The pharmacist and the management of arterial hypertension: the role of blood pressure monitoring and telemonitoring

Randomized controlled trials have documented that a team of health care professionals which includes a physician, a nurse and a community pharmacist may improve the benefit and adherence of anti-hypertensive therapy. If such a health care model relies on blood pressure telemonitoring, it can promote a stronger relationship between health care professionals and patients, and further improve BP control of hypertension. The major benefit of this collaborative approach is to center the patient’s management in a tailored way, providing comprehensive and preventive care based on health information technologies. In this review, the authors summarize recent clinical studies that evaluate the role of the community pharmacist in BP measurements, and in hypertension screening and control. The authors also describe the advantages of using blood pressure telemonitoring in home and ambulatory settings to evaluate potential alternatives to primary care in hypertension management.     

Motivators of adherence to integrated management among patients with chronic kidney disease: A qualitative study

The integrated management of chronic kidney disease (CKD) demands significant changes, as patients need to adhere to dialysis, medication, and dietary and fluid restrictions. Therefore, there is a need to identify the motivators of adherence to improve the quality of life of these patients. The aim of the present study was to explore the motivators of adherence to integrated management among patients with CKD in South Africa. A phenomenological design was used. A sample size of 12 participants was selected according to data saturation. The purposive sampling method was used to select the participants. Data were collected with the help of a semistructured interview schedule developed from the literature. A thematic framework analysis was conducted to identify the motivators of adherence to integrated management; these were found to be family support, anxiety about eligibility for kidney transplant, support of other patients, awareness of complications associated with non‐adherence to integrated management, and fear of being removed from the CKD program. Identified motivators could be used to develop specific interventions that address or foster adherence behavior as a requirement for integrated management.     

国内外老年慢性病患者用药依从性社区干预的研究进展

慢性病用药依从性直接关系到社区老年人的健康和入院率。本文综述了国内外老年慢性病患者用药依从性社区干预的进展,从干预对象、干预地点、实施人员、评价指标、干预的实施与效果、成本-效益评价等方面系统介绍,针对存在的问题提出了思考和建议,以期为今后社区护理干预和研究提供参考。     

Depression and medication adherence among older Korean patients with hypertension: Mediating role of self‐efficacy

Many studies have reported the negative effects of depression on adherence to antihypertensive medication. However, little is known about the mechanism underlying this relationship in elderly patients with hypertension. The aim of this cross‐sectional study is to examine the mediating role of self‐efficacy in the relationship between depression and medication adherence among older patients with hypertension. The data were collected from October to December 2014. A total of 255 older patients with hypertension were assessed using the Geriatric Depression Scale, the Self‐efficacy for Appropriate Medication Use Scale, and the Morisky Medication Adherence Scale. Hierarchical linear regression analysis and the Sobel test were used to examine the mediating role of self‐efficacy in the relationship between depression and medication adherence. Depression and self‐efficacy were statistically significant predictors of medication adherence in older patients with hypertension. Self‐efficacy partially mediated the relationship between depression and medication adherence. Interventions targeting self‐efficacy could increase the confidence of patients in their ability to actively take their medicines. Moreover, health care providers should be aware of the importance of early detection of depression in older patients with hypertension. Future studies with longitudinal data are warranted to clarify the multidirectional relationships between depression, self‐efficacy, and medication adherence.     

高血压患者家庭功能及社会支持对药物依从性的影响

目的了解高血压患者家庭功能、社会支持、药物依从性现状,并分析家庭功能和社会支持对药物依从性的影响。方法选取高血压患者496例,对其进行药物依从性、家庭功能、社会支持的问卷调查。结果药物依从性好155例,占31.25%;依从性差223例,占44.96%;依从性极差118例,占23.79%;药物依从性总分为(6.50±0.34)分。家庭功能良好373例,占75.20%;中度障碍98例,占19.76%;严重障碍25例,占5.04%。社会支持总分为(33.67±6.45)分。多元线性回归分析显示,药物依从性的主要影响因素有家庭人均月收入、病程、慢性病情况、情感度、亲密度、合作度、主观支持。结论临床护理人员应提高患者的家庭功能和社会支持水平,以提高患者的药物依从性,进而提高其生活质量。     

The effects of home blood pressure monitoring on blood pressure control and treatment planning

Objectives: Blood pressure monitoring is essential in hypertension, which is an important public health issue. Our objective was to compare the rates of blood pressure control and to investigate factors that affect blood pressure control in patients with hypertension.

Methods: The records of 1006 patients with hypertension were examined retrospectively. The blood pressure control rates of the 394 patients who measured their blood pressure at home (group 1) and those who did not (group 2) were compared.

Results: In group 1, the mean systolic and diastolic blood pressure was 123.91±12.63/78.64±8.92 mmHg measured at home, whereas it was 140.31±20.56/85.76±11.55 mmHg in the office setting (p<0.0001). In the total group (N=1006), the blood pressure control achievement rate was 56.1%. The number of cardiovascular events, hypertension duration, and the rate of being employed was higher in group 1 (p<0.0001, p<0.0001 and p=0.0001, respectively), while heart rate and grade 3-4 retinopathy was lower in group 1 (p<0.0001 for both) . Occupational status, geographical origin, BMI and the use of angiotensin converting enzyme (ACE) inhibitors were found to be the determinants of office BP control (p<0.05, p<0.05, p=0.001 and p<0.05, respectively), and BMI and grade 3-4 retinopathy findings were found to be the determinants of home BP control (p <0.05 for both).

Conclusion: Home blood pressure monitoring is useful in preventing complications and achieving therapy compliance and is essential in diagnosis and treatment planning of hypertension.     

The effect of adherence therapy on medication adherence,health beliefs,self-efficacy,and depressive symptoms among patients diagnosed with major depressive disorder

Medication adherence is a crucial health issue in major depressive disorder (MDD) that requires regular monitoring and attention. Hence, there are multiple reasons for medication non-adherence among them. This study aimed to examine the effect of adherence therapy (AT) on medication adherence, health beliefs, self-efficacy, and depressive symptoms among patients diagnosed with MDD. One group pretest-posttest, repeated measures time-series design was conducted. A sample of 32 patients was recruited conveniently; they received eight weekly sessions of AT. A self-reported questionnaire was used to measure variables. The analysis showed that the mean scores of the baseline indicated non-adherence, moderate general benefits beliefs about the medication, high beliefs that medication is harmful, high beliefs that doctors overuse medication, high beliefs about potential adverse effects from medication, low perception of MDD severity, and high threatening perception regarding MDD, a moderate degree of confidence in the ability to taking medications, and patients had moderately severe depressive symptoms (M = 16, 3.2, 3.1, 4.1, 3.8, 50, 3, 16 respectively). Over four measurement points, adherence therapy enhanced positive beliefs towards taking medication and illness, increased medication adherence self-efficacy, improved medication adherence, and decreased depressive symptoms (F = 68.57–379.2, P < 0.001). These improvements were clinically significant in all variables immediately post-AT but declined minimally over time. The study indicated that integrating AT as part of the pre-discharge protocol is one core component to sustaining positive healthcare outcomes. Continuous efforts should be paid in terms of the long-term sustainability of an intervention to enhance adherence and clinical outcomes.     

Salt restriction among hypertensive patients: Modest blood pressure effect and no adverse effects

Objective

Previous studies, mainly evaluating short-term very low salt diets, suggest that salt restriction may influence glucose and insulin metabolism, catecholamines, renin, aldosterone, and lipid levels adversely. The authors wanted to explore whether sodium restriction for eight weeks influenced insulin secretion unfavourably, and evaluate the efficacy and safety of such treatment also in terms of other parameters important in the management of hypertensive patients.

Design

A double-blind randomized controlled parallel group designed trial. All participants received dietary advice aimed at a moderate salt-restricted diet. Half of the participants received salt capsules, the others received identical placebo capsules.

Setting

General practice.

Subjects

Forty-six hypertensive patients inadequately controlled by drug treatment.

Main outcome measures

Fasting serum insulin C-peptide and glucose and levels of these measures after oral glucose, blood pressure, serum aldosterone and lipids, peripheral resistance, and skin conductance.

Results

Salt restriction did not influence glucose and insulin metabolism, aldosterone, or lipid levels adversely. We observed better blood pressure regulation in the low salt group than in the high salt group, with a systolic and diastolic blood pressure difference of 5/5 mmHg after eight weeks. The difference was only statistically significant for diastolic blood pressure, p 0.02.

Conclusion

This study revealed a modest diastolic blood pressure reducing effect of moderate sodium restriction. This reduction was obtained without any apparent unfavourable side effects such as increased insulin secretion, impaired glucose tolerance or dyslipidaemia.     

Salt restriction among hypertensive patients: Modest blood pressure effect and no adverse effects

Objective. Previous studies, mainly evaluating short-term very low salt diets, suggest that salt restriction may influence glucose and insulin metabolism, catecholamines, renin, aldosterone, and lipid levels adversely. The authors wanted to explore whether sodium restriction for eight weeks influenced insulin secretion unfavourably, and evaluate the efficacy and safety of such treatment also in terms of other parameters important in the management of hypertensive patients. Design. A double-blind randomized controlled parallel group designed trial. All participants received dietary advice aimed at a moderate salt-restricted diet. Half of the participants received salt capsules, the others received identical placebo capsules. Setting. General practice. Subjects. Forty-six hypertensive patients inadequately controlled by drug treatment. Main outcome measures. Fasting serum insulin C-peptide and glucose and levels of these measures after oral glucose, blood pressure, serum aldosterone and lipids, peripheral resistance, and skin conductance. Results. Salt restriction did not influence glucose and insulin metabolism, aldosterone, or lipid levels adversely. We observed better blood pressure regulation in the low salt group than in the high salt group, with a systolic and diastolic blood pressure difference of 5/5 mmHg after eight weeks. The difference was only statistically significant for diastolic blood pressure, p 0.02. Conclusion. This study revealed a modest diastolic blood pressure reducing effect of moderate sodium restriction. This reduction was obtained without any apparent unfavourable side effects such as increased insulin secretion, impaired glucose tolerance or dyslipidaemia.     

A multifactorial intervention to improve blood pressure control in co-existing diabetes and kidney disease: a feasibility randomized controlled trial

williams a., manias e., walker r. & gorelik a. (2012) A multifactorial intervention to improve blood pressure control in co-existing diabetes and kidney disease: a pilot randomized controlled trial. Journal of Advanced Nursing68(11), 2515-2525. ABSTRACT: Aims. The aim of this study was to test the feasibility and impact of an intervention consisting of self-monitored blood pressure, medicine review, a Digital Versatile Disc, and motivational interviewing telephone calls to help people with diabetes and kidney disease improve their blood pressure control and adherence to prescribed medications. Background. People with co-existing diabetes, kidney disease and hypertension require multiple medications to manage their health. About 50% of people are non-adherent to their prescribed medications with non-adherence increasing in the presence of chronic conditions. Design. Randomized controlled trial. Methods. Patients aged ≥18?years with diabetes, chronic kidney disease and systolic hypertension were recruited from nephrology and diabetes outpatients' clinics of an Australian metropolitan hospital between 2008-2009. Participants were randomly allocated on a 1:1 basis to one of two groups in a randomized controlled trial: the intervention delivered over 3?months (n?=?39) and usual care (n?=?41), with follow-up at 3, 6 and 9?months postintervention. People collecting data and assessing outcomes were blinded to group assignment. Results. Seventy-five participants completed the study. The intervention was acceptable and feasible for this cohort. There were no statistically significant differences between groups, although the mean systolic blood pressure reduction in the intervention group (n?=?36) was -6·9?mmHg 95% CI (-13·8, -0·02) at 9?months postintervention. Conclusion. The study was feasible and statistically significant differences may be determinable in a larger sample to overcome the variability between groups, paying attention to recommendations for further research. Trial registration. The trial was prospectively registered with the Australian and New Zealand Clinical Trials Register (ACTRN12607000044426).     

社区高血压患者血压计持有及测量情况的调查分析

目的 通过对社区高血压患者的调查,了解高血压患者的血压计持有状况、家庭自测基本要求的掌握情况,为实施有针对性的护理干预提供依据.方法 对符合入选标准的社区高血压患者300例,应用自制的<高血压患者家庭自测血压基本要求调查表>进行调查分析.结果 在调查的300例高血压患者中,自己拥有血压计的有162例,血压计的持有率达54.0%.持有血压计的162例患者中,会定期检测电子血压计性能、准确性的占14.6%;测血压前至少休息5 min的占53.7%;袖带与心脏保持在同一水平的占84.5%;坐背椅坐位、测血压不讲话、不活动肢体保持安静的占83.3%;每次测血压3次,取其平均值为本次血压值的只占14.8%;贮存血压值或真实记录血压数值的占8.0%;只有13.5%的患者每天或几乎每天测量血压.结论 高血压患者血压计使用率低,对自测血压基本要求的掌握情况有待进一步的提高.     

Efficacy and tolerability of candesartan cilexetil vs. amlodipine as assessed by home blood pressure in hypertensive patients

This randomised, double-blind study compared the anti-hypertensive efficacy and tolerability of Candesartan cilexetil (CC 8-16 mg) and Amlodipine (AML 5-10 mg) on home blood pressure (HBP) measurements in mild-to-moderate hypertensive patients. After a 2-week wash-out, patients aged 18-74 years, with a sitting diastolic blood pressure (sDBP)=95-115 mmHg, untreated or intolerant to therapy or uncontrolled were randomised to CC 8 mg or AML 5 mg O.D. for 12 weeks (W12). Patients not normalised or not responders at W12 had their dose doubled for the remaining 6 weeks. HBP was measured before each visit, during 5 days (three measurements in the morning, 24 h after last dose and before drug intake and three measurements before bedtime). The primary criterion was the comparison of mean morning sDBP at baseline and post-treatment. A total of 638 patients were enrolled, 540 of whom were randomised to CC or AML. The intent-to-treat and safety analyses were performed in 532 patients while 321 constituted the per protocol population. Baseline characteristics and BP values of the two groups were similar. Morning sDBP did not differ between groups at W12, but AML patients had significantly more adverse events (AEs) than those treated by CC (28 vs. 20%, p=0.03); 6% of AML patients vs. 1% of CC patients were withdrawn due to AEs (p=0.009). CC demonstrates a better tolerability over AML and an equivalent anti-hypertensive efficacy in terms of morning home DBP after 12 weeks of treatment.     

Beliefs about antidepressant medication and associated adherence among older Chinese patients with major depression: A cross‐sectional survey

Antidepressant non‐adherence among people with depressive disorder is a major, ongoing public health issue, yet few studies have focused on older adults and their medication adherence. Although treatment adherence is determined by multiple factors, one of the important and modifiable predictors are patients’ attitudes and beliefs about medication. We explored a sample of 135 older Chinese people with major depression, and the relationship between beliefs about antidepressants and medication adherence. Sociodemographic and illness variables were also examined. In all, high antidepressant adherence was reported in 37.8%, moderate adherence in 39.2%, and low adherence in 23%. Ordinal regression analysis showed perceived necessity (P < 0.01) and concern (P < 0.01) about antidepressants were significant influencing factors. Other variables with a positive association with higher adherence were lower average income (P < 0.05), fewer number of prior episodes of depression (P < 0.01), and comorbid anxiety (P < 0.05). The present study highlights low adherence in a sample of older depressed Chinese people, and highlights how beliefs about medication affect adherence. Therefore, more attention should be focused on non‐adherence in older patients, and there is a need to establish accessible and systematic education programmes to correct misconceptions to improve their adherence.     

应用多功能床垫降低妊娠期高血压病病人血压的研究

[目的]探讨妊娠期高血压病病人使用多功能床垫降低血压的临床价值。[方法]根据孕妇的生理体态设计多功能床垫。随机将110例产妇分为两组,实验组52例使用多功能床垫,对照组58例使用传统床垫。[结果]应用多功能床垫可降低收缩压和舒张压,同对照组比较差异有统计学意义(P<0.05)。[结论]妊娠期高血压病病人应用多功能床垫可及时有效的控制血压,延长孕周,减少母婴并发症。