Treatment adherence as a mediator of blood pressure control in Chinese older adults with depression

Abstract

Objectives: Both depression and hypertension (HTN) are prevalent, costly, and destructive, and frequently coexist among the aging population of China. This study aimed to examine the role that treatment adherence plays in blood pressure control in older adult Chinese with depression.Methods: Data for these analyses were taken from a randomized control trial of a collaborative depression care management intervention conducted in rural villages of Zhejiang Province, China with older adults who had comorbid depression and HTN. They included baseline assessments of 2362 subjects ages ≥60 years, whose blood pressure and depression were measured using a calibrated manual sphygmomanometer and the Chinese version of the 17-item Hamilton Depression Rating Scale (HDRS-17), respectively. Treatment adherence was identified by a single question asking whether patients on occasion did not take their medicine.Results: Uncontrolled HTN was associated with older age (t = 3.10, P<0.01), higher HDRS-17 score (t = 5.76, P<0.01), and higher rates of non-adherence to HTN treatment (χ 2 = 21.34, P<0.01). Logistic regression models indicated that adherence accounted for 39.4% of the total effect between depression and HTN. Specifically, those with poor adherence were at 1.417 greater odds of having their HTN uncontrolled compared with those with good adherence.Conclusions: Hypertension control in older adults with depression is complicated by nonadherence to treatment. In addition to diagnosing and treating depression in their older adult patients, primary care physicians can optimize blood pressure control by identifying and addressing their patients' adherence to recommendations for HTN management.

Association Between Medication Literacy and Medication Adherence Among Patients With Hypertension

“…It was found that more than half of the sampled hypertensive patients (63.6%) had low levels of medication adherence, which was higher than an international pooled percentage of 31.1% with the MMAS-8 (Uchmanowicz et al, 2019). Poor adherence to antihypertensive medication not only is associated with poor blood pressure control but also accelerates the development of hypertension-related complications and increases the rate of hospital admissions (Sabaté, 2003; Abegaz et al, 2017; Jafar et al, 2018; Beune et al, 2019; Xue et al, 2019). In accordance with the findings of other studies in the mainland of China, the rate of poor medication adherence across China was 64.8%, with values as high as 78.7% (Kang et al, 2015; Wong et al, 2015; Hou et al, 2016; Ma, 2016; Pan et al, 2017), indicating that adherence to drug therapy for Chinese hypertensive patients is a great concern and needs greater attention.…”

“…In addition, it has been confirmed that suboptimal blood pressure control is closely associated with patients’ poor adherence or nonadherence to antihypertensive drugs (Morisky et al, 2008; Abegaz et al, 2017; Al-Noumani et al, 2018; Beune et al, 2019; Uchmanowicz et al, 2019). Patients with poor adherence were found to be at 1.417 times more likely to have uncontrolled hypertension than those with good adherence (Xue et al, 2019). Therefore, good adherence to antihypertensive agents is considered critical for patients to achieve optimal blood pressure control.…”

Economic Burden of Depressive Symptoms Conditions among Middle-Aged and Elderly People with Hypertension in China

“…Thus, we can set up mental health counseling services in community health institutions so that we can diagnose depression and provide patients timely primary care. As for management of depression in hypertensive patients, studies have shown that collaborative depression care management conducted by a physician team is effective [ 53 ]. High-income countries created a cooperative primary care provider team to provide comprehensive health services for chronic patients, including regular symptom monitoring, health education, and social support [ 54 ].…”

Antihypertensive treatment and depressive symptoms in Chinese middle‐aged and older hypertensive adults: A population‐based longitudinal study

“…Meanwhile, depressive disorders are associated with poor adherence to antihypertensive medications, thereby complicating the hypertension management. 14,15 None of meta-analyses provided clear evidence on whether antihypertensive treatment reduced or increased the subsequent depressive symptoms. Prospective population-based studies indicated that antihypertensive treatment at baseline had a significantly reduced risk of developing neuropsychiatric consequences.…”

“…A number of studies confirmed that lack of communication skills of hypertension management, irrational use of medicines, or poor antihypertensive treatment adherence could result in the subsequent depressive symptoms. Meanwhile, depressive disorders are associated with poor adherence to antihypertensive medications, thereby complicating the hypertension management . None of meta‐analyses provided clear evidence on whether antihypertensive treatment reduced or increased the subsequent depressive symptoms.…”