Treatment adherence and blood pressure control in older individuals with hypertension.
BACKGROUND
Non-adherence to treatment has been identified as the main cause of uncontrolled blood pressure (BP), and may represent a greater risk in older individuals.


OBJECTIVE
The aim of this study was to evaluate and compare the rate of adherence to hypertension treatment using different methods, to estimate the BP control rate, and to observe if there is an association between BP control and adherence.


METHODS
Treatment adherence was evaluated in older patients with hypertension, followed by the public primary health care, through four methods, including the Morisky-Green test (reference), the Attitude regarding the Medication Intake questionnaire (AMI), an evaluation of adherence by the nurse in the office (Nurse Adherence Evaluation - NAE), and at home (Home Adherence Evaluation - HAE). Salt intake was estimated by 24-hour sodium urinary excretion. BP control was assessed by the awake ambulatory blood pressure monitoring.


RESULTS
Concordance between the Morisky-Green test and AMI (Kappa=0.27) or NAE (Kappa=0.05) was poor. There was a moderate concordance between the Morisky-Green test and HAE. Eighty percent had controlled BP, including 42% with white-coat effect. The group with lower salt excretion informed to avoid salt intake more times (p<0.001) and had better medication adherence (p<0.001) than the higher salt excretion group.


CONCLUSIONS
The evaluated tests did not show a good concordance to the Morisky-Green test. Adherence to hypertension treatment was low; however, there was a high rate of BP control when subjects with the white-coat effect were included in the analysis.
Departamento de Medicina Interna, Escola de Medicina, Universidade de São Paulo, Ribeirão Preto, Brazil.
Rachel G
RG
Bastos-Barbosa
Eduardo
E
Ferriolli
Julio C
JC
Moriguti
Charlys B
CB
Nogueira
Fernando
F
Nobre
Julieta
J
Ueta
Nereida K C
NK
Lima
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000379:methods*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods; D005260:Female; D006801:Humans; D006973:Hypertension / Q000517:prevention & control*; D008297:Male; D055118:Medication Adherence; D011320:Primary Health Care; D011795:Surveys and Questionnaires; D013997:Time Factors
D000959:Antihypertensive Agents