The drug adherence and lifestyle factors that contribute to blood pressure control among hypertensive patients

Abstract

Objectives: To investigate drug adherence and lifestyle behaviors affecting the blood pressure (BP) control among hypertensive patients that have uncontrolled and controlled BP.

Methods: Seventy-eight uncontrolled BP and 98 controlled BP hypertensive patients matched on age, gender, time since hypertension diagnosis and the number of antihypertensive drugs used were investigated using a standardized questionnaire to evaluate lifestyle behaviors, drug adherence, the use of complementary and alternative medicine, and health related quality of life. Drug-drug interactions were evaluated with an electronic drug reference software.

Results: Not taking therapy when feeling better was observed significantly more frequently in the uncontrolled hypertensive group (OR: 0.297, %95 CI: 0.115-0.770). Uncontrolled BP hypertensive patients live more frequently in extended family settings (p = 0.043), they sleep less controlled BP hypertensive patients (OR: 0.749, %95 CI: 0.605-0.929). The groups did not differ statistically in terms of Complementary and Alternative Medicine (CAM) use (p = 0.795) and informing doctors about the use of CAMs (p = 0.910). The EuroQol five-dimensional 3 level (EQ5D3L) questionnaire Visual Analogue Scale (VAS) score was significantly higher in the control group (p = 0.011). In both groups over 70% of patients should be monitored for therapy due to drug interactions evaluation.

Conclusions: Our study shows that increasing the drug adherence and sleeping hours and living in the nuclear family is associated with improvement in blood pressure control and health related quality of life. A comprehensive approach and good patient-physician communication and trust are essential for well-managed hypertension.

Keywords

• Hypertension,drug adherence,drug interaction

References

1. [1] World Health Organisation-International Society of Hypertension WHO-ISH statement on management of hypertension. J Hypertens 2003;21:1983-92.
2. [2] Wolf-Maier K, Cooper RS, Kramer H, Banegas JR, Giampaoli S, Joffres MR, et al. Hypertension treatment and control in five European countries,Canada, and the United States. Hypertension 2004;43:10-17.
3. [3] Kearney PM, Whelton M, Reynolds K, Whelton PK, He J. Worldwide prevalence of hypertension: a systematic review. J Hypertens 2004;22:11-9.
4. [4] Abaci A, Oguz A, Kozan O, Toprak N, Senocak H, Deger N, et al. Treatment and control of hypertension in Turkish population: a survey on high blood pressure in primary care (the TURKSAHA study). J Hum Hyperten 2006;20:355-61.
5. [5] Altun B, Arici M, Nergizoğlu G, Derici U, Karatan O, Turgan C, et al. Prevalence, awareness, treatment and control of hypertension inTurkey (the PatenT study) in 2003. J Hypertens 2005;23:1817-23.
6. [6] Mancia, G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, et al. 2013 Practice guidelines for the management of arterialhypertension of the European Society of Hypertension (ESH) and the European Society ofCardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens 2013;31:1925-38.
7. [7] Yiannakopoulou ECh, Papadopulos JS, Cokkinos DV, Mountokalakis TD. Adherence to antihypertensive treatment: a critical factor for blood pressure control. Eur J Cardiovasc Prev Rehabil 2005;12:243-9.
8. [8] Serour M, Alqhenaei H, Al-Saqabi S, Mustafa AR, Ben-Nakhi A. Cultural factors and patients' adherence to lifestyle measures. Br J Gen Pract 2007;57:291-5.

9. [9] Shafiq N, Gupta M, Kumari S, Pandhi P. Prevalence and pattern of use of complementary and alternative medicine (CAM) in hypertensive patients of a tertiary care center in India. Int J Clin Pharmacol Ther 2003;41:294-8.
10. [10] Tan M, Uzun O, Akçay F. Trends in complementary and alternative medicine in Eastern Turkey. J Altern Complement Med 2004;10:861-5.
11. [11] Carter BL, Lund BC, Hayase N, Chrischilles E. The extent of potential antihypertensive drug interactions in aMedicaid population. Am J Hypertens 2002;15:953-7.
12. [12] Mena-Martin FJ, Martin-Escudero JC, Simal-Blanco F, Carretero-Ares JL, Arzua-Mouronte D, Herreros-Fernandez V. Health-related quality of life of subjects with known andunknown hypertension: results from the population-based Hortega study. J Hypertens 2003;21:1283-9.
13. [13] Trevisol DJ, Moreira LB, Kerkhoff A, Fuchs SC, Fuchs FD. Health-related quality of life and hypertension: a systematic review and meta-analysis of observational studies. J Hypertens 2011;29:179-88.
14. [14] Bardage C, Isacson DG. Hypertension and health-related quality of life: an epidemiological study in Sweden. J Clin Epidemiol 2001;54: 172-81.
15. [15] EuroQol Group. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy 1990;16:199-208.
16. [16] Eser E, Dinç G, Cambaz S. EURO-QoL (EQ-5D) indeksinin toplum standartları ve psikometrik özellikleri: Manisa kent toplumu örneklemi. 2. Sağlıkta Yaşam Kalitesi Kongresi; İzmir, 2007.
17. [17] Ogedegbe G, Harrison M, Robbins L, Mancuso CA, Allegrante JP. Barriers and facilitators of medication adherence in hypertensive African Americans: a qualitative study. Ethn Dis 2003;14:3-12.
18. [18] Sengul S, Akpolat T, Erdem Y, Derici U, Arici M, Sindel S, et al. Changes in hypertension prevalence, awareness, treatment, and control rates in Turkey from 2003 to 2012. J Hypertens 2016;34:1208-17.
19. [19] Baltaci D, Erbilen E, Turker Y, Alemdar R, Aydin M, Kaya A. Predictors of hypertension control in Turkey: the MELEN study. Eur Rev Med Pharmacol Sci 2013;17:1884-8.
20. [20] Wai KC, Elley CR, Nosa V, Kennelly J, Mabotuwana T, Warren J. Perspectives on adherence to blood pressure-lowering medications among samoan patients: qualitative interviews. J Prim Health Care 2010;2:217-24.
21. [21] Karakaş S, Yılmaz Karabulutlu E, Çevik Akyıl R, Erdem N, Bahçecioğlu Turan G. [Investigatıng alexithymıa and social support in patients with hypertension and asthma]. Psikiyatri Hemşireliği Dergisi 2016;7:68-74. [Article in Turkish]
22. [22] Turagabeci AR, Nakamura K, Kizuki M, Takano T. Family structure and health, how companionship acts as a buffer against ill health. Health Qual Life Outcomes 2007;5:61.
23. [23] Sekuri C, Eser E, Akpınar G, Çakır H, Sıttı İ, Gulomur G, et al. Cardiovascular disease risk factors in post-menopausal women in West Anatolia. Jpn Heart J 2004;45:119-31.
24. [24] Pan A, De Silva DA, Yuan JM, Koh WP. Sleep duration and risk of stroke mortality among Chinese adults. Stroke 2014;45:1620-5.
25. [25] Bal C, Öztürk A, Çiçek B, Özdemir A, Zararsız G, Ünalan D, et al. The relationship between blood pressure and sleep duration in Turkish children: a cross-secretional study. J Clin Res Pediatr Endocrinol 2018;10:51-8.
26. [26] Haack M, Serrador J, Cohen D, Simpson N, Meier-Ewert H, Mullington JM. Increasing sleep duration to lower beat‐to‐beat blood pressure: apilot study. J Sleep Res 2013;22:295-304.
27. [27] Bacic-Vrca V, Marusic S, Erdeljic V, Falamic S, Gojo-Tomic N, Rahelic D. The incidence of potential drug-drug interactions in elderly patients with arterial hypertension. Pharm World Sci 2010;32:815-21.
28. [28] Appel LJ, Champagne CM, Harsha DW, Cooper LS, Obarzanek E, Elmer PJ, et al. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA 2003;289:2083-93.
29. [29] Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 2007;39:1423-34.
30. [30] Stranges S, Wu T, Dorn JM, Freudenheim JL, Muti P, Farinaro E, et al. Relationship of alcohol drinking pattern to risk of hypertension: a population-based study. Hypertension 2004;44:813-9.
31. [31] Onat A, Hergenc G, Dursunoglu D, Ordu S, Can G, Bulur S, et al. Associations of alcohol consumption with blood pressure, lipoproteins, and subclinical inflammation among Turks. Alcohol 2008;42:593-601.
32. [32] Neuhouser ML, Miller DL, Kristal AR, Barnett MJ, Cheskin LJ. Diet and exercise habits of patients with diabetes, dyslipidemia, cardiovascular disease or hypertension. J Am Coll Nutr 2002;21:394-401.
33. [33] Forslund HB, Torgerson JS, Sjöström L, Lindroos AK. Snacking frequency in relation to energy intake and foodchoices in obese men and women compared to a reference population. Int J Obes (Lond) 2005;29:711-9.
34. [34] Ucan O, Ovayolu N. Relationship between diabetes mellitus, hypertension and obesity, and health‐related quality of life in Gaziantep, a central south‐eastern city in Turkey. J Clin Nurs 2010;19:2511-19.
35. [35] Wiklund I, Halling K, Rydén-Bergsten T, Fletcher A. Does lowering the blood pressure improve the mood? Quality-of-life results from the Hypertension Optimal Treatment (HOT) study. Blood Press 1997;6:357-64.
36. [36] Roca-Cusachs A, Dalfó A, Badia X, Arístegui I, Roset M. Relation between clinical and therapeutic variables andquality of life in hypertension. J Hypertens 2001;19:1913-19.