Kronik Hastalıklarda Aile Katılımı: Hipertansiyon Yönetimi Üzerine Bir Derleme

Öz

Kronik hastalıkların yönetimi çok boyutlu bütüncül bir yaklaşım gerektirmektedir. Kronik hastalık yönetim süreci çoğu zaman hasta bireyin tek başına üstesinden gelmekte zorlanabileceği çeşitli güçlükleri beraberinde getirmektedir. Kronik hastalık yönetim sürecinde hastalar profesyonel sağlık sistemlerinin sunduğu hizmetten daha fazla desteğe ihtiyaç duyarlar. Hastalar ihtiyaç duyduğu bu desteği genellikle beraber yaşadığı aile üyelerinden beklemektedirler. 2025 yılının Türkiye'de “Aile Yılı” olarak ilan edilmiş olması bağlamında, bu çalışmanın aile temelli sağlık yaklaşımlarına dikkat çekmesi ve aile sağlığının güçlendirilmesine yönelik farkındalığı artırması amaçlanmaktadır. Bu derleme çalışmasında, kronik bir hastalık olan hipertansiyon yönetiminde hipertansiyon hastası ile aynı sosyal ağ içerisinde bulunan aile bireylerinin rolü güncel ulusal, uluslararası kılavuzlar ve literatürdeki bilimsel veriler doğrultusunda ele alınmıştır. Bu doğrultuda aile bireylerinin; yaşam tarzı değişikliklerinin desteklenmesi, ofis dışı kan basıncı izleminin etkin bir biçimde yürütülmesi, etkili iletişim ortamlarının sağlanması ve hastalık farkındalığının artırılması gibi alanlarda katkı sunduğu görülmektedir. Söz konusu katkılar, hipertansiyon yönetiminde klinik sonuçların iyileştirilmesine hizmet etmekte; aile temelli bakım modellerinin bu süreçte tamamlayıcı ve güçlendirici bir rol üstlendiğini ortaya koymaktadır.

Anahtar Kelimeler

• Aile desteği
• hipertansiyon
• kronik hastalık

Family Involvement in Chronic Diseases: A Review on Hypertension Management

Öz

The management of chronic diseases requires a multidimensional and holistic approach. The chronic disease management process often entails the various challenges that patients may struggle to overcome on their own. During this process, patients frequently require support that goes beyond the services provided by professional healthcare systems. Patients often seek the support they need from family members with whom they live. In the context of 2025 being declared the "Year of the Family" in Türkiye, this review aims to emphasise family-centered health approaches and to raise awareness about the strengthening of family health. This review examines the role of family members, who share the same social network as individuals diagnosed with hypertension, a common chronic disease, considering current national and international guidelines and scientific evidence from the literature. Accordingly, family members are seen to contribute to various aspects of hypertension management, including supporting lifestyle modifications, facilitating out-of-office blood pressure monitoring, fostering effective communication environments, and enhancing disease awareness. These contributions serve to improve clinical outcomes in the hypertension management, revealing that family-based care models play a complementary and empowering role in this process

Anahtar Kelimeler

• Family support
• hypertension
• chronic disease

Kaynakça

1. McEvoy JW, McCarthy CP, Bruno RM, Brouwers S, Canavan MD, Ceconi C, et al; ESC Scientific Document Group. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. Eur Heart J. 2024;45(38):3912-4018. DOI: 10.1093/eurheartj/ehae178.
2. Chacko S, Jeemon P. Role of family support and self-care practices in blood pressure control in individuals with hypertension: results from a cross-sectional study in Kollam District, Kerala. Wellcome Open Res. 2020 Jul 28;5:180. DOI: 10.12688/wellcomeopenres.16146.1. PMID: 33305010; PMCID: PMC7713892.
3. Settineri S, Frisone F, Merlo EM, Geraci D, Martino G. Compliance, adherence, concordance, empowerment, and self-management: five words to manifest a relational maladjustment in diabetes. J Multidiscip Healthc. 2019 Apr 29;12:299-314. DOI: 10.2147/JMDH.S193752. PMID: 31118655; PMCID: PMC6499139.
4. Olalemi OE, Muyibi SA, Ladipo MM. Perceived family support and medication adherence amongst hypertensive outpatients in a tertiary hospital, Ibadan, Nigeria. West Afr J Med. 2020 Oct;37(5):481-9. PMID: 33058123.
5. Ojo OS, Malomo SO, Sogunle PT. Blood pressure (BP) control and perceived family support in patients with essential hypertension seen at a primary care clinic in Western Nigeria. J Family Med Prim Care. 2016 Jul-Sep;5(3):569-75. DOI: 10.4103/2249-4863.197284. PMID: 28217585; PMCID: PMC5290762.
6. Olowookere A, Olowookere S, Talabi A, Etonyeaku A, Adeleke O, Akinboboye O. Perceived family support and factors influencing medication adherence among hypertensive patients attending a Nigerian tertiary hospital. Ann Trop Med Public Health. 2015 Nov-Dec 2015;8(6):241-5.
7. Türkiye Kardiyoloji Derneği. Arteriyel hipertansiyon tanı ve tedavi kılavuzu [Internet]. İstanbul: Türkiye Kardiyoloji Derneği; [cited 2025 May 14]. Available from: https://tkd.org.tr/kilavuz/k03.htm
8. Türkiye Endokrinoloji ve Metabolizma Derneği. Hipertansiyon tanı ve tedavi kılavuzu 2022 [Internet]. Ankara: Türkiye Endokrinoloji ve Metabolizma Derneği; 2022 [cited 2025 May 14]. Available from: https://file.temd.org.tr/Uploads/publications/guides/documents/Hipertansiyon-Kilavuzu-2022.pdf

9. Lechner K, Schunkert H. Recommendations on sodium intake for cardiovascular health: conviction or evidence? Eur Heart J. 2020 Sep 14;41(35):3374-5. DOI: 10.1093/eurheartj/ehaa545. PMID: 32710121.
10. O'Donnell M, Mente A, Alderman MH, Brady AJB, Diaz R, Gupta R, et al. Salt and cardiovascular disease: insufficient evidence to recommend low sodium intake. Eur Heart J. 2020 Sep 14;41(35):3363-73. DOI: 10.1093/eurheartj/ehaa586. PMID: 33011774.
11. He J, Gu D, Chen J, Jaquish CE, Rao DC, Hixson JE, et al. Gender difference in blood pressure responses to dietary sodium intervention in the GenSalt study. J Hypertens. 2009;27(1):48-54. DOI: 10.1097/hjh.0b013e328316bb87.
12. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. N Engl J Med. 2001;344(1):3-10. DOI: 10.1056/NEJM200101043440101.
13. Neal B, Wu Y, Feng X, Zhang R, Zhang Y, Shi J, et al. Effect of salt substitution on cardiovascular events and death. N Engl J Med. 2021 Sep 16;385(12):1067-77. DOI: 10.1056/NEJMoa2105675. Epub 2021 Aug 29. PMID: 34459569.
14. Mente A, O'Donnell M, Rangarajan S, McQueen M, Dagenais G, Wielgosz A, et al. Urinary sodium excretion, blood pressure, cardiovascular disease, and mortality: a community-level prospective epidemiological cohort study. Lancet. 2018 Aug 11;392(10146):496-506. DOI: 10.1016/S0140-6736(18)31376-X. Epub 2018 Aug 9. PMID: 30129465.
15. Yuan Y, Jin A, Neal B, Feng X, Qiao Q, Wang H, et al. Salt substitution and salt-supply restriction for lowering blood pressure in elderly care facilities: a cluster-randomized trial. Nat Med. 2023 Apr;29(4):973-81. DOI: 10.1038/s41591-023-02286-8. Epub 2023 Apr 13. PMID: 37055566.
16. Aburto NJ, Hanson S, Gutierrez H, Hooper L, Elliott P, Cappuccio FP. Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses. BMJ. 2013 Apr 3;346:f1378. DOI: 10.1136/bmj.f1378. PMID: 23558164; PMCID: PMC4816263.
17. O'Donnell M, Mente A, Rangarajan S, McQueen MJ, Wang X, Liu L, et al. Urinary sodium and potassium excretion, mortality, and cardiovascular events. N Engl J Med. 2014;371(7):612-23. DOI: 10.1056/NEJMoa1311889.
18. Wouda RD, Boekholdt SM, Khaw KT, Wareham NJ, de Borst MH, Hoorn EJ, et al. Sex-specific associations between potassium intake, blood pressure, and cardiovascular outcomes: the EPIC-Norfolk study. Eur Heart J. 2022 Aug 7;43(30):2867-75. DOI: 10.1093/eurheartj/ehac313. PMID: 35863377; PMCID: PMC9356908.
19. O'Donnell M, Yusuf S, Vogt L, Mente A, Messerli FH. Potassium intake: the Cinderella electrolyte. Eur Heart J. 2023 Dec 14;44(47):4925-34. DOI: 10.1093/eurheartj/ehad628. PMID: 37936275.
20. Kidney Disease Outcomes Quality Initiative (K/DOQI). K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis. 2004 May;43(5 Suppl 1):S1-290. PMID: 15114537.
21. Shah SA, Chu BW, Lacey CS, Riddock IC, Lee M, Dargush AE. Impact of acute energy drink consumption on blood pressure parameters: a meta-analysis. Ann Pharmacother. 2016 Oct;50(10):808-15. DOI: 10.1177/1060028016656433. Epub 2016 Jun 23. PMID: 27340146.
22. Shah SA, Szeto AH, Farewell R, Shek A, Fan D, Quach KN, et al. Impact of high volume energy drink consumption on electrocardiographic and blood pressure parameters: a randomized trial. J Am Heart Assoc. 2019 Jun 4;8(11):e011318. DOI: 10.1161/JAHA.118.011318. Epub 2019 May 29. PMID: 31137991; PMCID: PMC6585360.
23. Neter JE, Stam BE, Kok FJ, Grobbee DE, Geleijnse JM. Influence of weight reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension. 2003 Nov;42(5):878-84. DOI: 10.1161/01.HYP.0000094221.86888.AE. Epub 2003 Sep 15. PMID: 12975389.
24. Hanssen H, Boardman H, Deiseroth A, Moholdt T, Simonenko M, Kränkel N, et al. Personalized exercise prescription in the prevention and treatment of arterial hypertension: a Consensus Document from the European Association of Preventive Cardiology (EAPC) and the ESC Council on Hypertension. Eur J Prev Cardiol. 2022 Feb 19;29(1):205-15. DOI: 10.1093/eurjpc/zwaa141. PMID: 33758927.
25. Rossi A, Dikareva A, Bacon SL, Daskalopoulou SS. The impact of physical activity on mortality in patients with high blood pressure: a systematic review. J Hypertens. 2012 Jul;30(7):1277-88. DOI: 10.1097/HJH.0b013e3283544669. PMID: 22573122.
26. Santa-Rosa FA, Shimojo GL, Dias DS, Viana A, Lanza FC, Irigoyen MC, et al. Impact of an active lifestyle on heart rate variability and oxidative stress markers in offspring of hypertensives. Sci Rep. 2020 Jul 24;10(1):12439. DOI: 10.1038/s41598-020-69104-w. PMID: 32709890; PMCID: PMC7382460.
27. Susanto T, Hernawati S, Yunanto RA, Rahmawati I, Laras Ati NA, Fauziah W. Family self-management program for hypertension management and sodium consumption adherence: a parallel randomized control trial among family caregivers and people with hypertension. J Res Health Sci. 2024 Sep 30;24(4):e00628. DOI: 10.34172/jrhs.2024.163. Epub 2024 Sep 30. PMID: 39431653; PMCID: PMC11492525.
28. Shariful Islam M, Fardousi A, Sizear MI, Rabbani MG, Islam R, Saif-Ur-Rahman KM. Effect of leisure-time physical activity on blood pressure in people with hypertension: a systematic review and meta-analysis. Sci Rep. 2023 Jun 30;13(1):10639. DOI: 10.1038/s41598-023-37149-2. PMID: 37391436; PMCID: PMC10313796.
29. Diaz KM, Shimbo D. Physical activity and the prevention of hypertension. Curr Hypertens Rep. 2013 Dec;15(6):659-68. DOI: 10.1007/s11906-013-0386-8. PMID: 24052212; PMCID: PMC3901083.
30. Kang HW, Park M, Wallace Hernandez JP. The impact of perceived social support, loneliness, and physical activity on quality of life in South Korean older adults. J Sport Health Sci. 2018 Apr;7(2):237-44. DOI: 10.1016/j.jshs.2016.05.003. Epub 2016 May 11. PMID: 30356448; PMCID: PMC6180534.
31. Hodgkinson JA, Lee MM, Milner S, Bradburn P, Stevens R, Hobbs FR, et al. Accuracy of blood-pressure monitors owned by patients with hypertension (ACCU-RATE study): a cross-sectional, observational study in central England. Br J Gen Pract. 2020 Jul 30;70(697):e548-e554. DOI: 10.3399/bjgp20X710381. PMID: 32482629; PMCID: PMC7274541.
32. O'Kane C, Irwin JD, Morrow D, Tang L, Wong S, Buchholz AC, et al. Motivational interviewing with families in the home environment. Patient Educ Couns. 2019;102(11):2073-80. DOI: 10.1016/j.pec.2019.06.002.
33. Erikmen E, Keskin G. Kronik hastalığı olan bireylerin tedaviye uyum sürecinde aile faktörü: motivasyonel görüşmenin etkileri açısından gözden geçirme. Gümüşhane Sağlık Bilimleri Dergisi. 2022 Aralık;11(4):1392-400. DOI:10.37989/gumussagbil.945568
34. Rosland AM, Piette JD. Emerging models for mobilizing family support for chronic disease management: a structured review. Chronic Illn. 2010 Mar;6(1):7-21. DOI: 10.1177/1742395309352254. PMID: 20308347; PMCID: PMC4349200.
35. Burnier M, Egan BM. Adherence in hypertension. Circ Res. 2019 Mar 29;124(7):1124-40. DOI: 10.1161/CIRCRESAHA.118.313220. PMID: 30920917.
36. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71(19). DOI: 10.1016/j.jacc.2017.11.006.
37. Manangkot MV, Saputra IK, Suindrayasa IM. Family's knowledge, attitude, and behavior in supporting self-care management of hypertensive patients of community health care centers in Denpasar. Enferm Clin. 2020 Dec ;30(Suppl 2):78-81.
38. Maluwa C, Kapira S, Chuljerm H, Parklak W, Kulprachakarn K. Determinants of hypertension-related knowledge, attitude, and practices (KAP) among caregivers in Neno, rural Malawi: A cross-sectional study. Heliyon. 2024 Dec 27;11(1):e41546. DOI: 10.1016/j.heliyon.2024.e41546. PMID: 39844981; PMCID: PMC11750534.
39. Tanrıverdi G. Suggestion of a new nursing model: Model of cultural competence focused on the environment; Hemşirelikte yeni bir model önerisi: Çevre odaklı kültürel yeterlilik modeli. J Hum Sci. 2017;14:4658-70.
40. Önen C, Güneş G. Relationship between regional food and hypertension in the East of Turkey. Int J Community Med Public Health. 2019;6(6):2306-12. DOI:10.18203/2394-6040.ijcmph20192289
41. Daştan İ, Erem A, Çetinkaya V. Urban and rural differences in hypertension risk factors in Turkey. Anatol J Cardiol. 2017 Jul;18(1):39-47. DOI: 10.14744/AnatolJCardiol.2017.7452. Epub 2017 Apr 19. PMID: 28430114; PMCID: PMC5512197.
42. Al-Jafar R, Zografou Themeli M, Zaman S, Akbar S, Lhoste V, Khamliche A, et al. Effect of religious fasting in Ramadan on blood pressure: results from LORANS (London Ramadan Study) and a meta-analysis. J Am Heart Assoc. 2021;10(20). DOI: 10.1161/JAHA.120.021560.
43. Kord-Varkaneh H, Nazary-Vannani A, Mokhtari Z, Salehi-Sahlabadi A, Rahmani J, Clark CCT, et al. The influence of fasting and energy restricting diets on blood pressure in humans: a systematic review and meta-analysis. High Blood Press Cardiovasc Prev. 2020;27(4):271-80. DOI: 10.1007/s40292-020-00391-0.
44. Schutte AE, Srinivasapura Venkateshmurthy N, Mohan S, Prabhakaran D. Hypertension in low- and middle-income countries. Circ Res. 2021 Apr 2;128(7):808-26. DOI: 10.1161/CIRCRESAHA.120.318729. Epub 2021 Apr 1. PMID: 33793340; PMCID: PMC8091106.
45. Irazola VE, Gutierrez L, Bloomfield G, Carrillo-Larco RM, Dorairaj P, Gaziano T, et al. Hypertension prevalence, awareness, treatment, and control in selected LMIC communities: results from the NHLBI/UHG Network of Centers of Excellence for Chronic Diseases. Glob Heart. 2016;11(1):47-59. DOI: 10.1016/j.gheart.2015.12.008.