Psychological determinants of drug adherence and severity of hypertension in patients with apparently treatment-resistant vs. controlled hypertension.

IF 2.3 4区医学 Q2 PERIPHERAL VASCULAR DISEASE

Blood Pressure Pub Date : 2022-12-01 DOI:10.1080/08037051.2022.2099346

Coralie M G Georges, Sabrina Ritscher, Marco Pappaccogli, Géraldine Petit, Marilucy Lopez-Sublet, Achille Bapolisi, Silvia Di Monaco, Pierre Wallemacq, Franco Rabbia, Stefan W Toennes, Philippe de Timary, Alexandre Persu

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引用次数: 1

Abstract

Purpose: In a pilot study including 35 patients with apparently treatment-resistant hypertension (ATRH), we documented associations between psychological profile, drug adherence and severity of hypertension. The current study aims to confirm and expand our findings in a larger and more representative sample of patients with ATRH, using controlled hypertensive patients as the comparator.

Materials and methods: Patients with ATRH were enrolled in hypertension centres from Brussels and Torino. The psychological profile was assessed using five validated questionnaires. Drug adherence was assessed by high-performance liquid chromatography-tandem mass spectrometry analysis of urine samples, and drug resistance by 24-hour ambulatory blood pressure was adjusted for drug adherence.

Results: The study sample totalised 144 patients, including 81 ATRH and 63 controlled hypertensive patients. The mean adherence level was significantly lower in the "resistant" group (78.9% versus 92.7% in controlled patients, p-value = .022). In patients with ATRH, independent predictors of poor drug adherence were somatisation, smoking and low acceptance level of difficult situations, accounting for 41% of the variability in drug adherence. Independent predictors of severity of hypertension were somatisation, smoking, more frequent admissions to the emergency department and low acceptation, accounting for 63% of the variability in the severity of hypertension. In contrast, in patients with controlled hypertension, the single predictors of either drug adherence or severity of hypertension were the number of years of hypertension and, for the severity of hypertension, alcohol consumption, accounting for only 15-20% of the variability.

Conclusion: Psychological factors, mostly related to somatisation and expression of emotions are strong, independent predictors of both drug adherence and severity of hypertension in ATRH but not in controlled hypertensive patients.

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明显治疗抵抗与控制高血压患者药物依从性和高血压严重程度的心理决定因素

目的:在一项包括35例明显难治性高血压(ATRH)患者的初步研究中，我们记录了心理状况、药物依从性和高血压严重程度之间的关联。目前的研究旨在以控制高血压患者为对照，在更大、更有代表性的ATRH患者样本中证实和扩展我们的发现。材料和方法:纳入来自布鲁塞尔和都灵的高血压中心的ATRH患者。使用五份有效问卷对心理状况进行评估。采用高效液相色谱-串联质谱法对尿样进行药物依从性评估，并通过24小时动态血压调整耐药性来评估药物依从性。结果:研究样本共144例，其中ATRH 81例，控制高血压63例。“耐药”组的平均依从性水平明显较低(78.9% vs .对照组的92.7%，p值= 0.022)。在ATRH患者中，药物依从性差的独立预测因素是身体化、吸烟和对困难情况的接受程度低，占药物依从性变异性的41%。高血压严重程度的独立预测因素是躯体化、吸烟、更频繁地进入急诊科和低接受度，占高血压严重程度变化的63%。相比之下，在控制高血压的患者中，药物依从性或高血压严重程度的单一预测因素是高血压的年数，对于高血压的严重程度，饮酒仅占变异的15-20%。结论:心理因素主要与躯体化和情绪表达相关，是ATRH患者药物依从性和高血压严重程度的独立预测因素，但在控制高血压患者中并非如此。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Blood Pressure 医学-外周血管病

CiteScore

3.00

自引率

5.60%

发文量

审稿时长

6-12 weeks

期刊介绍： For outstanding coverage of the latest advances in hypertension research, turn to Blood Pressure, a primary source for authoritative and timely information on all aspects of hypertension research and management. Features include: • Physiology and pathophysiology of blood pressure regulation • Primary and secondary hypertension • Cerebrovascular and cardiovascular complications of hypertension • Detection, treatment and follow-up of hypertension • Non pharmacological and pharmacological management • Large outcome trials in hypertension.