Effects of Emotional Response on Adherence to Antihypertensive Medication and Blood Pressure Improvement

Robert D Keeley,Margaret Driscoll

doi:10.1155/2013/358562

Abstract

Background. Developing interventions to improve medication adherence may depend upon discovery of novel behavioral risk factors for nonadherence. Objective. Explore the effects of emotional response (ER) on adherence to antihypertensive medication and on systolic blood pressure (SBP) improvement. Design. We studied 101 adults with diabetes and hypertension. The primary outcome, 90-day “percentage of days covered” adherence score, was determined from pharmacy refill records. The secondary outcome was change in SBP over 90 days. ER was classified as positive, negative, or neutral. Results. Average adherence was 71.6% (SD 31.4%), and negative and positive ER were endorsed by 25% and 9% of subjects, respectively. Gender moderated the effect of positive or negative versus neutral ER on adherence (interaction P = 0.003); regardless of gender, negative and positive ER were associated with similarly high and low adherence, respectively, but males endorsing neutral ER had significantly higher adherence than their female counterparts (85.6% versus 57.1%, F value = 15.3, P = 0.0002). Adherence mediated ER's effect on SBP improvement: among participants with negative, but not positive or neutral, ER, increasing adherence and SBP improvement were correlated (Spearman's r = 0.49, P = 0.02). Conclusions. Negative, but not positive or neutral, ER predicted better medication adherence and a correlation between medication adherence and improvement in SBP.

Highlights

The World Health Organization has described nonadherence to medications as the leading cause of preventable morbidity and mortality [1]
There were no differences in mean clinical parameters between patients recruited at the time of the visit or by telephone
We examined whether adherence might explain why emotional response (ER) was significantly associated with change in systolic blood pressure (SBP) for at least a subset of subjects, those with baseline negative ER

Summary

Introduction

The World Health Organization has described nonadherence to medications as the leading cause of preventable morbidity and mortality [1]. 50% of those treated for hypertension experience clinically significant medication non-adherence, leading to worse blood pressure control, cardiovascular morbidity, higher medical costs, and increased all-cause mortality [2,3,4,5]. Factors thought to be causally related to non-adherence vary broadly and include regimen complexity, poor patientprovider communication, depression, minimal social support, and financial barriers [9]. Despite this knowledge, a 2008 Cochrane review concluded that most interventions to improve medication adherence did not neither achieve sustained improvements in adherence nor lead to better clinical outcomes [10]. But not positive or neutral, ER predicted better medication adherence and a correlation between medication adherence and improvement in SBP

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Conclusion