Monday, November 3, 2003

This presentation is part of : The Patient Factor: Adherence Predicts Outcome across Chronic Disorders

Relationship Between Adherence to Antihypertensive Medication and Blood Pressure

Elizabeth A. Schlenk, PhD, RN, Mildred Jones, PhD, RN, Julius Kitutu, PhD, Susan Sereika, PhD, Willa Doswell, PhD, RN, FAAN, and Jacqueline Dunbar-Jacob, PhD, RN, FAAN. School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA

Objective: The objective was to determine if there was a relationship between adherence and blood pressure (BP) controlling for selected demographics.

Design: A descriptive design was used in this secondary analysis of data from a larger study of ethnic differences in antihypertensive medication adherence.

Sample: Subjects (N=105) at least 35 years old on pharmacological treatment for hypertension were recruited at BP screenings. The sample was 56% (n=59) African American, 71% (n=75) female, 54% (n=57) married, 50% (n=52) employed, late mid-life (M=61.4 years, SD=12.6), well educated (M=13.7 years, SD=2.8), with an income =>$30,000 (55%, n=49), BP of 145/83 (SD=16/11), and hypertension for 12.0 years (SD=11.7).

Methods: BP was taken at enrollment, questionnaires were completed by telephone interview, and medication electronic event monitors were used for 90 days.

Findings: Three adherence measures were used with adherence defined as =>80%. Eighty-six percent were adherent for doses taken, 71% for days adherent, and 53% for optimal intervals. Hierarchical stepwise regression with age, race, years education, and household income entered in the first block and adherence entered in the second block in a forward fashion within blocks showed that doses taken [Change F(1,85)=3.988, Change R-square=.034, p=.049], days adherent [Change F(1,85)=4.898, Change R-square=.041, p=.030], and optimal intervals [Change F(1,85)=8.021, Change R-square=.065, p=.006] explained significant additional variance in diastolic BP but not systolic BP. The full models explained 26%-29% of the variance in diastolic BP.

Conclusions: Between 53% and 86% of subjects were classified as adherent based on the measure used. Older age, Caucasian race, and good adherence were associated with lower diastolic BP.

Implications: Interventions to improve BP control should focus on strategies to improve adherence to antihypertensive medication.

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