伴心房颤动的老老年高血压患者降压药服药依从性不良影响因素分析

目的探讨伴心房颤动(房颤)的老老年高血压患者降压药服药依从性不良的影响因素。方法连续入选2018年10月至2019年2月期间在阜外医院就诊的合并房颤的老老年高血压患者共110例。通过电子病历系统收集患者一般情况及临床资料,应用量表评估患者焦虑、抑郁、认知功能状态、社会支持度以及降压药服药依从性。根据依从性的不同将患者分为依从性良好组与依从性不良组。比较两组患者一般情况及临床资料,行Logistic回归分析明确依从性不良预测因素。结果107例患者完成问卷,41.1%的患者服用降压药依从性不良。多因素Logistic分析提示,抑郁、认知功能损害为依从性不良的预测因素优势比(oddsratio,OR)=4.16,95%置信区间(confidenceinterval,CI)1.39~12.44,P<0.05;0R=4.26,95%CI 1.39~12.98,P<0.05],焦虑、开展服药自我提醒以及社会支持评分>35分是依从性良好的预测因索(OR=0.23,95%CI 0.08~0.69,P<0.01;0R=0.17,95%CI 0.04~0.62,P<0.01;OR=0.16,95%CI 0.06~0.45,P<0.01)。结论伴房颤的老老年高血压患者降压药服药依从性总体不良。抑郁和认知功能损害为依从性不良的预测因素,焦虑和开展服药自我提醒以及社会支持评分>35分是依从性良好的预测因素。

Influencing factors of nonadherence on antihypertensive drugs in very elderly patients with hypertension combined with atrial fibrillation

Objective To investigate the influencing factors of nonadherence on antihypertensive drugs in very elderly patients with hypertension combined with atrial fibrillation.Methods One hundred and ten very elderly patients with hypertension combined with atrial fibrillation were continually recruited.The general data and clinical characteristics of the patients were collected by electric medical record.Scales were used to evaluate anxiety and depression states,cogaitive function,social support and adherence level to antihypertensive drugs.Patients were divided into inadequate adherence group and adequate adherence group.The general data and clinical characteristics were compared in the two groups.Factors associating with adherence to antihypertensive drugs were identifed by a logistic regression model.Results Of the total 110 patients,107 patients met the criteria and completed the survey.Among these patients and 41.1%patients were in adequate adherents.Depression and cognitive impairmentodds ratio(OR)=4.16,95%confidence interval(CI)1.39-12.44,P<0.05;OR=4.26,95%CI 1.39-12.98,P<0.05]were more likely to be with inadequate adherents.Suffering from anxiety(OR=0.23,95%CI 0.08-0.69,P<0.01),using methods to remind medication(0R=0.17,95%CI 0.04-0.62,P<0.01)and social support score>35(OR=0.16,95%CI 0.06-0.45,P<0.01)were more likely to be with adequate adherents.Conclusion Percentage of adequate adherence on antihypertensive drugs in very elderly patients with hypertension combined with atrial fibrillation is low.Depression and cognitive impairment are predictors to inadequate adherence.Anxiety,using methods to remind medication and social support score>35 are predictors to adequate adherence.