Adherence to anti-hypertensive treatment within a chronic disease
					management  program: A longitudinal, retrospective study

Raymundo, Ana Carolina Nascimento; Pierin, Angela Maria Geraldo

doi:10.1590/S0080-6234201400005000006

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Sumário

Original Article • Rev. esc. enferm. USP 48 (05) • Oct 2014 • https://doi.org/10.1590/S0080-6234201400005000006 copy

Adherence to anti-hypertensive treatment within a chronic disease management  program: A longitudinal, retrospective study^* * Extracted from the thesis "O monitoramento de enfermagem em um programa de gestão de doenças crônicas: seguimento de um grupo de hipertensos", Graduate Program in Adult Health Nursing, School of Nursing, University of São Paulo, 2014

Adesão ao tratamento de hipertensos em um programa de gestão de doenças crônicas: estudo longitudinal retrospectivo  adhesión al tratamiento de hipertensos en un programa de gestión de enfermedades crónicas: estudio longitudinal retrospectivo

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective

This study assessed pharmacological treatment adherence using the Morisky-Green Test and identified related variables.

Method

A longitudinal and retrospective study examined 283 patients with hypertension (62.5% women, 73.4 [10.9] years old) who were being monitored by a chronic disease management program for 17 months between 2011 and 2012. Nurses performed all the actions of the program, which consisted of advice via telephone and periodic home visits based on the risk stratification of the patients.

Results

A significant increase in treatment adherence (25.1% vs. 85.5%) and a decrease in blood pressure were observed (p<0.05). Patients with hypertension and chronic renal failure as well as those treated using angiotensin-converting enzyme inhibitors were the most adherent (p<0.05). Patients with hypertension who received angiotensin receptor blockers were less adherent (p<0.05).

Conclusions

Strategies such as nurse-performed chronic disease management can increase adherence to anti-hypertensive treatment and therefore contribute to the control of blood pressure, minimizing the morbidity profiles of patients with hypertension.

Hypertension; Medication adherence; Nursing care; Chronic disease; Treatment outcome

Variables	Hypertensive patients
Variables	N	%
Gender
Female	177	62.5
Male	106	37.5
Smoke
Yes	10	3.5
Alcohol consumption
Yes	29	10.2
Sedentary
Yes	274	96.8
BMI (kg/m2)
<18.5	3	1.1
18,5 – 24.9	82	30.8
25 – 29.9	97	36.5
30 – 34.9	59	22.2
35 – 39.9	19	7.1
>40	6	2.3
Mean BMI (sd) in kg/m2	27.7 (4.9)
Age group in years
≤ 40	2	0.7
41 - 50	8	2.8
51 - 60	21	7.4
61 - 70	73	25.8
71 - 80	100	35.3
> 80	79	27.9
Mean age (sd) in years	73.4 (10.9)
Blood pressure systolic/diastolic, mmHg
Optimal (<120/80)	34	13
Normal (<130/85)	104	39.8
Borderline (130-139/85-89)	25	9.6
Stage 1 (140-159/90-99)	24	9.2
Stage 2 (160-179/100-109)	13	5
Stage 3 (> 180/110)	11	4.2
Isolated Systolic >140/<90)	50	19.2
Mean blood pressure (sd), systolic/diastolic, mmHg	128.8 (11.4)/78.9 (7.8)

Variables	Hypertensive patients
Variables	N	%
Comorbidades
Type 2 diabetes	218	77.0
Heart failure	105	37.1
Dyslipidemia	79	27.9
Chronic renal failure	53	18.7
Coronary artery disease	38	13.4
Stroke	30	10.6
Myocardial infarction	17	6.0
Type 1 diabetes	10	3.5
Medications
Angiotensin receptor blockers	156	55.1
Statins	151	53.4
Diuretics	149	52.7
Beta-blockers	108	38.2
Hypoglycemic agents	105	37.1
Calcium channel blockers	78	27.6
Angiotensin-converting enzyme inhibitors	48	17.0
Insulins	29	10.3
Antiarrhythmics	22	7.8
Central adrenergic agonists	4	1.4
Adherence to medication (Morisky-Green test)
Yes	71	25.1
No	212	74.9
Controlled blood pressure
Yes	163	62.4
No	98	37.6

Variables	Evaluation periods
	1		2		3		4		5
	N	%	N	%	N	%	N	%	N	%
Drug treatment adherence
Yes	71	25.1	150	53	184	65	209	73.9	242	85.5
No	212	74.9	133	47	99	35	74	26.1	41	14.5
p-valvue^* * p-value at period 1 vs. periods 2, 3, 4 and 5			0.00		0.00		0.00		0.00
Mean blood pressure (sd) mmHg
Systolic	128.8 (11.4)		128.2 (11.9)		127.8 (11.90)		126.1 (10.9)		125.1 (11.6)
p-value			0.61		0.23		0.02		0
Diastolic	78.9 (7.8)		79.7 (9.4)		78.5 (7.3)		77.3 (7.0)		77.2 (8.0)
p-value^§ § p-value at period 1 vs. periods 4 and 5			0.11		0.95		0.03		0.05

Variables s	Drug treatment adherence
Variables s	Yes		No		Total		p-valvue
N	%	N	%	N	%		p-valvue
Anti-hypertensives Drug
Angiotensin receptor blockers
Yes	134	53.0	22	73.3	156	55.1	0.03
No	119	47.0	8	26.7	127	44.9
Diuretics
Yes	133	52.6	16	53.3	149	52.7	0.23
No		47.4	14	46.7	134	47.3
Beta-blockers
Yes	96	37.9	12	40.0	108	38.2	0.83
No	157	62.1	18	60.0	175	61.8
Channel calcium blockers
Yes	70	27.7	8	26.7	78	27.6	0.91
No	183	72.3	22	73.3	205	72.4
Angiotensin-converting enzyme inhibitors
Yes	47	18.6	1	3.3	48	17	0.03
No	206	81.4	29	96.7	235	83
Comorbidades
Type 2 diabetes
Yes	193	76.3	25	83.3	218	77	0.38
No	60	23.7	5	16.7	65	23
Heart disease
Yes	116	45.8	14	46.7	130	45.9	0.54
No	137	54.2	16	53.3	153	54.1
Chronic renal failure
Yes	52	20.6	1	3.3	53	18.7	0.02
No	201	79.4	29	96.7	230	81.3
Stroke
Yes	25	9.9	5	16.7	30	10.6	0.34
No	228	90.1	25	83.3	253	89.4
Dyslipidemia
Yes	69	27.3	10	33.3	79	27.9	0.48
No	184	72.7	20	66.7	204	72.1

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Correspondence: Angela Maria Geraldo Pierin.  Rua Heitor Penteado, 250 – Apto. 63 - Sumaré.  CEP 05438-000 – São Paulo, SP, Brazil.  pierin@usp.br

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Adesão ao tratamento de hipertensos em um programa de gestão de doenças crônicas: estudo longitudinal retrospectivo adhesión al tratamiento de hipertensos en un programa de gestión de enfermedades crónicas: estudio longitudinal retrospectivo

Objective

Method

Results

Conclusions

Adesão ao tratamento de hipertensos em um programa de gestão de doenças crônicas: estudo longitudinal retrospectivo  adhesión al tratamiento de hipertensos en un programa de gestión de enfermedades crónicas: estudio longitudinal retrospectivo