Treating hypertension in patients with medical comorbidities

Kennard, Lucinda; O’Shaughnessy, Kevin M.

doi:10.1136/bmj.i101

Cited by 15 publications

(6 citation statements)

References 19 publications

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“…The everyday use of multiple daily medications is an essential intervention to decrease cardiovascular complications in patients with poorly controlled hypertension. Also, their benefits in treating hypertensive patients with comorbidities have been shown in the literature [ 40 , 41 ]. However, regimens with more than one medication per day are inconvenient, and as a consequence, patients find them difficult to follow, and potentially compromising the effectiveness of the treatment.…”

Section: Discussionmentioning

confidence: 99%

“…It is crucial for healthcare providers to effectively communicate the risks and benefits of each medication, especially when potential interactions exist [ 21 ]. By understanding the significance, patients may be more motivated to adhere to the prescribed regimen and report any unusual side effects promptly [ 21 , 40 ]. Therefore, hypertensive patients with a comorbidity warrant adequate care, supervision and counseling during their treatment.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of non-adherence to antihypertensive medications: A cross-sectional study from a regional hospital in Afghanistan

Stanikzai,

Wafa,

Tawfiq

et al. 2023

PLoS ONE

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Background Non-adherence to antihypertensive medications (AHMs) is a widespread problem. Cardiovascular morbidity and mortality reduction is possible via better adherence rates among hypertensive patients. Objectives This study aimed to assess the prevalence of non-adherence to AHMs and its predictors among hypertensive patients who attended Mirwais Regional Hospital in Kandahar, Afghanistan. Methods A cross-sectional study using random sampling method was conducted among hypertensive patients, aged ≥18 years in Mirwais Regional Hospital at a 6-month follow-up between October and December 2022. To assess non-adherence to AHMs, we employed the Hill-Bone Medication Adherence scale. A value below or equal to 80% of the total score was used to signify non-adherence. A multivariable binary logistic regression model was used to identify predictors of non-adherence to AHMs. Results We used data from 669 patients and found that 47.9% (95%CI: 44.1–51.8%) of them were non-adherent to AHMs. The majority (71.2%) of patients had poorly controlled blood pressure (BP). The likelihood of non-adherence to AHMs was significantly higher among patients from low monthly-income households [Adjusted odds ratio (AOR) 1.70 (95%CI: 1.13–2.55)], those with daily intake of multiple AHMs [AOR 2.02 (1.29–3.16)], presence of comorbid medical conditions [AOR 1.68 (1.05–2.67), lack of awareness of hypertension-related complications [AOR 2.40 (1.59–3.63)], and presence of depressive symptoms [AOR 1.65 (1.14–2.38)]. Conclusion Non-adherence to AHMs was high. Non-adherence to AHMs is a potential risk factor for uncontrolled hypertension and subsequent cardiovascular complications. Policymakers and clinicians should implement evidence-based interventions to address factors undermining AHMs adherence in Afghanistan.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Predictors of non-adherence to antihypertensive medications: A cross-sectional study from a regional hospital in Afghanistan

Stanikzai,

Wafa,

Tawfiq

et al. 2023

PLoS ONE

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“…4,5 Two out of 3 people with hypertension have additional long-term condition. 6 A systematic review of 45 studies showed that the overall prevalence of multimorbidity was 66.1% (when multimorbidity was defined as having ≥2 chronic conditions), and 44.2% (when multimorbidity was defined as having ≥3 chronic conditions) in older adults in high-income countries. 7 In the United States, 81 million adults were estimated to have multimorbidity in 2020.…”

Section: Introductionmentioning

confidence: 99%

Multimorbidity and Blood Pressure Control in Patients Attending Primary Care in Canada

Nguyen,

Kalia,

Hanlon

et al. 2023

J Prim Care Community Health

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Background: There has been conflicting evidence on the association between multimorbidity and blood pressure (BP) control. This study aimed to investigate this associations in people with hypertension attending primary care in Canada, and to assess whether individual long-term conditions are associated with BP control. Methods: This was a cross-sectional study in people with hypertension attending primary care in Toronto between January 1, 2017 and December 31, 2019. Uncontrolled BP was defined as systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg. A list of 11 a priori selected chronic conditions was used to define multimorbidity. Multimorbidity was defined as having ≥1 long-term condition in addition to hypertension. Logistic regression models were used to estimate the association between multimorbidity (or individual long-term conditions) with uncontrolled BP. Results: A total of 67 385 patients with hypertension were included. They had a mean age of 70, 53.1% were female, 80.6% had multimorbidity, and 35.7% had uncontrolled BP. Patients with multimorbidity had lower odds of uncontrolled BP than those without multimorbidity (adjusted OR = 0.72, 95% CI 0.68-0.76). Among the long-term conditions, diabetes (aOR = 0.73, 95%CI 0.70-0.77), heart failure (aOR = 0.81, 95%CI 0.73-0.91), ischemic heart disease (aOR = 0.74, 95%CI 0.69-0.79), schizophrenia (aOR = 0.79, 95%CI 0.65-0.97), depression/anxiety (aOR = 0.91, 95%CI 0.86-0.95), dementia (aOR = 0.87, 95%CI 0.80-0.95), and osteoarthritis (aOR = 0.89, 95%CI 0.85-0.93) were associated with a lower likelihood of uncontrolled BP. Conclusion: We found that multimorbidity was associated with better BP control. Several conditions were associated with better control, including diabetes, heart failure, ischemic heart disease, schizophrenia, depression/anxiety, dementia, and osteoarthritis.

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“…Up to two-thirds of patients with hypertension have other comorbidities [1]. Yet, patients with multi-morbidity are commonly excluded from or underrepresented in major clinical trials, hence, limiting the evidence on how best to manage elevated blood pressure (BP) of hypertensive patients with additional comorbidities.…”

Section: Introductionmentioning

confidence: 99%

Multi-morbidity and blood pressure trajectories in hypertensive patients: A multiple landmark cohort study

et al. 2021

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Background Our knowledge of how to better manage elevated blood pressure (BP) in the presence of comorbidities is limited, in part due to exclusion or underrepresentation of patients with multiple chronic conditions from major clinical trials. We aimed to investigate the burden and types of comorbidities in patients with hypertension and to assess how such comorbidities and other variables affect BP levels over time. Methods and findings In this multiple landmark cohort study, we used linked electronic health records from the United Kingdom Clinical Practice Research Datalink (CPRD) to compare systolic blood pressure (SBP) levels in 295,487 patients (51% women) aged 61.5 (SD = 13.1) years with first recorded diagnosis of hypertension between 2000 and 2014, by type and numbers of major comorbidities, from at least 5 years before and up to 10 years after hypertension diagnosis. Time-updated multivariable linear regression analyses showed that the presence of more comorbidities was associated with lower SBP during follow-up. In hypertensive patients without comorbidities, mean SBP at diagnosis and at 10 years were 162.3 mm Hg (95% confidence interval [CI] 162.0 to 162.6) and 140.5 mm Hg (95% CI 140.4 to 140.6), respectively; in hypertensive patients with ≥5 comorbidities, these were 157.3 mm Hg (95% CI 156.9 to 157.6) and 136.8 mm Hg (95% 136.4 to 137.3), respectively. This inverse association between numbers of comorbidities and SBP was not specific to particular types of comorbidities, although associations were stronger in those with preexisting cardiovascular disease. Retrospective analysis of recorded SBP showed that the difference in mean SBP 5 years before diagnosis between those without and with ≥5 comorbidities was −9 mm Hg (95% CI −9.7 to −8.3), suggesting that mean recorded SBP already differed according to the presence of comorbidity before baseline. Within 1 year after the diagnosis, SBP substantially declined, but subsequent SBP changes across comorbidity status were modest, with no evidence of a more rapid decline in those with more or specific types of comorbidities. We identified factors, such as prescriptions of antihypertensive drugs and frequency of healthcare visits, that can explain SBP differences according to numbers or types of comorbidities, but these factors only partly explained the recorded SBP differences. Nevertheless, some limitations have to be considered including the possibility that diagnosis of some conditions may not have been recorded, varying degrees of missing data inherent in analytical datasets extracted from routine health records, and greater measurement errors in clinical measurements taken in routine practices than those taken in well-controlled clinical study settings. Conclusions BP levels at which patients were diagnosed with hypertension varied substantially according to the presence of comorbidities and were lowest in patients with multi-morbidity. Our findings suggest that this early selection bias of hypertension diagnosis at different BP levels was a key determinant of long-term differences in BP by comorbidity status. The lack of a more rapid decline in SBP in those with multi-morbidity provides some reassurance for BP treatment in these high-risk individuals.

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Treating hypertension in patients with medical comorbidities

Cited by 15 publications

References 19 publications

Predictors of non-adherence to antihypertensive medications: A cross-sectional study from a regional hospital in Afghanistan

Predictors of non-adherence to antihypertensive medications: A cross-sectional study from a regional hospital in Afghanistan

Multimorbidity and Blood Pressure Control in Patients Attending Primary Care in Canada

Multi-morbidity and blood pressure trajectories in hypertensive patients: A multiple landmark cohort study

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