ABSTRACT
Antecedentes: Inadecuado control de presión arterial (PA) y baja adherencia a tratamiento farmacológico (Rx) en hipertensos son problemas persistentes globales y en Chile. Factores socioeconómicos y psicosociales han sido frecuentemente mencionados, pero escasamente en Chile. Objetivo: Evaluar control de la PA y adherencia a Rx en hipertensos seguidos en el Programa de Salud Cardiovascular (PSCV) y su asociación con factores clínicos, socioeconómicos y psicosociales. Métodos: Muestra randomizada de 1.794 hipertensos seguidos por 1 año en PSCV en Región Metropolitana. Se evaluó la asociación de edad, sexo, educación, ingreso familiar, Rx, diabetes, obesidad, tabaquismo, consumo problemático de alcohol y actividad física con el control de la PA (<140/90 mmHg) y adherencia. Además, en 600 pacientes, se evaluó la asociación con estrés emocional/depre-sión, relación médico-paciente y apoyo social. Se obtuvieron Odds Ratio (OR) mediante análisis de regresión logística multivariante. Resultados: PA controlada se comprobó en 56,5% y adherencia en 37,3% sin documentarse asociación entre ambas (OR 1,01 [IC 95% 0,78 - 1,32]). Factores asociados a PA no controlada y no adherencia fueron: edad, bajo ingreso familiar, inadecuada relación medico-paciente y alto nivel de estrés emocio-nal/depresión. Rx múltiple y obesidad se asociaron a PA no controlada; sexo masculino y baja educación a no adherencia. Conclusiones: El control de la PA (56,5%) fue similar a resultados de países desarrollados y supera ampliamente cifras de la Encuesta Nacional de Salud 2010 (16,9%). Estos resultados y la falta de asociación entre el control de la PA y la adherencia, sugieren la favorable influencia de otros factores posiblemente relacionados al PSCV.
Background: Unsatisfactory blood pressure (BP) control and low adherence to antihypertensive pharmacotherapy (Rx) in hypertensive populations are persistent problems worldwide and also in Chile. Socioeconomic and psychosocial factors have been frequently mentioned, but with limited contributions from Chile. Objective: The assessment of BP control and adherence to Rx in hypertensive patients followed in the Cardiovascular Health Program (CVHP) and to determine their association with clinical, socioeconomic and psychosocial characteristics. Methods: A randomized sample of 1,794 hypertensive patients followed for 1 year under the CVHP in Metropolitan Region. Association of BP control (<140/90 mmHg) and adherence with age, gender, education, income, Rx, diabetes, obesity, smoking, alcohol use problem and physical activity were analyzed. In a subgroup of 600 patients additional analysis included the association with emotional stress and depression, patient-physician relation and social support. Odds Ratio (OR) were obtained by multivariate logistic regression. Results: BP control was achieved in 56.5% and adherence in 37.3%. No association was found between them (OR 1.01 [CI 95% 0.78-1.32]). Uncontrolled BP and no adherence were associated to advanced age, low income, poor patient-physician relation and high stress-depression. Obesity and multiple Rx were associated to uncontrolled BP. Male gender and low education, were associated to no adherence. Conclusions: BP control (56.5%) was similar to results obtained in developed countries and is strikingly higher than the results reported in the 2010 Chilean National Health Survey (16.9%). These results and the lack of association between BP control and adherence suggest the favorable influence of unaccounted factors, possibly related to the CVHP.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Primary Health Care , Patient Compliance , Arterial Pressure/drug effects , Hypertension/drug therapy , Physician-Patient Relations , Socioeconomic Factors , Logistic Models , Multivariate Analysis , Surveys and Questionnaires , Medication Adherence , Life Style , Antihypertensive Agents/therapeutic useABSTRACT
Background: Inadequate blood pressure control in hypertensive patients remains a persistent health problem in Chile and worldwide. Poor adherence to antihypertensive drug therapy is one of the frequently cited factors. Objectives: To determine the influence of psychosocial factors in the adherence to drug therapy in hypertensive patients followed through a Cardiovascular Health Program (CHP) that provides free access to primary care centers located in the Metropolitan Region of Santiago, Chile. Methods: Cross sectional study. A randomized sample of 513 hypertensive patients (30 to 68 years) was obtained from a universe of 1.484 patients. Adherence to treatment was determined by the Morisky-Green-Levine test. Demographic, socioeconomic and average values of blood pressure were recorded. Validated questionnaires were utilized to assess the patient-physician relationship, awareness of being hypertensive, patient perception of social support, family cohesion, patient self-health assessment and symptoms of emotional stress and depression. Results: The drug therapy adherence was 36.6%, higher in women (38.4% vs 28.9%; p < 0.001). After multivariate analysis, absence of adherence was associated with male gender (OR: 1.76 [95% CI 1.21-2.56]), low education (OR: 1.72 [95% CI 1.18 to 2.53]), inadequate patient-physician relationship (OR: 1.56 [95% CI 1.13 to 2.27]), and high level of emotional stress and depression (OR: 1.93 [95% CI 1.27 to 2.94]). Conclusions: Our study highlights the influence of inadequate patient-physician relation, high level of emotional stress and depression, low education level and income and male gender in the lack of adherence to antihypertensive drug therapy in hypertensive patients followed throughout the CHP.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Hypertension/drug therapy , Medication Adherence/psychology , Antihypertensive Agents/therapeutic use , Chile , Cohort Studies , Hypertension/psychology , Medication Adherence/statistics & numerical data , Surveys and Questionnaires , Risk Factors , Socioeconomic Factors , Urban PopulationABSTRACT
Antecedentes: El control de la presión arterial (PA) es fundamental en reducir la morbi-mor-talidad en hipertensos, pero con resultados hasta la fecha insatisfactorios en Chile y en países de alto desarrollo socioeconómico. En Chile se inició en 2002 el Programa de Salud Cardiovascular (PSCV) intentando mejorar el manejo de estos pacientes. Objetivos: Evaluar características sociodemográ-ficas, clínicas, antropométricas, psicosociales y de estilos de vida de un grupo de pacientes participantes en el PSCV, y la influencia de estos factores en el control de la PA. Métodos: Se obtuvo una muestra aleatoria de 525 pacientes (380 mujeres) de un universo de 1.533 hipertensos entre 30 y 68 años bajo seguimiento en el PSCV. Se registraron datos sociodemográficos, clínicos, antropométricos, psicosociales y de estilos de vida a través de evaluación clínica y cuestionarios validados. La PA fue medida utilizando un protocolo estándar por personal entrenado. El análisis estadístico incluyó la predicción del riesgo (Odds RATIO) de PA no controlada por las diversas características estudiadas. Resultados: El 47 por ciento de los pacientes logró una PA controlada (<140/90 mmHg). La presencia de diabetes mellitus (DM) fue documentada en el 38,5 por ciento. Factores predictores significativos de PA no controlada fueron DM, baja educación, inadecuada relación médico paciente y alto nivel de estrés emocional/depresión. Conclusiones: El PSCV ha logrado un avance importante en el control de la PA resaltando la influencia significativa de factores psicosociales. Sin embargo es preocupante la alta proporción de hipertensos diabéticos, su inferior control de PA, y la limitada captación de hombres al programa.
Background: Blood pressure (BP) control is a necessary requirement to reduce cardiovascular events and mortality in hypertensive patients, but so far results have been disappointing in Chile and also in countries with advanced socioeconomic development. Since 2002 a Cardiovascular Health Program (CHP) was launched in Chile attempting to improve the outcomes in these patients. Objectives: To assess the influence of sociodemo-graphic, clinical, anthropometric, psychosocial, lifestyle habits characteristics upon BP control (<140/90 mmHg) in a group of hypertensive patients referred to the CHP. Methods: A cross sectional study of a random sample of 525 hypertensive patients (380 women) obtained from a universe of 1,533 patients with ages ranging from 30 to 68 years was performed. Socio-demographic, clinical, anthropometric, psychosocial and lifestyle habits data were collected through clinical evaluation and validated questionnaires. Trai-ned personnel using standard protocols recorded BP. Adjusted ODDS RATIOS were used to assess theinfluence of different population characteristics upon blood pressure control . Results: A controlled BP (<140/90 mmHg) was achieved in 47 percent of patients, and 38.5 percent presented diabetes mellitus (DM). Significant predictors of uncontrolled BP (>140/90 mmHg) were DM, low education, unsatisfactory patient-physician relation, and high score of emotional stress /depression. Conclusions: In Chile the CHP has achieved an important progress in BP control in hypertensive patients. Psychosocial factors influenced significantly these results. It is concern the high proportion of diabetics in this hypertensive population and their unsatisfactory BP control. The lower proportion of men enrolled in the CHP needs additional analysis and corrective actions.