During the past two decades, hypertension has been the most prevalent chronic disease in Korea. According to the Korean Health Statistics 2015 (Korea Centers for Disease Control and Prevention, 2016), 27.9% of adults aged 30 years or over have been diagnosed with hypertension. With the increasing prevalence, the treatment and management of hypertension have also improved. However, adults with hypertension are at high risk of serious adverse events, such as myocardial infraction and stroke, and also feel pressured to strictly adhere to a medical regimen, despite possible adverse effects. For those reasons, quality of life in persons with hypertension is relatively lower than that in persons with normotensive (Carvalho, Siquerira, Sousa, & Jardim, 2013). In particular, some previous studies reported that health-related quality of life for women with hypertension tends to be lower than for men with hypertension (Choi & Lee, 2015). Nevertheless, there is few studies for identifying factors of health-related quality of life in only women with hypertension in Korea. Thus, this study aimed to explore the predictors of health-related quality of life in women with hypertension in Korea.
Methods:
This was a secondary data analysis. From the original study, which aimed to identify the barriers to self-management behaviors in adults with hypertension, data from 229 women with hypertension were retrieved for this study. Based on Stuifbergen’s conceptual model of health promotion and quality of life for people with chronic and disabling conditions, nine variables were assessed: age, comorbidity, measured with the Charlson Comorbity Index; barriers to hypertension management, measured with a social- and job-related barriers scale; hypertension-related knowledge, measured with the Check Your High Blood Pressure Prevention Scale; health promoting behaviors measured with the Health Promoting Behaviors Scale; stress, measured with the Brief Encounter Psychosocial Instrument; social support, measured with the ENRICHD Social Support Instrument; communication with healthcare providers, measured with the Communication Scale; and health-related quality of life, measured with the Healthy Days Core Module. To analyze the data, a correlational analysis and a multiple regression analysis with a enter method were performed. Before conducting the multiple regression analysis, several assumptions such as multicollinearity was checked.
Results:
The mean age of the sample was 51.58±6.45, ranging from 35 to 59 years. The results of the correlational analysis showed that the social support score was positively correlated with the health-related quality of life score (r=.133, p=.045), while the level of stress (r=-.304, p<.001) and the comorbidity score (r=-.220, p=.001) were negatively correlated with health-related quality of life. However, barriers to hypertension management (r=.013, p=.849), communication with healthcare providers (r=.061, p=.357), hypertension-related knowledge (r=.050, p=.450), health promoting behavior (r=.106, p=.110), age (r=-.051, p=.439) were not correlated with health-related quality of life in women with hypertension. The results of the multiple regression analysis indicated the most powerful predictor of health-related quality of life was the level of stress (β=-.280, p<.001). In addition, the comorbidity score was a significantly negative predictor of health-related quality of life in women with hypertension (β=-.197, p=.003). However, other variables including age (β=.029, p=.669), barriers to hypertension management (β=.019, p=.777), hypertension-related knowledge (β=.022, p=.725), health promoting behaviors (β=-.005, p=.946), social support (β=.014, p=.840), and communication with healthcare providers (β=.015, p=.823) did not show statistically significant associations with health-related quality of life. This regression model accounted for 12.9% of the total variance.
Conclusion:
The finding that the level of stress predicts health-related quality of life is consistent with previous studies (Choi & Lee, 2015; Stanley et al., 2011). Stress might cause high blood pressure and consequently lower health-related quality of life. In addition, the negative association found between the comorbidity score and health-related quality of life agrees with a previous study (Zygmuntowicz et al., 2013) as well as a systematic review which reported factors influencing quality of life in patients with hypertension (Chang, Jang, Lee, & Lee, 2017). Therefore, with respect to improving health-related quality of life in women with hypertension, healthcare providers should be aware of how to manage the level of stress in this population. In addition, regular checkup programs for preventing hypertension-related complications should be considered in primary healthcare service. Further studies would be needed to consider hypertension-specific quality of life measurements to detect more precise effects of hypertension on quality of life.
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