Adherence Self-Efficacy Scale-Short Form (MASES-SF) in an independent sample of 150 hypertensive Turkish patients. Methods: This is a methodological study and 150 adult patients, who are receiving medication for hypertension in the last one year, were included as the study sample. The sample of the study was chosen with the method of simple random sampling. The study was conducted between October 25, 2010 and December 31, 2010 at Family Health Center (FHC). In this study, exploratory and confirmatory factor analyses were used for psychometric evaluation. Cronbach's alpha coefficient was used to evaluate the reliability of the scale. Results: Confirmatory factor analysis showed that all goodness indexes were at acceptable quality: χ 2 =61.72, df=65, p>0.05, GFI=0.99, CFI=1.00, RMSA=0.00. Reliability coefficient of the Turkish adaptation of MASES-SF was found as 0.94 and item-total correlations ranged between 0.13 -0.52. Patients with uncontrolled hypertension had lower self-efficacy scores compared to those with normal blood pressure. Conclusion: This result indicated that the preliminary criterion validity is adequate. Psychometric testing demonstrated satisfactory internal consistency and validity of the instrument for patients in the study group. It can be used confidently in determining and testing interventions to improve medication adherence self-efficacy perceptions and behaviors in hypertensive Turkish patients. The MASES-SF is brief, quick to administer, and capture useful data on medication adherence self-efficacy in hypertensive patients. Bu çalışmada psikometrik değerlendirme için açıklayıcı ve doğrulayıcı faktör analizleri kullanılmıştır. Ölçek güvenirliliğini belirlemek için Cronbach's alfa katsayısı kullanıldı. Bulgular: Doğrulayıcı faktör analizinin tüm indekslerinde kabul edilebilir düzeyde olduğu belirlendi. χ 2 =65 (n=150)=61.72, p>0.05, GFI=0.99, AGFI=0.98, RMSA=0.00, CFI=1.00. Türkçe'ye uyarlanan ilaca uyum öz-etkililik ölçeği kısa formunun güvenirlik katsayısının 0.94 ve madde toplam korelasyonunun 0.13-52 arasında olduğu belirlenmiştir. Kan basınçları kontrol altında olmayan hastaların öz-etkililik puanlarının, kan basınçları normal olan hastalara göre daha düşük olduğu belirlenmiştir. Sonuç: Bu sonuç ölçek geçerliliğinin yeterli olduğunu göstermektedir. Yapılan psikometrik ölçüm, çalışılan gruptaki hastalar için kullanılan ölçe-ğin geçerliliğinin ve iç güvenirliliğinin yeterli olduğunu göstermektedir. Ölçek Türk hipertansif hastalarda ilaca uyum öz-etkililik algılarını ve davranışlarını geliştirmek için yapılan müdahalelerin belirlenmesinde güvenle kullanılabilir. İlaca uyum öz-etkilik ölçeği uygulaması kolay, hipertansif bireylerde ilaca uyum öz-etkililiği hakkında faydalı ve kapsamlı bilgi sağlayan bir ölçektir.

show abstract

The problem of uncontrolled hypertension

Cited by 34 publications

References 22 publications

Does it matter whether patients take their antihypertensive medication as prescribed? The complex relationship between adherence and blood pressure control

Does it matter whether patients take their antihypertensive medication as prescribed? The complex relationship between adherence and blood pressure control

Accumulation of 30 min of moderately intense physical activity is a clinically meaningful treatment to reduce systolic blood pressure in prehypertension

Inflammation is related to unbalanced cardiac autonomic functions in hypertension: an observational study

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