Perception of risk of hypertension related complications and adherence to antihypertensive drugs: a primary healthcare based cross-sectional study

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Abstract

Background

Blood pressure control is suboptimal in more than half of treated hypertensive patients. The purpose of this study was to assess perceived risk of high blood pressure sequelae and adherence to medications in known cases of hypertension.

Methods

A cross-sectional study was designed using a sample of 600 hypertensive patients who were randomly selected from 32 primary healthcare centers in Shiraz, Iran. A structured interviewer-administered questionnaire was used to collect data. Participants were asked about their basic demographic information, smoking history, access to healthcare services, duration of antihypertensive therapy, number of drugs taken concurrently and their perceived risk of hypertension-related complications. The outcome of interest was adherence to antihypertensive medications measured by the Persian version of the Morisky Medication Adherence Scale (MMAS-8). Multivariate logistic regression analysis was used to identify independent factors associated with better adherence.

Results

Nearly half (48.8%) of participants had uncontrolled hypertension. Just over one fifth (22.3%) of all the patients reported high adherence to antihypertensive medications. Independent factors associated with better adherence to antihypertensive medications were higher educational level (OR: 1.71, CI 95%: 1.06–2.75), being a never smoker (OR: 1.62, CI 95%: 1.06–2.46), having easy access to healthcare services (OR: 1.91, CI 95%: 1.10–3.35), lower mean treatment duration (OR: 0.96, CI 95%: 0.92–0.99), and having higher perceived risk of hypertension-related complications (OR:2.34, CI 95%: 1.52–3.60).

Conclusion

High perceived risk of hypertension-related complications is significantly associated with adherence to antihypertensive therapy. Our findings suggest that primary care physicians should regularly emphasize on negative consequences of uncontrolled/poorly controlled blood pressure while visiting hypertensive patients.

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Most cited references 29

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The global epidemiology of hypertension

Katherine T. Mills, Andrei Stefanescu, Jiang Ping He (2020)

Hypertension is the leading cause of cardiovascular disease and premature death worldwide. Owing to widespread use of antihypertensive medications, global mean blood pressure (BP) has remained constant or decreased slightly over the past four decades. By contrast, the prevalence of hypertension has increased, especially in low and middle-income countries (LMICs). Estimates suggest that in 2010, 31.1% of adults (1.39 billion) worldwide had hypertension. The prevalence of hypertension among adults was higher in LMICs (31.5%, 1.04 billion people) than in high-income countries (HICs; 28.5%, 349 million people). Variations in the levels of risk factors for hypertension, such as high sodium intake, low potassium intake, obesity, alcohol consumption, physical inactivity and unhealthy diet, may explain some of the regional heterogeneity in hypertension prevalence. Despite the increasing prevalence, the proportions of hypertension awareness, treatment and BP control are low, particularly in LMICs, and few comprehensive assessments of the economic impact of hypertension exist. Future studies are warranted to test implementation strategies for hypertension prevention and control, especially in low-income populations, and to accurately assess the prevalence and financial burden of hypertension worldwide.

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Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants

José Huerta, Kim Overvad (2017)

Summary Background Raised blood pressure is an important risk factor for cardiovascular diseases and chronic kidney disease. We estimated worldwide trends in mean systolic and mean diastolic blood pressure, and the prevalence of, and number of people with, raised blood pressure, defined as systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher. Methods For this analysis, we pooled national, subnational, or community population-based studies that had measured blood pressure in adults aged 18 years and older. We used a Bayesian hierarchical model to estimate trends from 1975 to 2015 in mean systolic and mean diastolic blood pressure, and the prevalence of raised blood pressure for 200 countries. We calculated the contributions of changes in prevalence versus population growth and ageing to the increase in the number of adults with raised blood pressure. Findings We pooled 1479 studies that had measured the blood pressures of 19·1 million adults. Global age-standardised mean systolic blood pressure in 2015 was 127·0 mm Hg (95% credible interval 125·7–128·3) in men and 122·3 mm Hg (121·0–123·6) in women; age-standardised mean diastolic blood pressure was 78·7 mm Hg (77·9–79·5) for men and 76·7 mm Hg (75·9–77·6) for women. Global age-standardised prevalence of raised blood pressure was 24·1% (21·4–27·1) in men and 20·1% (17·8–22·5) in women in 2015. Mean systolic and mean diastolic blood pressure decreased substantially from 1975 to 2015 in high-income western and Asia Pacific countries, moving these countries from having some of the highest worldwide blood pressure in 1975 to the lowest in 2015. Mean blood pressure also decreased in women in central and eastern Europe, Latin America and the Caribbean, and, more recently, central Asia, Middle East, and north Africa, but the estimated trends in these super-regions had larger uncertainty than in high-income super-regions. By contrast, mean blood pressure might have increased in east and southeast Asia, south Asia, Oceania, and sub-Saharan Africa. In 2015, central and eastern Europe, sub-Saharan Africa, and south Asia had the highest blood pressure levels. Prevalence of raised blood pressure decreased in high-income and some middle-income countries; it remained unchanged elsewhere. The number of adults with raised blood pressure increased from 594 million in 1975 to 1·13 billion in 2015, with the increase largely in low-income and middle-income countries. The global increase in the number of adults with raised blood pressure is a net effect of increase due to population growth and ageing, and decrease due to declining age-specific prevalence. Interpretation During the past four decades, the highest worldwide blood pressure levels have shifted from high-income countries to low-income countries in south Asia and sub-Saharan Africa due to opposite trends, while blood pressure has been persistently high in central and eastern Europe. Funding Wellcome Trust.

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Predictive validity of a medication adherence measure in an outpatient setting.

Donald E. Morisky, Alfonso Ang, Marie Krousel-Wood … (2008)

This study examines the psychometric properties and tests the concurrent and predictive validity of a structured, self-reported medication adherence measure in patients with hypertension. The authors also assessed various psychosocial determinants of adherence, such as knowledge, social support, satisfaction with care, and complexity of the medical regimen. A total of 1367 patients participated in the study; mean age was 52.5 years, 40.8% were male, 76.5% were black, 50.8% graduated from high school, 26% were married, and 54.1% had income <$5,000. The 8-item medication adherence scale was reliable (alpha=.83) and significantly associated with blood pressure control (P<.05). Using a cutpoint of <6, the sensitivity of the measure to identify patients with poor blood pressure control was estimated to be 93%, and the specificity was 53%. The medication adherence measure proved to be reliable, with good concurrent and predictive validity in primarily low-income, minority patients with hypertension and might function as a screening tool in outpatient settings with other patient groups.

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Author and article information

Contributors

Ramin Shiraly: rshiraly@gmail.com

Ali Khani Jeihooni: khani_1512@yahoo.com

Rozita Bakhshizadeh Shirazi: Shirazi.rozita@gmail.com

Journal

Journal ID (nlm-ta): BMC Prim Care

Journal ID (iso-abbrev): BMC Prim Care

Title: BMC Primary Care

Publisher: BioMed Central (London )

ISSN (Electronic): 2731-4553

Publication date (Electronic): 29 November 2022

Publication date PMC-release: 29 November 2022

Publication date Collection: 2022

Volume: 23

Electronic Location Identifier: 303

Affiliations

[1 ]GRID grid.412571.4, ISNI 0000 0000 8819 4698, Department of Community Medicine, School of Medicine, Health Behavior Science Research Center, , Shiraz University of Medical Sciences, ; Shiraz, Iran

[2 ]GRID grid.412571.4, ISNI 0000 0000 8819 4698, Nutrition Research Center, Department of Public Health, School of Health, , Shiraz University of Medical Sciences, ; Shiraz, Iran

[3 ]GRID grid.412571.4, ISNI 0000 0000 8819 4698, Zarghan Hospital, , Shiraz University of Medical Sciences, ; Shiraz, Iran

Article

Publisher ID: 1918

DOI: 10.1186/s12875-022-01918-1

PMC ID: 9706951

PubMed ID: 36443657

SO-VID: 72d59d82-d63f-4dbc-ab8d-35852334088d

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 2 August 2022

Date accepted : 18 November 2022

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Keywords: hypertension,complications,perceived risk,medication adherence

Data availability:

Keywords: hypertension, complications, perceived risk, medication adherence

Perception of risk of hypertension related complications and adherence to antihypertensive drugs: a primary healthcare based cross-sectional study

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Karger: Nephrology

Most cited references 29

The global epidemiology of hypertension

Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants

Predictive validity of a medication adherence measure in an outpatient setting.

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