Understanding Barriers to Adherence to Optimal Treatment of Elevated Blood Pressure and Hypertension—Insights From Primary Care

Abstract

Lifestyle modifications, including the restriction of dietary sodium intake, have been recommended worldwide as first-line treatment for people with elevated blood pressure. 1 Recent evidence has further confirmed the benefits of salt substitutes in terms of reduced rates of stroke, major cardiovascular events, and death. 2 The study by Liu et al 3 explores the acceptability of, and adherence to, a salt substitute as well as the barriers to sodium reduction. In this mixed-methods investigation conducted in rural China, participants from the Salt Substitute and Stroke Study were used. 2 A total of 1025 participants completed the knowledge, attitude, and practice questionnaire regarding salt intake, while 30 participants receiving salt substitutes completed qualitative interviews. Despite finding that the overall acceptability of the use of salt substitutes in daily life among rural participants was high, an inadequate awareness of the recommended daily salt intake was reported. In addition, participants commonly reported being unaware of the health benefits of consuming salt substitutes and reported still favoring the use of regular salt when preparing pickled foods. Barriers to sustainable adoption of salt substitutes included insufficient health education, self-perceived high costs, and contextual factors (such as preference for habitual flavors of food). The authors suggested that these barriers should be taken into account in formulating sodium reduction strategies in rural areas.

Frequency of Follow-Up Attendance and Blood Glucose Monitoring in Type 2 Diabetic Patients at Moderate to High Cardiovascular Risk: A Cross-Sectional Study in Primary Care

“…It was previously reported that a lower frequency of blood glucose monitoring profile was related to poor knowledge of blood glucose control [ 16 ]. It is reasonable to assume that patients who reported that they had their blood glucose tested only at primary care facilities may have no additional monitoring of blood glucose or blood pressure at home, which may contribute to the barriers to continuous treatment [ 34 ]. This may underscore a greater need for developing patients’ knowledge and skills required to control blood glucose among T2DM patients with risk factors identified in our study.…”

Longitudinal changes in blood pressure and fasting plasma glucose among 5,398 primary care patients with concomitant hypertension and diabetes: An observational study and implications for community-based cardiovascular prevention

“…However, there remain substantial physician- and system-level barriers to the management of hypertension and its complications, given the poor availability of manpower and limited clinical capacity in low-resource primary care settings where multi-component complex interventions are less common ( 21 – 23 ). The barriers are likely exacerbated by the traditional single disease approach ( 24 , 25 ), coupled with “clinical inertia”, i.e., a common failure of physicians to initiate or intensify care regime when indicated ( 26 ), thus leading to difficulties in maintaining satisfactory control of BP and FPG over time ( 27 , 28 ), with increased incidence of cardiovascular events ( 29 ).…”

Identifying barriers, facilitators, and interventions to support healthy eating in pregnant women with or at risk for hypertensive disorders of pregnancy

“…While various studies have examined the associated difficulties in adherence to hypertensive treatment regimens in nonpregnant populations, 9 , 10 studies examining the barriers to a healthy diet in pregnant women with HTN or HDP are limited. Other studies have looked at barriers to therapies addressing obesity and diabetes, common risk factors for HDP.…”