Clinical, Socioeconomic, and Psychosocial Factors Associated with Blood Pressure Control and Adherence: Results from a Multidisciplinary Cardiovascular National Program Providing Universal Coverage in a Developing Country

Abstract

Background Limited information exists on blood pressure (BP) control factors and adherence to antihypertensive drug therapy (Rx) in developing countries. Methods Cross-sectional study in randomly selected 992 hypertensive patients under a Chilean national comprehensive Cardiovascular Health Program (CVHP). Association of education, income, diabetes, obesity, physical activity, psychosocial characteristics, smoking, and alcohol abuse with BP control and adherence were evaluated by multivariate logistic regression. Results BP control (<140/90 mmHg) was achieved in 63.1% of patients, with 38.4% adherent to Rx. Uncontrolled BP significantly associated with male sex (OR: 1.73 [95% CI 1.35-2.22]), low family income, high emotional-stress-depression score, body mass index, no adherence (OR: 1.83 [95% CI 1.44 - 2.32]), multiple Rx, baseline systolic BP value, and sedentary life style. Males (OR: 1.54 [95% CI 1.23 - 1.93]), low family income, high emotional stress-depression score (OR: 2.15 [95% CI 1.68 - 2.76]), low social support, and uncontrolled BP (OR: 1.52 [95% CI 1.22-1.90]) associated with no adherence. Conclusions Comparable BP control (63.1%) to higher-income societies was observed. Uncontrolled BP associated significantly to no adherence and both to male sex, socioeconomic, and psychosocial factors. Global low adherence (38.4%) and improved BP control and adherence in diabetics were noted.

<p>Magnitude and Determinants of Uncontrolled Blood Pressure Among Adult Hypertensive Patients on Follow-Up at Nekemte Referral Hospital, Western Ethiopia</p>

“…The major finding of this study revealed that about two-thirds of the hypertensive patients on antihypertensive treatment had controlled BP. The level of BP control found in this study (63.6%) was relatively comparable with studies from health care in Chilean (59.7%), 39 in USA at different levels of the health system (60%), 40 South Africa (57%), 41 Bhusal et al in India (58.9%), 5 by Sandoval et al in Chile (63.1%) 27 and by Cordero et al in Spain (55.4%). 10 This close similarity in the level of BP control might be due to similarities in the eligibility criteria for the studies as only hypertensive patients on pharmacologic therapy were included.…”

“…The participants were classified as physically active if they perform a physical exercise for at least 30 minutes per day for at least 5 days per week (≥150minutes per week), otherwise, they were classified as physically inactive. 9,21,27,38 This physical exercise includes work or sports that involve a moderate-intensity activity that causes small increases in breathing or heart rate, such as brisk walking, carrying light loads, cycling, swimming, volleyball, dancing, farming, gardening, and house working. 16,21…”

“…15 Limited information exists on BP control factors and adherence to antihypertensive drug therapy in developing countries. 1,27 Current disease estimates for SSA are based on limited data and hypertension control assumes a relatively low priority and little experience exists in implementing sustainable and successful programs. 3 Although several studies have shown the prevalence and factors associated with HTN in Ethiopia, there is limited information about the magnitude and determinants of blood control status in Ethiopia.…”

The Relationship between Socioeconomic Status and Adherence to Antihypertensive Treatment Regimen in a Metropolitan Community Sample of Hypertensive African Americans in New York

“…Socioeconomic factors impact hypertension control with respect to diagnosis, treatment, and patient's access and longterm adherence to recommended treatment regimens, and studies suggest that patients with lower SES receive fewer preventive services, lower rates of use of evidence-based therapies, and fewer indicated interventions such as coronary angiography and organ transplantation. [12][13][14] The World Health Organization (WHO) Global Action Plan for the Prevention and Control of noncommunicable diseases (NCDs) targets seven major health risk factors, including insufficient physical activity, current tobacco use and raised blood pressure, for reducing premature mortality from non-communicable diseases by 25% by 2025. Despite being one of the strongest predictors of morbidity and premature mortality worldwide, low socioeconomic status was not included among modifiable risk factors.…”

“…19 Psychosocial factors seem to be the driving force of the relationships between socioeconomic factors and adherence. 14,16 For example, in a cross sectional study of randomly selected hypertensive patients (N=992) under a comprehensive cardiovascular health program, the associations of education, income, diabetes, obesity, physical activity, psychosocial characteristics, smoking, and alcohol abuse with blood pressure control and adherence were evaluated by multivariate logistic regression. 14 Uncontrolled blood pressure was significantly associated with low family income, high emotional-stress-depression score and sedentary life style, among other factors.…”