Antihypertensive Treatment Compliance in Stroke Patients With Hypertension

Yıl 2024, Cilt: 57 Sayı: 3, 88 - 92, 22.01.2025

Esra Tekin Taşkıran , Bilgin Öztürk

https://doi.org/10.20492/aeahtd.1381457

Öz

Aim
Stroke is responsible for approximately 6 millions of all the annual deaths worldwide. An effective method to prevent stroke and its comorbidities is the adequate control of the risk factors. This study aimed to evaluate the compliance of stroke patients in their antihypertensive treatment and the frequency of measuring blood pressure.
Material and methods
Patient’s files were retrieved from the hospital patients database using the ICD codes (I60-64, I67-69). In total, 5289 files were accessed. The age, sex, hypertension diagnosis, treatment compliance, the frequency of blood pressure measurements, and the presence of hypertensive crisis during admission were evaluated. Compliance with drug treatment and blood pressure monitoring was directly asked to patients, and when this was not possible, such as in patients with aphasia or coma, questions were asked to their relatives.
Results
In this study, 478 files (female: male, 201 (42.1%):277 (57.9%)) with complete data were included. Among the patients, 76.3% had a good to very good treatment compliance and 29.8% had a good to very good frequency of blood pressure measurement. During admission, 23% of patients were in hypertensive crisis.
Discussion
In patients with poor drug compliance and who did not have their blood pressure regularly measured, hypertensive crises occurred significantly more often. Strict blood pressure monitoring and regular doctor follow-ups are neglected by patients.
Conclusion
Drug compliance is insufficient to prevent stroke and blood pressure monitoring and follow-ups are also important points to consider.

Anahtar Kelimeler

Blood pressure, Hypertension, Patient compliance, Stroke

Etik Beyan

Authors declared no conflict of interest and no funding.

Hipertansiyonlu İnmeli Hastalarda Antihipertansif Tedavi Uyumu

Öz

Amaç
İnme, dünya çapında tüm yıllık ölümlerin yaklaşık 6 milyonundan sorumludur. İnmeyi ve eşlik eden hastalıklarını önlemenin en etkili yöntemi, risk faktörlerinin yeterli şekilde kontrol altına alınmasıdır. Bu çalışmada, inme hastalarının antihipertansif tedaviye uyumunu ve kan basıncı ölçüm sıklığını değerlendirmeyi amaçladık.
Gereç ve yöntem
Hasta dosyaları, hastane veri tabanından ICD kodları (I60-64, I67-69) kullanılarak toplam 5289 dosyaya erişildi. Bu dosyalardan yaş, cinsiyet, hipertansiyon tanısı, tedavi uyumu, kan basıncı ölçüm sıklığı ve başvuru sırasında hipertansif kriz varlığı bilgileri değerlendirildi. İlaç tedavisine uyum ve kan basıncı takibine ilişkin veriler epikrizlerden retrospektif olarak incelenerek doğrudan hasta veya yakınlarından alındığı takdirde kabul edildi.
Bulgular
Bu çalışmaya, verileri eksiksiz olan 478 dosya (kadın: erkek, 201 (%42,1):277 (%57,9)) dahil edildi. Hastaların %76,3'ü iyi-çok iyi tedavi uyumuna ve %29,8'i iyi-çok iyi tansiyon ölçüm sıklığına sahipti. Başvuru sırasında hastaların %23'ü hipertansif krizdeydi.
Tartışma
İlaç uyumsuzluğu olan ve kan basıncı düzenli olarak ölçülmeyen hastalarda, hipertansif krizler önemli ölçüde daha sık meydana geldiği gözlendi. Sıkı tansiyon takibi ve düzenli doktor takipleri hastalar tarafından ihmal edilmektedir. Sonuç
İlaç uyumu inmeyi önlemede yetersiz olarak görülmüş olup tansiyon takibi ve hastaların kontrolleri de dikkat edilmesi gereken önemli noktalardır.

Anahtar Kelimeler

Kan basıncı, Hipertansiyon, Hasta uyumu, İnme

Kaynakça

• 1. GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990- 2019: a systematic analysis for the Global Burden of Disease Study 2019 [published correction appears in Lancet. 2020 Nov 14;396(10262):1562]. Lancet 2020;396(10258):1204-1222. doi:10.1016/S0140-6736(20)30925-9
• 2. Goldstein, L. B., Adams, R., Alberts, M. J., Appel, L. J., Brass, L. M., Bushnell, C. D. et al. Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council: cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2006;113:e873– e923.
• 3. Mennini, F. S., Marcellusi, A., von der Schulenburg, J. M., Gray, A., Levy, P., Sciattella, P et al. Cost of poor adherence to anti- hypertensive therapy in five European countries. Eur. J. Health Econ 2015;16:65–72. doi:10.1007/s10198-013-0554-4
• 4. Kung HC, Xu J. Hypertension-related Mortality in the United States, 2000-2013. NCHS Data Brief. 2015;(193):1-8
• 5. Mazzaglia, G., Ambrosioni, E., Alacqua, M., Filippi, A., Sessa, E., Immordino, Vet al. Adherence to antihypertensive medications and cardiovascular morbidity among newly diagnosed hypertensive patients. Circulation 2009;120:1598–605. doi: 10.1161/ CIRCULATIONAHA.108.830299.
• 6. Kettani, F. Z., Dragomir, A., Côté, R., Roy, L., Bérard, A., Blais, Let al. Impact of a better adherence to antihypertensive agents on cerebrovascular disease for primary prevention. Stroke 2009;40:213–20. doi: 10.1161/STROKEAHA.108.522193
• 7. James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison- Himmelfarb, C., Handler et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014;311:507–20. doi: 10.1001/ jama.2013.284427
• 8. Whitworth JA. World Health Organization, International Society of Hypertension Writing Group. 2003 World Health Organization (WHO)/International Society of hypertension (ISH) statement on management of hypertension. J Hypertens 2003;21:1983–92. doi: 10.1097/00004872-200311000-00002.
• 9. Bramley TJ, Gerbino PP, Nightengale BS, Feride Frech-Tamas. Relationship of blood pressure control to adherence with antihypertensive monotherapy in 13 managed care organizations. J Manag Care Pharm. 2006;12:239 –45. doi: 10.18553/ jmcp.2006.12.3.239.
• 10. Sokol MC, McGuigan KA, Verbrugge RR, Robert S Epstein. Impact of medication adherence on hospitalization risk and healthcare cost. Med Care. 2005;43:521–30. doi: 10.1097/01. mlr.0000163641.86870.af.
• 11. Herttua K, Tabák AG, Martikainen P, Jussi Vahtera, Mika Kivimäki. Adherence to antihypertensive therapy prior to the first presentation of stroke in hypertensive adults: population-based study. Eur Heart J 2013;34:2933–9 . doi: 10.1093/eurheartj/ eht219. Epub 2013 Jul 16.
• 12. Wu, P. H., Yang, C. Y., Yao, Z. L., Lin, W. Z., Wu, L. W., Chang, C. C. Relationship of blood pressure control and hospitalization risk to medication adherence among patients with hypertension in Taiwan. Am J Hypertens 2010;23:155–60. doi: 10.1038/ ajh.2009.210. Epub 2009 Nov 19
• 13. Degli Esposti, L., Saragoni, S., Benemei, S., Batacchi, P., Geppetti, P., Di Bari, M. et al. Adherence to antihypertensive medications and health outcomes among newly treated hypertensive patients. Clinicoecon Outcomes Res 2011;3:47–54. doi: 10.2147/CEOR.S15619. Epub 2011 Mar 7
• 14. Shin, S., Song, H., Oh, S. K., Choi, K. E., Kim, H., Jang, S. Effect of antihypertensive medication adherence on hospitalization for cardiovascular disease and mortality in hypertensive patients. Hypertens Res 2013;36:1000–5. doi: 10.1038/hr.2013.85. Epub 92 2013 Aug 22.
• 15. Bailey, J. E., Wan, J. Y., Tang, J., Ghani, M. A., Cushman, W. C. Antihypertensive medication adherence, ambulatory visits, and risk of stroke and death. J Gen Intern Med 2010;25:495–503. doi: 10.1007/s11606-009-1240-1
• 16. Lee HJ, Jang S-I, Park E-C. Effect of adherence to antihypertensive medication on stroke incidence in patients with hypertension: a population-based retrospective cohort study. BMJ Open 2017;7:e014486. doi: 10.1136/bmjopen-2016-014486.
• 17. Xu, T., Yu, X., Ou, S., Liu, X., Yuan, J., Tan, X. et al. Adherence to Antihypertensive Medications and Stroke Risk: A Dose-Response Meta-Analysis. J Am Heart Assoc. 2017;6(7):e006371 doi: 10.1161/JAHA.117.006371.
• 18. Herttua, K., Martikainen, P., Batty, G. D., Kivimäki, M. Poor adherence to statin and antihypertensive therapies as risk factors for fatal stroke. J Am Coll Cardiol. 2016;67:1507-15. doi: 10.1016/j. jacc.2016.01.044
• 19. Krousel-Wood, M., Holt, E., Joyce, C., Ruiz, R., Dornelles, A., Webber, L. S. et al. Differences in cardiovascular disease risk of medication adherence among older adults (cosmo). J Hypertens. 2015;33:412-20 doi:10.1097/HJH.0000000000000382
• 20. Pittman, D. G., Tao, Z., Chen, W., Stettin, G. D. Antihypertensive medication adherence and subsequent healthcare utilization and costs. Am J Manag Care 2010;16:568–76.
• 21. Abegaz, T. M., Shehab, A., Gebreyohannes, E. A., Bhagavathula, A. S., Elnour, A. A. Nonadherence to antihypertensive drugs: A systematic review and meta-analysis. Medicine (Baltimore). 2017 Jan;96(4):e5641. doi: 10.1097/MD.0000000000005641.
• 22. Egan BM. Treatment resistant hypertension. Ethn Dis 2015;25: 495–8. doi:10.18865/ed.25.4.495
• 23. Blaschke, T. F., Osterberg, L., Vrijens, B., Urquhart, J. Adherence to medications: insights arising from studies on the unreliable link between prescribed and actual drug dosing histories. Annu. Rev. Pharmacol. Toxicol. 2012;52:275–301. doi:10.1146/annurev- pharmtox-011711-113247
• 24. Ettehad, D., Emdin, C. A., Kiran, A., Anderson, S. G., Callender, T., Emberson, J. et al. Blood pressure lowering for prevention of cardiovascular diseases and death: a systematic review and meta-analysis. Lancet 2016;387:957–67. doi:10.1016/S0140- 6736(15)01225-8
• 25. Bruno, A., Muppa, J., & Cabahug, I. N. K.. Pre-stroke Adherence to Hypertension Medications in a Bi-racial United States Stroke Belt. High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension 2023;30(4):333–6. doi:10.1007/s40292-023-00581-6
• 26. Bawand, R., Ghiasian, M., Khazaei, M., Samadyan, M., & Moradi, A.. Effects of blood pressure unawareness and poor adherence to antihypertensive drugs on outcomes of cerebrovascular accidents among patients with their first-ever stroke. Journal of hypertension 2023;41(3):459–69. doi:10.1097/ HJH.0000000000003358