Factores relacionados a la adhesión al tratamiento no medicamentoso de la hipertensión en la atención primaria

Nascimento, Monique Oliveira do; Belo, Rebeka Maria de Oliveira; Araújo, Thaís Lorena Lopes de Santana; Silva, Klara Gabriella Nascimento Marques da; Barros, Marcella Di Fatima Ferreira Noya; Figueirêdo, Thaisa Remigio; Bezerra, Simone Maria Muniz da Silva

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Revista Brasileira de Enfermagem

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Sumário

ORIGINAL ARTICLE • Rev. Bras. Enferm. 74 (suppl 6) • 2021 • https://doi.org/10.1590/0034-7167-2020-0173 copiar

Factores relacionados a la adhesión al tratamiento no medicamentoso de la hipertensión en la atención primaria

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivos:

evaluar factores relacionados a adhesión al tratamiento no medicamentoso de hipertensión en Atención Primaria.

Métodos:

estudio transversal, con 421 individuos. Evaluó la adhesión por los componentes: control de peso, circunferencia abdominal, actividad física y consumo de alcohol - conforme recomendaciones de la 7ª Directriz Brasileña de Hipertensión Arterial. Análisis se utilizaron los testes chi-cuadrado y Mann-Whitney.

Resultados:

adhesión al control de circunferencia abdominal relacionado al tabaquismo, sexo y estrés. Tabaquismo, edad y actividad laboral fueron relacionados al control de peso. Adhesión a actividad física varió entre los sexos y entre individuos que usaban o no beta-bloqueadores. Consumo de alcohol moderado relacionado al sexo, edad, actividad laboral, renta, comorbilidades (diabetes mellitus y tabaquismo), tiempo de tratamiento antihipertensivo y uso de otros fármacos.

Conclusiones:

factores socioeconómicos y clínicos relacionados a adhesión al tratamiento antihipertensivo. Técnicas innovadoras como el modelo transteórico de cambio, entrevista motivacional y autocuidado apoyado pueden auxiliar los cambios comportamentales.

Descriptores:
Hipertensión; Enfermería en Salud Pública; Cumplimiento y Adherencia al Tratamiento; Atención Primaria de Salud; Cooperación del Paciente

Variables	Mean (±SD) / Median (min.–max.)	n (%)
Sex	-
Female		324 (77.0)
Male		97 (23.0)
Age	59.9 (±11)
≤ 65 years		288 (68.4)
> 65 years		133 (31.6)
Ethnicity	-
White		95 (22.6)
Brown		219 (51.5)
Black		100 (23.8)
Indian (native)		4 (1.0)
Other		5 (1.2)
Marital status	-
Has a partner		210 (49.5)
Does not have a partner		211 (50.5)
Paid work	-
Yes		117 (27.8)
No		304 (72.2)
Income^* * Income in Brazilian reais, considering the Brazilian minimum wage from 2018 (R$ 954,00);	954.00 (0.00–4.950.00)
≤ 1 minimum wage		252 (59.9)
> 1 minimum wage		169 (40.1)
Educational level	6 (0–17)
≤ 9 years		287 (68.2)
> 9 years		134 (31.8)
Arterial pressure classification	-
Normal		55 (13.1)
Borderline		150 (35.6)
Stage 1		144 (34.2)
Stage 2		40 (9.5)
Stage 3		30 (7.1)
Does not know		2 (0.5)
Body mass index	29.9 (16.5–54.2)
Low weight		6 (1.4)
Adequate weight		70 (16.7)
Overweight		148 (35.4)
Obesity		194 (46.4)
Does not know		3 (0.7)
Time of anti-hypertensive treatment (in months)	120 (6–784)
≤ 60 months		139 (33.0)
> 60 months		282 (67.0)
Type of anti-hypertensive^□ □ Patients may use more than one type, SD – standard deviation; min. – minimum value; max. – maximum value; ARC – angiotensin II receptor antagonist; ACEI – angiotensin converting enzyme inhibitor; CCB – calcium channel blockers.
Thiazide diuretics		247 (58.6)
BRA		224 (53.2)
IECA		142 (33.7)
Beta blocker		95 (22.6)
BCC		83 (19.7)
Other diuretics		21 (5.0)
Use of other medications	-
Yes		297 (70.5)
No		124 (29.5)

Categories	n (%)
Weight control
Adhered	97 (23.2)
Did not adhere	321 (76.8)
Abdominal circumference (AC) control
Adhered	42 (10.0)
Did not adhere	377 (90.0)
Physical activity
Adhered	172 (40.9)
Did not adhere	249 (59.1)
Limited alcohol consumption
Adhered	355 (84.3)
Did not adhere	66 (15.7)

Variables	Adherence				OR	CI 95%	p ^* * Chi-squared test; OR - odds ratio; CI – confidence interval.
	Yes		No
	n	%	N	%
Adherence to weight control
Age
≤ 65 years	42	14.7	243	85.3	0.245	0.152–0.394	0.000
> 65 years	55	41.4	78	58.3	0.245	0.152–0.394	0.000
Paid work
Yes	19	16.4	97	83.6	0.563	0.323–0.980	0.040
No	78	25.8	224	74.2	0.563	0.323–0.980	0.040
Smoking
Yes	18	37.5	30	62.5	2.210	1.171–4.171	0.013
No	79	21.4	291	78.6	2.210	1.171–4.171	0.013
Adherence to abdominal circumference
Sex
Female	20	6.2	303	93.8	0.222	0.115–0.428	0.000
Male	22	22.9	74	77.1	0.222	0.115–0.428	0.000
Smoking
Yes	11	23.4	36	76.6	3.361	1.558–7.251	0.001
No	31	8.3	341	91.7	3.361	1.558–7.251	0.001
Stress
Yes	23	7.9	269	92.1	0.486	0.254–0.929	0.026
No	19	15.0	108	85.0	0.486	0.254–0.929	0.026
Adherence to physical activity
Sex
Female	110	34.0	214	66.0	0.290	0.181–0.466	0.000
Male	62	63.9	35	36.1	0.290	0.181–0.466	0.000
Use of beta blocker
Yes	27	28.4	68	71.6	0.498	0.303–0.818	0.005
No	142	44.4	178	55.9	0.498	0.303–0.818	0.005
Adherence to a limited alcohol consumption
Sex
Female	287	88.6	37	11.4	3.308	1.902–5.753	0.000
Male	68	70.1	29	29.9	3.308	1.902–5.753	0.000
Age
≤ 65 years	233	80.9	55	19.1	0.382	0.193–0.757	0.005
> 65 years	122	91.7	11	8.3	0.382	0.193–0.757	0.005
Paid work
Yes	88	75.2	29	24.8	0.421	0.244–0.723	0.001
No	267	87.8	37	12.2	0.421	0.244–0.723	0.001
Income
≤ 1 minimum wage	224	88.9	28	11.1	2.221	1.361–3.957	0.002
> 1 minimum wage	131	77.5	38	22.5	2.221	1.361–3.957	0.002
Time of anti-hypertensive treatment
≤ 5 years	110	79.1	29	20.9	0.573	0.335–0.979	0.040
> 5 years	245	86.9	37	13.1	0.573	0.335–0.979	0.040
Use of other medications
Yes	258	86.9	39	13.1	1.841	1.069–3.171	0.026
No	97	78.2	27	21.8	1.841	1.069–3.171	0.026
Smoking
Yes	32	66.7	16	33.3	0.310	0.158–0.605	0.000
No	323	86.6	50	13.4	0.310	0.158–0.605	0.000
Diabetes mellitus
Yes	135	90.6	14	9.4	2.279	1.217–4.270	0.009
No	220	80.9	52	19.1	2.279	1.217–4.270	0.009

Variables		SAP		DAP
Variables		Median (min.-max.)	p ^* * Mann-Whitney's test.	Median (min.-max.)	p ^* * Mann-Whitney's test.
Adherence to weight control	Yes	140 (100–212)	0.701	80 (51–116)	0.000
	No	169 (101–224)		84 (51–148)
Adherence to abdominal circumference	Yes	136 (100–212)	0.464	81 (52–110)	0.250
	No	138 (97–224)		83 (51–148)
Adherence to physical activity	Yes	136 (97–224)	0.164	81 (52–148)	0.072
	No	140 (100–212)		84 (51–118)
Adherence to a limited alcohol consumption	Yes	137 (97–213)	0.109	82 (51–123)	0.002
	No	142 (113–224)		87 (71–148)

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[1] Corresponding author: Monique Oliveira do Nascimento E-mail: moniquenascimento16@gmail.com