Affect Blood Pressure Control Research Articles

EFFECT OF ANTIHYPERTENSIVE DEPRESCRIBING ON SERIOUS ADVERSE EVENTS, MORTALITY, AND CARDIOVASCULAR DISEASE: LONG-TERM FOLLOW-UP OF THE OPTIMISE RANDOMISED CONTROLLED TRIAL

Objective: Deprescribing of antihypertensive medications is recommended for some older patients with polypharmacy and frailty. The OPTIMISE trial showed that this can be achieved without affecting blood pressure control at 3-month follow-up. This longer-term follow-up study aimed to examine the impact on serious adverse events (SAEs), mortality and cardiovascular disease (CVD) outcomes after at least 3 years. Design and method: Participants aged 80 years or older, with systolic blood pressure <150 mmHg, and receiving at least 2 antihypertensive medications were randomised (1:1) to a strategy of antihypertensive medication reduction (removal of one antihypertensive) or usual care. Participants were followed-up via their primary and secondary care electronic health records, at least 3 years after randomisation. The primary outcome was SAEs, defined as hospitalisation or death from any cause. Secondary outcomes included mortality, stroke, myocardial infarction and major CVD events. Analyses were undertaken using Cox proportional hazards modelling. Results: Among 569 randomised participants (intervention=282; control=287) with a mean age 85 years (276 [48.5%] women), 564 (99.1%) were followed-up for a median of 3.9 years. Medication reduction was sustained in 109 participants (52.7% of those alive in the intervention group) at 3 years. Participants in the intervention group were prescribed fewer antihypertensives than the control group (mean difference -0.35, 95%CI -0.52 to -0.18). Overall, 202 (72.1%) patients in the intervention group and 218 (76.8%) patients in the control group experienced SAEs during follow-up (adjusted HR 0.93, 95%CI 0.76-1.12). There was no evidence of a difference in mortality (aHR 0.81, 95%CI 0.58-1.13), stroke (aHR 0.91, 95%CI 0.40-2.06), myocardial infarction (aHR 0.86, 95%CI 0.42-1.77) or CVD events (aHR 1.00, 95%CI 0.68-1.46). Conclusions: Medication reduction was sustained in half of those attempting it, with no evidence of harm from SAEs, mortality or CVD after almost four years. These findings suggest that deprescribing antihypertensive medication is safe in older patients living in the community with controlled blood pressure.

Effectiveness of the knowledge, attitude, practice intervention model in the management of hypertension in the elderly.

This study illustrated the effectiveness of the knowledge, attitude, practice (KAP) intervention model for community hypertension in the elderly by the community physician-led, describing the study design and baseline data. The aim of the study was to compare the changes in the elderly hypertensive population before and after the KAP intervention model by managing the elderly hypertensive patients for a period of 1 year. Basic information and risk factors affecting blood pressure control based on baseline data of recruited elderly hypertensive patients. The management approach consists of two parts: (1) the unified management of the community physician to whom the patient belongs; and (2) the management of the contracted patient by the community physician. The aim was to demonstrate the anti-hypertensive effectiveness (control rate, blood pressure reduction, and pulse pressure), the distribution of blood pressure types, and the change of the KAP in elderly hypertensive patients before and after the intervention. The KAP intervention model was administered to 2660 elderly hypertensive patients in a 1-year period. The blood pressure control rate improved by 54.03%. Mean values of overall systolic and diastolic blood pressure decreased by 16.00 and 5.31mmHg, respectively. The proportion of isolated systolic hypertension (ISH) and systolic-diastolic hypertension (SDH) decreased by 29.14% and 24.81%, respectively. The KAP compliance improved significantly. These results suggest that the community physician-led KAP intervention model is effective in the management of hypertension in the elderly.

Blood pressure control and treatment burden from comorbidities

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): the National Research Foundation of Korea grants funded by the Korea government (MEST) Background Achieving the optimal target blood pressure is important for patients with hypertension to prevent cardiovascular complications. Adhering to recommended therapeutic regimens is crucial to control the blood pressure. However, patients with non-cardiovascular comorbid conditions along with hypertension may experience difficulty performing adequate self-care of hypertension and achieving the optimal target blood pressure because they need to simultaneously manage hypertension and comorbidities. Treatment burden refers to workloads to manage chronic conditions and their impact. Thus, it is possible that the burden of treatment associated with managing multiple conditions adversely affects blood pressure control. Purpose To examine whether treatment burden was associated with achieving the optimal target blood pressure in patients with hypertension and non-cardiovascular comorbidities. Methods Patients with hypertension and non-cardiovascular comorbidities were recruited and asked to complete the questionnaires via online survey. Treatment burden was measured with the Multimorbidity Treatment Burden Questionnaire. Comorbid conditions that were diagnosed and/or treated were measured with the list developed to document self-reported chronic conditions in primary care. Patients were asked to report their blood pressure readings that were measured most recently within three months. Based on their blood pressure readings, patients were classified into two groups: controlled group with the blood pressure readings of < 140/90 mmHg and uncontrolled group with the blood pressure readings of 140/90 mmHg or above. To determine whether treatment burden was associated with blood pressure group assignment, multivariable logistic regression was used after adjusting for covariates (i.e., age, gender, education levels, employment status, periods since hypertension diagnosis, the number of non-cardiovascular comorbidities, and self-care maintenance of hypertension). Results A total of 280 patients with hypertension and non-cardiovascular comorbidities (52 years old, 33.2% female) were included in this study. Patients had an average of 3 comorbidities (SD 1.3). Of 280 patients, 153 (54.6%) had the blood pressure readings of <140/90 mmHg (i.e., controlled group). The multivariate logistic regression model shows that patients with greater levels of treatment burden were less likely to be in the controlled group after adjusting for covariates (adjusted odds ratio: 0.98, 95% confidence interval: 0.971-0.997). Conclusion We found that treatment burden was negatively associated with achieving the optimal target blood pressure in patients with hypertension and non-cardiovascular comorbidities. It is important for clinicians to assess patients’ burden of treatment associated with managing hypertension and comorbidities when discussing blood pressure management.

PARACETAMOL AND BLOOD PRESSURE CONTROL IN 45211 PATIENTS TREATED FOR HYPERTENSION: A CROSS-SECTIONAL STUDY FROM THE SWEDISH PRIMARY CARE CARDIOVASCULAR DATABASE

Objective: Paracetamol (acetaminophen) is widely recommended for analgetic and antipyretic indications due to its perceived high safety. However, studies have shown contradicting results regarding the effect of paracetamol on blood pressure (BP). We aimed to study how regular paracetamol use could affect BP control in patients on antihypertensive mediation. Design and method: Data for 42 511 patients attending primary care and a documented diagnosis of hypertension before 2007 (to rule out new onset of hypertension) and with 1 or more BP measurements recorded 2007–2008 were collected from the Swedish primary care cardiovascular database (SPCCD). There were 8 367 paracetamol users, defined as 1 or more dispensed prescriptions 6 months prior to the last BP recorded, and 34 144 non-users of paracetamol. Target BP was set to <140/90 mm Hg. Dose-response relationships were examined by the number of defined daily doses (DDD) dispensed. Multivariate linear regression analyses accounted for potential confounders. Results: Paracetamol users were older, had higher creatinine levels, more often diabetes, cardiovascular diseases and musculoskeletal diseases, and lower educational level than non-users (all P < 0.001), but attained target systolic and diastolic BP to similar degrees (58 and 93% vs 58 and 92%, respectively). There were no relations between number of DDD and systolic and diastolic BP in paracetamol users, also when DDD deciles were evaluated to account for the low proportion of patients with high DDD dispensed (all R2 <0.001). Sensitivity analyses including dispensed prescriptions of paracetamol 3 months before and 6 months after the first BP measurement provided similar results. Paracetamol had no impact on attaining target BP in subgroup analyses on patients with diabetes, musculoskeletal diseases, with concomitant use of NSAID, or in relation to number of antihypertensive medications (suggesting severity of hypertensive disease). Conclusions: Concomitant use of paracetamol does not impair the ability to reach target BP in hypertensive patients. No dose-response relationship was observed between dispensed prescriptions of paracetamol and BP.

Effects of ADIPOQ and NOS3 SNPs/haplotypes on blood pressure control in patients with adherence to antihypertensive therapy.

Aim: We examined whether ADIPOQ (rs266729 and rs1501299) and NOS3 (rs3918226 and rs1799983) SNPs or the haplotypes formed by them, affect blood pressure (BP) control in 196 patients with adherence to antihypertensive therapy grouped into controlled (BP <140/90mmHg) and uncontrolled (BP ≥140/90mmHg) hypertension. Materials & methods: The average of the three most recent BP measurements was retrieved from thepatients' electronic medical records. Adherence to antihypertensive therapy was evaluated using the Morisky-Green test. Haplotype frequencies were estimated using Haplo.stats. Multiple logistic/linear regression analyses were adjusted for the covariates ethnicity, dyslipidemia, obesity, cardiovascular disease and uric acid. Results: ADIPOQ rs266729 genotypes CG (additive model) and CG+GG (dominant model) were associated with uncontrolled hypertension and CG was associated with higher systolic BP and mean arterial pressure (p <0.05). ADIPOQ haplotypes 'GT' and 'GG' were associated with uncontrolled hypertension and 'GT' was associated with higher diastolic BP and mean arterial pressure (p <0.05). Conclusion: ADIPOQ SNPs and haplotypes affect BP control in hypertensive patients undergoing treatment.

Effectiveness of self-care intervention in hypertension patients: A systematic review

Objective: To analyze the effectiveness and characteristics of self-care interventions affect blood pressure control in hypertensive patients. Methodology: This systematic review was done through Scopus, EBSCOhost, Embase, ScienceDirect, PubMed, and Sage in March 2023. The eligibility criteria for study selection were true experimental research with a randomized controlled trial (RCT) design and self-care or self-management interventions in patients with hypertension. Inclusion criteria were self-care or self-management intervention, blood pressure control outcomes, English articles, all open access journals, free articles, and original research. We excluded pregnant and terminal hypertensive patients. The process and selection of articles used the Prisma flow chart. The review method used Cochrane 2.0 risk of bias (ROB 2.0) for RCTs followed by using Robvis application. Results: Self-care interventions were significant for blood pressure control in hypertensive patients in two studies. All studies showed that self-care interventions were effective in reducing mean systolic and diastolic blood pressure. Conclusion: Educational and counseling materials to improve decision-making skills, individual reflection, and hypertension case management with face-to-face methods followed by telephone or home visits are characteristics of effective self-care interventions.

The potential of blood pressure telemonitoring: experience in the UK and Japan.

Hypertension is the most important and modifiable risk factor for cardiovascular disease (CVD) morbidity and mortality worldwide, and a growing issue as the global population with hypertension increases (estimated to be 626 million women and 652 million men in 2019, almost double the number in 1990). In addition, global control rates for hypertension remain poor: 23% for women and 18% for men in 2019 (Lancet. 2021:957). Measures to reduce the number of poorly controlled hypertensive patients are urgently needed. Remarkable advances in healthcare technology have changed healthcare delivery dramatically in the last decade with out-of-office blood pressure (BP) telemonitoring being widely used in clinical research (Hypertension. 2020:1368). We have demonstrated the efficacy of BP telemonitoring and digital intervention for the management of hypertension in the Telemonitoring And Self-Management IN the control of Hypertension (TASMINH) trials (Lancet. 2010:163, JAMA. 2014:799, Lancet. 2018:949), the Home and Online Management and Evaluation of Blood Pressure (HOME BP) trial (BMJ. 2021:m4858), and the HERB Digital Hypertension 1(HERB-DH1) pivotal trial (Eur Heart J. 2021:4111). A recent meta-analysis found that home BP telemonitoring improved office systolic BP (SBP) by 3.99 mmHg and home BP telemonitoring plus additional support (e.g., counselling and medications management) also showed a reduction of office SBP by 2.44 mmHg versus home BP telemonitoring alone (J Hum Hypertens. 2017:427). This evidence suggests that BP telemonitoring is an optimal tool for reducing BP levels and that combining BP telemonitoring and co-interventions would be the most effective approach for the management of hypertension. There are additional benefits from BP telemonitoring system in clinical practice, including assessment of accurate and reliable out-of-office BP data, and ease of BP measurement and recording by patients without the need for manual systems. Furthermore, such systems can reduce nonadherence of antihypertensive medications and clinical inertia, both of which contribute to a treatment-resistant hypertension (J Hypertens. 2017:2346, J Hypertens. 2021:1238). In practical terms, telemonitoring also facilitates optimal BP management for patients living in geographically remote or poorly medically resourced areas (Hypertension. 2021:1927). In this session, through discussion of the evidence base and clinical experience in the UK and Japan, we will examine the prospects of BP telemonitoring systems for the future management of hypertension. We will examine how BP telemonitoring systems are used and affect BP control in both clinical trials and subsequent implementation. In addition, by comparing such work in the UK and Japan, we will assess the potential of BP telemonitoring systems as a solution to the inadequate BP control status worldwide.

NATIONAL HEALTH INSURANCE SCHEME: A MEANS TO EFFECTIVE STROKE PREVENTION AMONG HYPERTENSIVES IN SUBSAHARAN AFRICA

<h2>ABSTRACT</h2><h3>Background and Aims</h3> Uncontrolled hypertension is a leading cause of stroke in Sub-Saharan Africa. Factors affecting blood pressure control include low income, sedentary lifestyle and unhealthy diet. We sought to determine the role of National Health Insurance Scheme (NHIS) in achieving good blood control among hypertensives in Ghana and Nigeria and thus prevention of stroke and other cardiovascular complications of uncontrolled hypertension. <h3>Methods</h3> A hospital-based descriptive cross-sectional study of 206 adult hypertensives systematically selected from 4 hospitals in Ghana (Adabraka and Maproby Polyclinics) and Nigeria (Ekiti State University Teaching Hospital, Ado-Ekiti and Federal Teaching Hospital, Ido-Ekiti). Patients were interviewed and physically examined and information entered into a questionnaire and analysed using SPSS 21. Informed consent was obtained from respondents and ethical approval obtained from all the four institutions. <h3>Results</h3> Respondents were mostly middle aged 113 (54.8%) with a mean age of 57±14; females 134 (65.5%); married 132 (64.1%) and NHIS enrollees 108 (52.4%). Majority of respondents had poor BP control 122 (59.2%). There was a significantly better blood pressure control among respondents from Ghana (OR 5.526; CI 3.006 to 10.161) and those on NHIS (OR 3.516; CI 1.946 to 6.352). <h3>Conclusions</h3> Out of pocket spending is a major cause of poor Blood Pressure control with predisposition to stroke. Universal Health Coverage through enrolment of all citizens under the NHIS scheme would provide standard healthcare to citizens irrespective of their income levels and help in blood pressure control and in turn prevent stroke in these patients.

Factors affecting blood pressure control in women aged 15–49

Background: While 25% of adult women in the world are hypertensive, the percentage of women who cannot achieve blood pressure control despite taking medication is 55.9 ± 1.5%. The aim of this study was to determine the prevalence and control rate of hypertension and to detect the factors affecting this situation in women in the 15–49 age group. Material and methods: Seven hundred women in the 15–49 age group were selected and a questionnaire was applied. Height, weight, and blood pressure were measured and spot urines were collected on the same day. 24-hour sodium excretion and daily salt intake were calculated using the Kawasaki method. Results: While 14.3% of the women were hypertensive, only 19% of them were able to achieve blood pressure control. Fifty-eight percent of the hypertensive women use more than 15 g/day of salt and the estimated 24-hour urinary sodium excretion of these women was 311.6 ± 39.5 mmol/L. Hypertensive women using less than 5 g/day of salt were 0.3%. Salty foods consumed by the hypertensive women were pickles (55.6%), cheese (92.6%), olives (88.8%), vine leaves (71.6%), sujuk and Turkish pastrami (47.6%), and tomato paste (100%). Conclusions: In our study, participants were consuming large amounts of salt and there was a positive correlation between salt intake and blood pressure. Therefore, all efforts for sodium restriction are very important in the management of hypertension.

The effect of drug information service using leaflet media and medication reminder chart on adherence and blood pressure of hypertensive patients in primary health care

Abstract Background: Treatment adherence is an important factor affecting blood pressure control in hypertensive patients. Intervention in pharmacy service can improve medication adherence and lower blood pressure. Objective: This study aimed to evaluate the effect of drug information service using leaflets and MRC on the level of patient compliance and lowering blood pressure. Method: The research design was a quasi-experimental pre-and post-design with control, the intervention group (n=20), and the control group (n=20). The patient adherence was measured using the MGLS questionnaire at the beginning and the end of the study. The intervention was performed by distributing a drug information leaflet and medication reminder chart (MRC). The differences of adherence pre and post-intervention were analyzed using paired t-test, while the differences in adherence and blood pressure between the control and the intervention group were analyzed using the Mann-Whitney test. Results: The results showed that there was a significant difference in adherence between pre and post-intervention (p&lt;0.001). A significant difference was also found in the level of adherence between the control group and the intervention group (p&lt;0.001). Whereas the decrease of systolic (p=0.396) and diastolic (p=0.564) blood pressure in the intervention group and control group was not different significantly. Conclusion: Drug information services using leaflets and MRCs affected patient adherence to medication, but did not interfere with the decrease of systolic and diastolic blood pressure. Keywords: leaflets, medication reminder chart, adherence, blood pressure

The association between socioeconomic status and prevalence, awareness, treatment and control of hypertension in different ethnic groups: the Healthy Life in an Urban Setting study.

Socioeconomic status (SES) and ethnicity are both important determinants of hypertension prevalence and control rates but their separate contribution is unknown. We assessed the association of SES with hypertension prevalence, awareness, treatment and control, and whether this differs between ethnic groups. We used baseline data from the Healthy Life in an Urban Setting (HELIUS) study, a multiethnic population-based cohort study, including 18 106 participants (84% of the total cohort) of Dutch (n = 4262), African Surinamese (n = 3732), Moroccan (n = 2902), Turkish (n = 2694), South-Asian Surinamese (n = 2664) and Ghanaian (n = 1947) descent with data on SES and hypertension status. Regardless of ethnicity, lower SES was associated with higher hypertension prevalence, especially in participants with no education compared with those with higher levels of education [OR 2.29 (2.05-2.56)]. There was an inverse association between SES and hypertension treatment with the strongest association for lower compared with higher educated participants [OR 1.63 (1.39-1.90)]. In addition, lower SES was associated with lower hypertension control with the strongest association for participants with the lowest compared with the highest occupational level [OR 0.76 (0.60-0.95)]. The association between educational level and treatment but not the other SES- or hypertension-indicators, was influenced by ethnicity, with lower educated Dutch and African Surinamese having higher ORs for hypertensive treatment [Dutch OR 1.98 (1.43-2.76); African Surinamese OR 1.44 (1.10-1.89)]. SES, in particular education, impacts hypertension treatment in the Netherlands, whereas the association of specific SES parameters with hypertension indicators differ across ethnic groups. Further exploration is needed on how sociocultural beliefs and behaviours may differentially affect blood pressure control across ethnic minority populations.

Factors Affecting Blood Pressure Control in Hypertension Patients and Their Social Adaptation

Aim: In this research, we aimed to analyze the factors affecting the control of blood pressure and social adaptation in hypertensive patients. Material and Method: Our study was conducted with 100 hypertensive patients in Ankara Training and Research Hospital Family Medicine Polyclinics between December 2015 and March 2016. Five-day blood pressure follow-up, socio-demographic characteristics and "Fatih Social Tendencies Scale" questionnaire data of the patients were recorded. 5-day blood pressure follow-up of the patients was performed. Results: In our research, physical activity, regular exercise, being on diet, smoking, regular doctor check, medication compliance, marital status, years of education, regular book reading, working status and monthly income were found to be effective in blood pressure control. “Social Adaptation”, “Avoidance of Substance”, “Avoidance of Violence”, “Family Status” and “Economic Status” among social tendency factors were found to be better in patients with blood pressure under control. Conclusion: In blood pressure follow-up, the lifestyle characteristics of the patient should be questioned and taken into consideration. Questioning psychological factors such as social adaptation and providing support through the provision of necessary information and education to the patient will make a great contribution to the patients in terms of blood pressure control.

Medication discrepancies among hospitalized patients with hypertension: assessment of prevalence and risk factors

BackgroundMedication errors remained among the top 10 leading causes of death worldwide. Furthermore, a high percentage of medication errors are classified as medication discrepancies. This study aimed to identify and quantify the different types of unintentional medication discrepancies among hospitalized hypertensive patients; it also explored the predictors of unintentional medication discrepancies among this cohort of patients.MethodsThis was a prospective observational study undertaken in a large teaching hospital. A convenience sample of adult patients, taking ≥4 regular medications, with a prior history of treated hypertension admitted to a medical or surgical ward were recruited. The best possible medication histories were obtained by hospital pharmacists using at least two information sources. These histories were compared to the admission medication orders to identify any possible unintentional discrepancies. These discrepancies were classified based on their severity. Finally, the different predictors affecting unintentional discrepancies occurrence were recognized.ResultsA high rate of unintentional medication discrepancies has been found, with approximately 46.7% of the patients had at least one unintentional discrepancy. Regression analysis showed that for every one year of increased age, the number of unintentional discrepancies per patient increased by 0.172 (P = 0.007), and for every additional medication taken prior to hospital admission, the number of discrepancies increased by 0.258 (P= 0.003). While for every additional medication at hospital admission, the number of discrepancies decreased by 0.288 (P < 0.001). Cardiovascular medications, such as diuretics and beta-blockers, were associated with the highest rates of unintentional discrepancies in our study. Medication omission was the most common type of the identified discrepancies, with approximately 46.1% of the identified discrepancies were related to omission. Regarding the clinical significance of the identified discrepancies, around two-third of them were of moderate to high significance (n= 124, 64.2%), which had the potential to cause moderate or severe worsening of the patient´s medical condition.ConclusionsUnintentional medication discrepancies are highly prevalent among hypertensive patients. Medication omission was the most commonly encountered discrepancy type. Health institutions should implement appropriate and effective tools and strategies to reduce these medication discrepancies and enhance patient safety at different care transitions. Further studies are needed to assess whether such discrepancies might affect blood pressure control in hypertensive patients.

Hubungan Aspek Dukungan Sosial Keluarga terhadap Tekanan Darah Terkontrol pada Lansia dengan Hipertensi

Life Expectancy (UHH) in Indonesia has increased which makes the number of elderly people high, thereby increasing the burden of non-productive age on productive age related to problems that can occur in the elderly. One of them is hypertension where the elderly have a risk level of 2.18 times in the elderly aged 60-64 years. Hypertension treatment is carried out continuously so that support from the family is needed to achieve a controlled pressure value to avoid complications considering the weakening ability of the elderly. This study aims to analyze the relationship between aspects of family social support and controlled blood pressure in the elderly with hypertension. The design of this study was cross sectional with purposive sampling so that 42 elderly people were obtained according to the inclusion and exclusion criteria. The research instrument used the Widiawati Adoption Family Support Questionnaire (2016). The results of the analysis using Spearman Rank showed that there was a relationship between aspects of family social support and controlled blood pressure in the elderly with hypertension (r=0.598**; p=0.000). Family support affects blood pressure control so that it is expected that the family will provide optimal support.

The Effect of COVID-19 on Blood Pressure Control in Hypertension Patients– A Literature Review

COVID-19 is caused by Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2). First identifiedin Wuhan, China, in December 2019, and declared an International Public Health Emergency in January2020, the WHO declared a pandemic in March 2020. Hypertension, a disease that has long been a problemfor most people in Indonesia and around the world . COVID-19 can affect blood pressure control for peoplewith hypertension due to obstruction of the RAAS system. This research was conducted to find out whateffect COVID-19 has on blood pressure control in people with hypertension. In the condition of COVID-19patients with comorbid hypertension, SARS-CoV-2 which attacks ACE2 can eliminate the role of ACE2 inthe RAAS system. Inhibition of ACE2 can also cause buildup of angiotensin II which has a vasoconstrictiveeffect. This results in the absence of homeostasis in the blood pressure control system and makes bloodpressure conditions that continue to be at high pressure.

Patient related barriers to adequate blood pressure control among adult hypertensive patients seen at Kiambu County Hospital, Kenya

Introduction: Hypertension is a key precursor to cardiovascular and renal disease globally. According to WHO, Prevalence of hypertension was about 40 % globally in 2015 and 45% in Sub Saharan Africa in 2015. Despite much emphasis on treatment of the syndrome, the related blood pressure control remains poor or inadequate.&#x0D; Objective: The study sought to establish the patient related barriers to adequate blood pressure control among adult hypertensive patients in Kiambu Count Hospital in Kenya.&#x0D; Methods: A cross -sectional descriptive study method approach was used to examine sample of 330 patients selected through consecutive sampling technique in the medical outpatient chronic disease clinic. Multivariate logistic regression analysis was used to determine variables associated with inadequate or poorly controlled hypertension among adult patients.&#x0D; Results: Most of the patients were females (71.5%). However, the presence of inadequate blood pressure control was significantly higher among males (P-value= 0.009). Regularly taking of hypertension drugs for the last 6 months was significantly associated with adequate blood pressure control (p-value=0.033). The other barriers including single status, inadequate knowledge, employment and time duration since diagnosis of hypertension did not significantly affect blood pressure control status.&#x0D; Discussion: Males were 54% more likely to have inadequate blood pressure control compared to females (AOR=0.543; 95%CI=0.323-0.914). Patients with low adherence to treatment were 11% more likely to have inadequate blood pressure control than those with high adherence rate (AOR=1.093; 95%CI=0.224-5.332) though the association was not significant (p-value=0.912).&#x0D; Conclusion: Male gender was a major barrier to adequate blood pressure control. Patients who well adhered to treatment scheme for a duration of six months preceding the study had their blood pressure better controlled than those who did not. Male hypertensive patients need to be followed up to ensure they adhere to drug treatment in order to reduce the rates of inadequate blood pressure control and other related complications.

The impact of reference pricing on healthcare outcomes in patients with arterial hypertension

ObjectivesReference pricing is a proven cost-containment measure; however, there are concerns about its potential negative effects on patients. Slovenia introduced generic reference pricing (GRP) in 2003 and therapeutic reference pricing (TRP) in 2013, including TRP for ACE inhibitors and a new group of angiotensin II receptor blockers in September 2018. We aimed to evaluate the impact of GRP and TRP on medication adherence and blood pressure control in patients with hypertension. MethodsWe performed a prospective cohort study in community pharmacies in Slovenia. At visit 1, we recorded patient characteristics, including history of antihypertensive treatment, medicine substitutions, and co-payments, as well as blood pressure measurements and medication adherence. Eight weeks later on visit 2, we re-assessed medication adherence and blood pressure. ResultsOf the 114 patients, only three (2.6%) patients’ therapies changed because of GRP and none changed due to TRP. Thirty-six (31.6%) patients co-paid for prescribed antihypertensive medicine. Medication adherence was significantly better among patients who co-paid for their blood-pressure-lowering therapy than it was among those prescribed a reference medicine. Patients with reference medicines had lower blood pressure compared to patients with co-payments; however, the multiple linear regression models showed no effect of co-payment on blood pressure. ConclusionWe conclude that reference pricing did not negatively affect blood pressure control in patients with hypertension; in fact, it may promote medication adherence in these patients.

Beyond Medication Adherence: The Role of Patients' Beliefs and Life Context in Blood Pressure Control.

Despite numerous interventions to address adherence to antihypertensive medications, continued high rates of uncontrolled blood pressure (BP) suggest a need to better understand patient factors beyond adherence associated with BP control. We examined how patients' BP-related beliefs, and aspects of life context affect BP control, beyond medication adherence. We conducted a cross-sectional telephone survey of primary care patients with hypertension between 2010 and 2011 (N=103; 93 had complete data on all variables and were included in the regression analyses). We assessed patient sociodemographics (including race/ethnicity), medication adherence, BP-related beliefs, aspects of life context, and used clinical BP assessments. Regression models including sociodemographics, medication adherence, and either beliefs or context consistently predicted BP control. Adding context after beliefs added no predictive value while adding beliefs after context significantly predicted BP control. Results suggest that when clinicians must choose a dimension on which to intervene, focusing on beliefs would be the most fruitful approach to effecting change in BP control.

Electronic Pill Bottles or Bidirectional Text Messaging to Improve Hypertension Medication Adherence (Way 2 Text): a Randomized Clinical Trial.

Poor medication adherence contributes to inadequate control of hypertension. However, the value of adherence monitoring is unknown. To evaluate the impact of monitoring adherence with electronic pill bottles or bidirectional text messaging on improving hypertension control. Three-arm pragmatic randomized controlled trial. One hundred forty-nine primary care patients aged 18-75 with hypertension and text messaging capabilities who were seen at least twice in the prior 12months with at least two out-of-range blood pressure (BP) measurements, including the most recent visit. Patients were randomized in a 1:2:2 ratio to receive (1) usual care, (2) electronic pill bottles for medication adherence monitoring (pill bottle), and (3) bidirectional text messaging for medication adherence monitoring (bidirectional text). Change in systolic BP during the final 4-month visit compared with baseline. At the 4-month follow-up visit, mean (SD) change values in systolic blood pressure were - 4.7 (23.4) mmHg in usual care, - 4.3 (21.5) mmHg in the pill bottle arm, and - 4.6 (19.8) mmHg in the text arm. There was no significant change in systolic blood pressure between control and the pill bottle arm (p = 0.94) or the text messaging arm (p = 1.00), and the two intervention arms did not differ from each other (p = 0.93). Despite good measured adherence, neither feedback with electronic pill bottles nor bidirectional text messaging about medication adherence improved blood pressure control. Adherence to prescribed medications was not improved enough to affect BP control or it was not the primary driver of poor control. clinicaltrials.gov (NCT02778542).

Predictors of nonadherence to antihypertensive medications among stroke survivors in Benin City Nigeria

Background: Hypertension is the single most important modifiable risk factor for developing stroke and its recurrence. Evidence suggests that antihypertensive treatment rates following stroke remain poor worldwide and non-adherence to secondary preventive medication is a disturbing clinical problem associated with recurrence and poor outcomes. Aim: The aim of this study was to determine the predictors of non-adherence to antihypertensive medications among stroke survivors 3 months after their stroke. Materials and methods: This was a cross-sectional study, involving stroke survivors attending the out-patient neurology clinic at the University of Benin Teaching Hospital, Benin City, 3 months after their stroke. Demographic and clinical characteristic were obtained, with a questionnaire, while medication adherence was measured by pill count method. In the final logistic regression analysis, the independent variables were age, gender, educational status, marital status, modified Rankin scale, polypharmacy, and types of stroke while medication non-adherence was the dependent variable. Results: One hundred and twelve stroke survivors participated. There were 58(51.8%) males and the mean age was 72(12) years. The non-adherence rate in this study was 57.1 %(64/112). The significant predictors of non-adherence to antihypertensive medications were the female gender (P = 0.009), severe disability (P = 0.003), the older participants (P = 0.004), and polypharmacy (P = 0.002). Conclusion: Non-adherence to antihypertensive drugs following stroke was observed in our study, which would affect blood pressure control leading to stroke recurrence. To prevent recurrent strokes, stroke survivors must adhere to their antihypertensive drugs, while involving patient and family members in decision making with regards to treatment plans.