title: The influence of cognition, anxiety and psychiatric disorders over treatment adherence in uncontrolled hypertensive patients.
abstract: BACKGROUND
  Poor adherence is estimated to cause 125 thousand deaths per year and is linked to 10% of all hospital stays in the U.S. Up to one third of elderly hypertensive patients don't have adherence, which is responsible for high proportion of hospitalizations. Hypertension is also related to poor performance in tests that assess cognitive functions. On the other hand, poor cognitive performance is associated with low adherence to treatment.
  
  
  OBJECTIVE
  To assess the association between cognitive function, anxiety and psychiatric disorders with adherence to drug treatment in patients with hypertension.
  
  
  RESULTS
  This a cohort studies with 56 adult patients with uncontrolled hypertension who participated of all meetings of a pharmaceutical intervention in a randomized clinical trial of pharmaceutical care. Cognitive function was measured by the Mini Mental State Examination (Mini-mental). The memory was measured by digit and word spans, tower and church shadow test, short story test and metamemory. Anxiety and psychiatric disorders were evaluated by the State Trace Anxiety Inventory and the Self-Report Questionnaire, respectively. The participants were classified as adherent or non-adherent to the drug treatment, according to the identification of plasma levels of hydrochlorothiazide. All non-adherent patients (n = 12) and 35 out 44 (79.5%) patients with adherence to treatment had at least one memory test with an altered score (P = 0.180). Participants with an unsatisfactory score in the Mini-mental had six-fold higher risk of non-adherence to treatment when compared to those with a normal score (RR = 5.8; CI 95%: 1.6-20.8; P = 0.007). The scores of anxiety and psychiatric disorders were not associated with adherence to the pharmacological treatment.
  
  
  CONCLUSIONS
  Cognitive deficit impairs adherence to drug therapy and should be screened as part of a program of pharmaceutical care to improve adherence to treatment.
authors.affiliation: Postgraduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Úrsula
authors.initials: Ú
authors.lastname: Jacobs
authors.forename: Mauro S
authors.initials: MS
authors.lastname: De Castro
authors.forename: Flávio D
authors.initials: FD
authors.lastname: Fuchs
authors.forename: Maria Beatriz C
authors.initials: MB
authors.lastname: Ferreira
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001007:Anxiety / Q000503:physiopathology*; D003071:Cognition / Q000502:physiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use*; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D001523:Mental Disorders / Q000503:physiopathology*; D008875:Middle Aged; D012044:Regression Analysis; D011795:Surveys and Questionnaires
chemical_list: D000959:Antihypertensive Agents; D006852:Hydrochlorothiazide