Macrovascular complications are common in diabetic hypertensive patients. Appropriate antihypertensive therapy and tight blood pressure control are believed to prevent or delay such complication. Objective: To evaluate utilization patterns of antihypertensive agents and blood pressure (BP) control among diabetic hypertensive patients with and without ischemic heart disease (IHD). Methods: Retrospective cohort study of all diabetic hypertensive patients attending Al-watani medical center from August 2006 until August 2007. Proportions of use of different antihypertensive drug classes were compared for all patients receiving 1, 2, 3, or 4 or more drugs, and separately among patients with and without IHD. Blood pressure control (equal or lower 130/80 mmHg) was compared for patients receiving no therapy, monotherapy, or combination therapy and separately among patients with and without IHD. Results: 255 patients were included in the study; their mean age was 64.4 (SD=11.4) years. Sixty one (23.9%) of the included patients was on target BP. Over 60% of the total patients were receiving angiotensin-converting enzyme inhibitors (ACEI)/ angiotensin receptor blocker (ARB), followed by diuretics (40.8%), calcium channel blockers (25.1%) and beta-blockers (12.5%). The majority (> 55%) of patients were either on mono or no drug therapy. More than 55% of patients with controlled BP were using ACE-I. More than half (50.8%) of the patients with controlled BP were on combination therapy while 42.3% of patients with uncontrolled BP were on combination therapy (p=0.24). More patient in the IHD achieved target BP than those in non-IHD group (p=0.019). Comparison between IHD and non-IHD groups indicated no significant difference in the utilization of any drug class with ACE-I being the most commonly utilized in both groups. Conclusions: Patterns of antihypertensive therapy were generally but not adequately consistent with international guidelines. Areas of improvement include increasing ACE-I drug combinations, decreasing the number of untreated patients, and increasing the proportion of patients with controlled BP in this population. RESUMEN Las complicaciones macrovasculares son frecuentes en pacientes diabéticos hipertensos. Se cree que un apropiado tratamiento antihipertensivo y un control estrecho de la presión arterial previenen o retrasan estas complicaciones. Objetivo: Evaluar los patrones de utilización de antihipertensivos y el control de la presión arterial (PA) en pacientes diabéticos hipertensos con y sin enfermedad isquémica cardiaca (EIC). Métodos: Estudio de cohorte retrospectivo de todos los pacientes diabéticos hipertensos que acudieron al centro médico Al-watani desde agosto 2006 a agosto 2007. Se compararon las proporciones de pacientes que recibían 1,2,3 o 4 o más medicamentos, y por separado los pacientes con y sin EIC. El control de presión arterial (menor o igual a 130/80 mmHg) se comparó en los pacientes recibiendo ningún tratamiento, monoterapia o tratamiento de combinación y por separado los que tenían o no EIC. Resultados: Se incluyeron en el estudio 255 pacientes; su media de edad era de 64,4 (DE=11,4) años. Sesenta y uno (23,9%) de los pacientes incluidos estaban en la presión arterial deseada. Más del 60% del total recibían inhibidores de la enzima convertidor de la angiotensina (IECA)/Antagonistas del receptor de angiotensina (ARA), seguidos de diuréticos (40,8%), bloqueantes de canales de calcio (25,1%), y betabloqueantes (12,5%). La mayoría (más del 55%) estaban en monoterapia o sin tratamiento. Más del 55% de los pacientes con la PA controlada utilizaban IECA. Más de la mitad (50,8%) de los pacientes con la PA controlada estaban con tratamiento de combinación, mientras que el 42,3% de los pacientes con PA descontrolada estaban con tratamiento combinado (p=0,24). Alcanzaron la PA deseada más pacientes del grupo EIC que del grupo no-EIC (p=0,019). La comparación entre los grupos EIC y no-EIC indicó que no había diferencia significativa en la utilización de ningún grupo de medicamentos con los IECA, siendo estos los más utilizados en los dos grupos. Conclusión: Los patrones de utilización de antihipertensivos fueron generalmente no consistentes con las recomendaciones internacionales. Las posibles mejoras incluyen aumentar las combinaciones de los IECA, disminuir la proporciona de pacientes no tratados, y aumentar la proporción de pacientes con PA controlada en esta población.
Objective To assess adherence of
Palestinian hypertensive patients to therapy and to investigate the effect of a
range of demographic and psychosocial variables on medication adherence.
Methods
A questionnaire-based, cross-sectional descriptive study was undertaken at
a group of outpatient clinics of the Ministry of Health, in addition to a group
of private clinics and pharmacies in the West Bank. Social and demographic
variables and self-reported drug adherence (Morisky scale) were determined for
each patient.
Results Low adherence with medications was present in 244 (54.2%) of the
patients. The multivariate logistic regression showed that younger age
(<45 years), living in a village compared with a city, evaluating
health status as very good, good or poor compared with excellent,
forgetfulness, fear of getting used to medication, adverse effect, and dissatisfaction
with treatment had a statistically significant association with lower levels of
medication adherence (P < 0.05).
Conclusions Poor adherence to medications was very common. The findings
of this study may be used to identify the subset of population at risk of poor
adherence who should be targeted for interventions to achieve better blood
pressure control and hence prevent complications. This study should encourage
the health policy makers in Palestine to implement strategies to reduce
non-compliance, and thus contribute toward reducing national health care
expenditures. Better patient education and communication with healthcare
professionals could improve some factors that decrease adherence such as forgetfulness
and dissatisfaction with treatment.
Purpose To explore the frequency of CAM
use among hypertensive patients in Palestine, determine demographic
characteristics that may increase the likelihood of CAM use and to find out how
benefits were perceived by patients.
Methods Across-sectional survey of
patients attending outpatient hypertension clinics. The method was based on a
semi-structured questionnaire.
Results Of the 4575 hypertensive patients
interviewed, 85.7% respondents used at least one type of CAM. Of the 3921 CAM
users, 62.13% reported taking herbs. Most of these users were >50 years old,
of low educational level, and had a family history of HTN, 62.9% claimed to
have obtained the desired effect from taking these herbs; however, 68.1% did
not disclose this fact to their health care providers, 83 plant taxa were
reported by these patients, Allium sativum was the most commonly used herb.
Conclusions
The use of CAM, particularly herbal therapies for hypertension treatment,
is highly prevalent in Palestine.
Background: The concepts of medication adherence and
Treatment satisfactions are commonly used in clinical research for assessing
pharmaceutical care and improving treatment outcomes. Generally, one would
expect a positive relationship between the two concepts. The objectives of this
study were to investigate the factors associated with adherence to
antihypertensive therapy among hypertensive patients and to assess the
relationship between antihypertensive medication adherence and treatment
satisfaction.
Methods: A cross-sectional study was conducted, adopting the Morisky eight-item
Medication Adherence Scale (MMAS) for the assessment of medication adherence
and using the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4)
for the assessment of treatment satisfaction. Descriptive and comparative
statistics were used to describe socio-demographic and disease-related
characteristics of the patients. All analyses were performed using SPSS v 15.0.
Results: Four hundred and ten hypertensive patients were enrolled in the study.
The mean age of participants was 58.38 ± 10.65 years; 52% were female and
36.8% had low antihypertensive medication adherence. There was a significant
difference in the mean scores in the Effectiveness (p < 0.001), Convenience
(p < 0.001), and Global Satisfaction (p < 0.001) domains, but not in the
Side Effects (p = 0.466) domain among patients with different levels of
adherence. After adjustment for covariates using multiple linear regression,
global treatment satisfaction was still statistically significantly (p = 0.001)
associated with medication adherence.
Conclusions: Low treatment satisfaction may be an important barrier for
achieving high rates of adherence to treatment. These study findings could be
helpful in clinical practice, mainly in the early treatment of hypertensive
patients, at a point where improving treatment satisfaction is still possible.
Objective: The aim of this study was to assess the
relationship between antihypertensive medication adherence and HRQoL. Methods:
A cross-sectional study was conducted, adopting the Morisky eight-item
Medication Adherence Scale (MMAS) for the assessment of medication adherence
and using the European Quality of Life scale (EQ-5D-5L) for the assessment of
HRQoL. Descriptive and comparative statistics were used to describe
socio-demographic and disease-related characteristics of the patients. All
analyses were performed using SPSS v 15.0.
Results: Four hundred and ten
hypertensive patients were enrolled in the study. The mean age of participants
was 58.38 ± 10.65 years; 52% were female and 36.8% had low antihypertensive
medication adherence. Patients with a high adherence rate had the highest HRQoL
scores compared with those with a low or medium adherence rate (Kruskal–Wallis
test; p < 0.05). After adjustment for covariates using multiple regression,
HRQoL was still statistically significantly associated with medication
adherence (p = 0.001). Conclusions: Low HRQoL may be an important barrier to
achieving high rates of adherence to treatment. These study findings could be
helpful in clinical practice, mainly in the early treatment of hypertensive
patients, at a point where improving HRQoL is still possible.
Hypertension is one of the most important risk factors for coronary heart disease, heart failure, renal failure and stroke, and it remains an important public health challenge which contributes to disability, health care costs and mortality [1] and [2]. The concepts of medication adherence and health-related quality of life (HRQoL) are commonly used in clinical research for assessing pharmaceutical care and improving treatment outcomes [3]. Adherence to drug treatment usually refers to the extent to which patients follow the instructions of their physician or health care providers. HRQoL also refers to the physical, psychological and social dimensions of health that are influenced by a person's experiences, beliefs, expectations and perceptions [4]. Generally one would expect a positive relationship between the two concepts. The objective of this study was to examine the relationship between adherence and HRQoL in a hypertensive population. Knowledge of any differences in HRQoL in this population may be helpful in the planning of therapeutic interventions that will ensure desirable HRQoL and not just the control of blood pressure. Knowledge of HRQoL in hypertensive patients and of the relationship between HRQoL and adherence, being a reliable determinant of cardiovascular disease (CVD) events, will be helpful in preventing or reducing the incidence of CVDs.
Abstract BACKGROUND: Hypertension and ischemic heart disease (IHD) are among the most prevalent modifiable risk factors for stroke. Clinical trial evidence suggests that antihypertensive medications are recommended for prevention of recurrent ischemic stroke in hypertensive and normotensive patients.
OBJECTIVES: The objectives of this study were to analyze and evaluate the utilization of antihypertensive medication for acute ischemic stroke (AIS) or transient ischemic attack (TIA) survivors in relation to recent recommendations and guidelines and to compare their use among patients with or without IHD.
METHODS: This was a retrospective cohort study of all patients with AIS/TIA attending the hospital from July 1, 2008 to December 31, 2008. Demographic data, clinical characteristics, different classes of antihypertensive medications, and different antihypertensive combinations prescribed to AIS/TIA survivors were analyzed among patients with and without IHD. Statistical Package for Social Sciences (SPSS) program version 15 was used for data analysis. RESULTS: In all, 383 AIS/TIA survivors were studied, of which 66 (19.5%) had a documented history of IHD. Three quarters (n = 260; 76.9%) of AIS or TIA survivors received antihypertensive medication, mostly as monotherapy, at discharge. The majority of patients (n = 201, 59.5%) were prescribed angiotensin-converting enzyme inhibitors (ACEIs). Patients with IHD were significantly prescribed more β-blockers than patients without IHD (P = .003). A history of hypertension, a history of diabetes mellitus, and age were significantly associated with prescription of antihypertensive medications at discharge (P < .001, P < .001, and P < .001, respectively).
CONCLUSION: Patterns of antihypertensive therapy were commonly but not adequately consistent with international guidelines. Screening stroke survivors for blood pressure control, initiating appropriate antihypertensive medications, and decreasing the number of untreated patients might help reduce the risk of recurrent strokes and increase survival.
Background and objective Anti-hypertensive medications are recommended for prevention of recurrent ischemic stroke in hypertensive and normotensive patients. The objective of this study was to analyze the use of anti-hypertensive therapy in acute ischemic stroke survivors.
Methods All ischemic stroke survivors discharged from Al-watani governmental hospital in Palestine from August 2006 until September 2007 were investigated. Demographic data, clinical characteristics, and different classes of anti-hypertensive medications prescribed to stroke survivors were analyzed using SPSS 15. Results One hundred and twenty four ischemic stroke survivors were identified, of which 80 (64.5%) had a documented history of hypertension (HTN). Two thirds of the survivors (n = 82; 66.1%) were prescribed anti-hypertensive medications, mostly as mono-therapy, at discharge. Angiotensin-converting enzyme inhibitors (ACEI) 65 (45.6%), followed by diuretics 41 (34.5%) were the most common drug classes prescribed. ACEI were used in combination with diuretics in 29 (23.4%) survivors. Among survivors with a documented history of HTN, 70 (85.5%) were prescribed anti-hypertensive medications at discharge while 12 (8.5%) of survivors with no history of HTN were prescribed anti-hypertensive medications at discharge.
Conclusion In this study, the use of anti-hypertensive medications as a mono-therapy was common among those with a history of hypertension but not among those without a history of hypertension.
Background and objective Anti-hypertensive medications are recommended for prevention of recurrent ischemic stroke in hypertensive and normotensive patients. The objective of this study was to analyze the use of anti-hypertensive therapy in acute ischemic stroke survivors.
Methods All ischemic stroke survivors discharged from Al-watani governmental hospital in Palestine from August 2006 until September 2007 were investigated. Demographic data, clinical characteristics, and different classes of anti-hypertensive medications prescribed to stroke survivors were analyzed using SPSS 15. Results One hundred and twenty four ischemic stroke survivors were identified, of which 80 (64.5%) had a documented history of hypertension (HTN). Two thirds of the survivors (n = 82; 66.1%) were prescribed anti-hypertensive medications, mostly as mono-therapy, at discharge. Angiotensin-converting enzyme inhibitors (ACEI) 65 (45.6%), followed by diuretics 41 (34.5%) were the most common drug classes prescribed. ACEI were used in combination with diuretics in 29 (23.4%) survivors. Among survivors with a documented history of HTN, 70 (85.5%) were prescribed anti-hypertensive medications at discharge while 12 (8.5%) of survivors with no history of HTN were prescribed anti-hypertensive medications at discharge.
Conclusion In this study, the use of anti-hypertensive medications as a mono-therapy was common among those with a history of hypertension but not among those without a history of hypertension.