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Psychosocial factors influence control of moderate and severe hypertension
Insights
Achieving optimal blood pressure control in patients with essential hypertension is challenging. Factors like ideal body weight, compliance, and socioeconomic status significantly impact treatment effectiveness.
Area of Science:
- Cardiology
- Hypertension Management
- Public Health
Background:
- Essential hypertension is a prevalent condition often requiring complex management.
- Many patients struggle to achieve target blood pressure control despite antihypertensive drug treatment.
- Factors influencing treatment outcomes in moderate to severe essential hypertension require further investigation.
Purpose of the Study:
- To analyze factors affecting blood pressure control in patients with moderate and severe essential hypertension.
- To identify predictors of poor, satisfactory, and excellent blood pressure control.
- To explore the interplay of physical, psychosocial, and socioeconomic factors on treatment outcomes.
Main Methods:
- Retrospective analysis of 150 patients with essential hypertension under long-term antihypertensive therapy.
- Assessment of blood pressure control, ideal body weight (IBW), compliance index, life events score, marital status, work status, and income.
- Statistical analysis to determine relationships between these factors and blood pressure control.
Main Results:
- Excellent blood pressure control was achieved in 55% of patients, satisfactory in 35%, and poor in 11%.
- Higher ideal body weight correlated with increased antihypertensive medication dosage.
- Poor blood pressure control was associated with lower compliance, higher life events scores, unemployment, lower income, and being unmarried.
Conclusions:
- Blood pressure control in essential hypertension is multifactorial, influenced by physical (e.g., ideal body weight), psychosocial (e.g., life events), and socioeconomic factors (e.g., income, employment).
- Compliance and patient-reported factors play a crucial role in treatment success.
- Addressing these diverse factors is essential for optimizing hypertension management.
Abstract:
Factors affecting the degree of blood pressure control achieved by antihypertensive drug treatment in 150 patients with moderate and severe essential hypertension were analyzed. Patients were under continuing treatment for 1-23 years. Most patients were referred for hypertension which was difficult to control. All were managed by the senior author. They received multiple drug regimens and extensive efforts were made to encourage their adherence to the regimens. In spite of these efforts, 16 (11%) had poor blood pressure control. Satisfactory control was achieved in 52 (35%) patients and excellent control in 82 (55%) patients. As a group, their ideal body weight (IBW) was 125 +/- 22% (mean +/- SD) of normal. The mean number of antihypertensive tablets per day was significantly greater (P = 0.0009) in those with poor control as compared to those with satisfactory and excellent control. As % IBW increased, the number of antihypertensive tablets increased (P = 0.0021). We examined the relationship of blood pressure control with an index of compliance, with psychosocial factors (life events score, martial status) and with socioeconomic factors (work status, income). Poor blood pressure control was associated with a lower compliance index (P less than 0.0001) and a higher life events score (P less than 0.006). Poorly controlled patients were more likely to have poor health in general (P = 0.0002), to have kept fewer medical appointments during the preceding year (P less than 0.0001), to be unmarried (P less than 0.0001), to be unemployed (P less than 0.0028) and have a lower income (P less than 0.009). As % IBW increased, compliance index decreased, (P = 0.0045). Therefore, psychosocial and socioeconomic factors, as well as physical factors, influence blood pressure control in moderate and severe essential hypertension.