Exploring factors associated with patients’ adherence to antihypertensive drugs among people with primary hypertension in the United Kingdom

Kurdi, Amanj; Chen, Li‐Chia; Elliott, Rachel A.

doi:10.1097/hjh.0000000000001382

Cited by 14 publications

(9 citation statements)

References 49 publications

(54 reference statements)

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“…Perceived barrier was the important predictor in non-compliance to antihypertensive drugs this was agreed with study conducted on Health Beliefs and Medication Adherence in Patients with Hypertension, reported adherence to antihypertensive medications is higher with less perceived barriers [23]. This is true according health belief model when a person perceives there is a barrier of taking medication, he will not comply to his medication as supposed and this will lead to complications and/or death.…”

Section: Discussionsupporting

confidence: 72%

Using the Health Believe Model to Explain the Patient’s Compliance to Anti-hypertensive Treatment in Three District Hospitals - Dar Es Salaam, Tanzania: A Cross Section Study

Joho

Leshabari

2019

Preprint

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Background Hypertension is one of the most important cardiovascular risk factors; but compliance to anti-hypertensive medications remains to be a public health challenge worldwide. Health belief model have been used to explain adoption of preventive measures to health problems. This study used the health belief model as a framework to explain the compliance to anti-hypertensive drugs among elderly hypertensive patients. The study aimed at finding the influence of health belief model in treatment compliance among elderly hypertensive patients in three district hospitals in Dar es Salaam, Tanzania. Methods We conducted an analytical cross- sectional study in three District hospitals in Dar es Salaam Region. We included patients who were on antihypertensive medications. Simple random sampling was used to enrol study participants. Data were collected using structured questionnaires. Data were analysed using SPSS. Frequency distribution and Multivariate analysis was done using Linear Multiple Regression to identify variables which are strongest predictor of treatment compliance among variables of Health Believe Model. Results: A total of 135 participants were enrolled, 56% were compliant to treatment. Multiple linear regression was used to operationalize the Health Belief Model with treatment compliance being dependant variable. The predictor variables were perceived benefit, perceived barriers and cues to action. Multivariate analysis indicated significant model fit for the data (F = 11.19 and P value < 0.001). The amount of variance in treatment compliance that is explained by the predictors is 30.3% (R² = 0.303) with perceived barrier being the strongest predictor of treatment compliance (β = -0.477; p < 0.001). A negative beta coefficient indicates a negative association between perceived barriers and treatment compliance. Other predictor variables were not statistically associated with treatment compliance. Conclusion: The study showed that almost half of study participants had hypertensive treatment compliance, with the use of health believe model the important strongest variable was perceived barrier to treatment. An innovative strategy on improving patients’ perception of barrier to treatment is recommended to increase treatment compliance. Key words: Hypertension, Treatment compliance, lifestyle

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Section: Discussionsupporting

confidence: 72%

Using the Health Believe Model to Explain the Patient’s Compliance to Anti-hypertensive Treatment in Three District Hospitals - Dar Es Salaam, Tanzania: A Cross Section Study

Joho

Leshabari

2019

Preprint

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“…Indeed, this decreasing trend was also seen in our findings specific to patients with hypertension. As thiazide diuretics have been associated with lower treatment adherence compared with ACE inhibitors, ARBs and CCBs,40–42 this could have led clinicians to favour other classes with higher adherence. Indeed, we observed a shorter number of days between treatment changes in patients with thiazide diuretic prescriptions relative to other drugs.…”

Section: Discussionmentioning

confidence: 99%

Treatment and prescribing trends of antihypertensive drugs in 2.7 million UK primary care patients over 31 years: a population-based cohort study

Rouette,

McDonald,

Schuster

et al. 2022

BMJ Open

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ObjectivesTo describe the prescribing trends of antihypertensive drugs in primary care patients and assess the trajectory of antihypertensive drug prescriptions, from first-line to third-line, in patients with hypertension according to changes to the United Kingdom (UK) hypertension management guidelines.DesignPopulation-based cohort study.Setting and participantsWe used the UK Clinical Practice Research Datalink, an electronic primary care database representative of the UK population. Between 1988 and 2018, we identified all adult patients with at least one prescription for a thiazide diuretic, angiotensin-converting enzyme (ACE) inhibitor, angiotensin receptor blocker, beta-blocker or calcium channel blocker (CCB).Primary and secondary outcome measuresWe estimated the period prevalence of patients with antihypertensive drug prescriptions for each calendar year over a 31-year period. Treatment trajectory was assessed by identifying patients with hypertension newly initiating an antihypertensive drug, and treatment changes were defined by a switch or add-on of a new class. This cohort was stratified before and after 2007, the year following important changes to UK hypertension management guidelines.ResultsThe cohort included 2 709 241 patients. The prevalence of primary care patients with antihypertensive drug prescriptions increased from 7.8% (1988) to 21.9% (2018) and was observed for all major classes except thiazide diuretics. Patients with hypertension initiated thiazide diuretics (36.8%) and beta-blockers (23.6%) as first-line drugs before 2007, and ACE inhibitors (39.9%) and CCBs (31.8%) after 2007. After 2007, 17.3% were not prescribed guideline-recommended first-line agents. Overall, patients were prescribed a median of 2 classes (IQR 1–2) after first-line treatment.ConclusionNearly one-quarter of primary care patients were prescribed antihypertensive drugs by the end of the study period. Most patients with hypertension initiated guideline-recommended first-line agents. Not all patients, particularly females, were prescribed recommended agents however, potentially leading to suboptimal cardiovascular outcomes. Future research should aim to better understand the implication of this finding.

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“…Differences in adherence by subclasses may influence our results, but evidence does not suggest adherence is clearly better or worse for angiotensin-II-stimulating compared to angiotensin-II-inhibiting drug classes; dosing frequency and number of concurrent medications seem more important factors for adherence. [35][36][37][38] How treatment duration and exposure affects the observed risks requires future study. Third, dementia was operationalized as an independent committeeadjudicated clinical diagnosis, confirmed after one year additional follow-up.…”

Section: A C C E P T E D Discussionmentioning

confidence: 99%

Association of Angiotensin II–Stimulating Antihypertensive Use and Dementia Risk

et al. 2021

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ObjectiveTo assess whether angiotensin-II stimulating antihypertensives (thiazides, dihydropyridine calcium channel blockers, and angiotensin-1 receptor blockers) convey a lower risk of incident dementia compared to angiotensin-II inhibiting antihypertensives (angiotensin-converting enzyme inhibitors, beta blockers, and non-dihydropyridine calcium channel blockers), in accordance with the “angiotensin hypothesis.”MethodsCox regression analyses of incident dementia (and/or mortality as competing risk) during 6–8 years of follow-up, in a population sample of 1909 non-demented community-dwelling individuals (54% women), aged 70–78 (mean: 74.5 ± 2.5) years.ResultsAfter a median of 6.7 years of follow-up, dementia status was available for 1,870 (98%) and mortality for 1,904 (>99%) participants. Dementia incidence was 5.6% (27/480) in angiotensin-II stimulating, 8.2% (59/721) in angiotensin-II inhibiting, and 6.9% (46/669) in both antihypertensive type users. Adjusted for dementia risk factors including blood pressure and medical history, angiotensin-II stimulating antihypertensive users had a 45% lower incident dementia rate (HR = 0.55, 95% CI = 0.34–0.89) without excess mortality (HR = 0.86, 95% CI = 0.64–1.16), and individuals using both types had a non-significant 20% lower dementia rate (HR = 0.80, 95% CI = 0.53–1.20) without excess mortality (HR = 0.97, 95% CI = 0.76–1.24), compared to angiotensin-II inhibiting antihypertensive users. Results were consistent for subgroups based on diabetes and stroke history, but may be specific for individuals without a history of cardiovascular disease.ConclusionsUsers of angiotensin-II stimulating antihypertensives had lower dementia rates compared to angiotensin-II inhibiting antihypertensive users, supporting the “angiotensin hypothesis.” Confounding by indication must be examined further, although sub-analyses suggest this did not influence results. If replicated, dementia prevention could become a compelling indication for older individuals receiving antihypertensive treatment.

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Exploring factors associated with patients’ adherence to antihypertensive drugs among people with primary hypertension in the United Kingdom

Abstract: (248 words) 1Objective 2

Cited by 14 publications

References 49 publications

Using the Health Believe Model to Explain the Patient’s Compliance to Anti-hypertensive Treatment in Three District Hospitals - Dar Es Salaam, Tanzania: A Cross Section Study

Using the Health Believe Model to Explain the Patient’s Compliance to Anti-hypertensive Treatment in Three District Hospitals - Dar Es Salaam, Tanzania: A Cross Section Study

Treatment and prescribing trends of antihypertensive drugs in 2.7 million UK primary care patients over 31 years: a population-based cohort study

Association of Angiotensin II–Stimulating Antihypertensive Use and Dementia Risk

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