Medication adherence and its associated factors among Chinese community-dwelling older adults with hypertension

Cross-cultural adaptation and psychometric evaluation of the urdu version of the morisky, greene, and levine medication adherence scale (MGLS-4) for major depressive disorder patients

In Pakistan, Major depressive disorder (MDD) contributes significantly to the mental health burden. It is crucial to understand patients' medication adherence status for developing a strategy for improving adherence and treatment outcomes. Therefore, a valid and reliable tool in the local Urdu language is required. The Morisky, Greene, and Levine Medication Adherence Scale (MGLS-4) is a reliable, valid and straightforward instrument to assess medication-taking behavior. The valid and reliable Urdu translation of MGLS-4 can fill this gap within the local context. Therefore, the present study aims to validate the Urdu Morisky, Green and Levine Adherence Scale (UMGLS-4) for MDD patients. This was a quantitative, cross-sectional validation study for Pakistani MDD patients. Reliability was measured using Cronbach's α and for test-retest reliability intraclass correlation coefficient (ICC) was calculated. Validity was assessed through face validity, content validity, construct validity, and convergent validity with the Drug Attitude Inventory (DAI-10). Descriptive and inferential statistical analyses were carried out to demonstrate adherence level and statistical significance, respectively. Linear regression was applied to find the association between the UGMLS-4 score and demographic characteristics. The UMGLS-4 demonstrated high reliability (Cronbach's α = 0.829) and a significant strong ICC (x = 0.601, p < 0.01) was detected. Exploratory factor analysis (EFA) revealed a single-factor structure explaining 66.084% of the variance. Confirmatory factor analysis (CFA) confirmed good model fit (GFI = 0.950, AGFI = 0.920, NFI = 0.930, RMSEA = 0.050, SRMSR = 0.055). Medication adherence was observed to be high in 39.1% of patients, moderate in 28.6%, and poor in 32.3%. Significant associations were found between adherence scores and gender, educational attainment, and occupational status (p < 0.005) with education predicting adherence (B = 0.301, p < 0.000), indicating the scale's robustness in detecting adherence variations among Urdu-speaking MDD patients. The UMGLS-4 is a reliable and valid tool for assessing medication adherence in Pakistani MDD patients, effectively capturing adherence variations across demographic variables.

The role of depressive symptoms and self-efficacy in the relationship between activities of daily living and medication adherence among the elderly with chronic diseases: a serial mediation model

The current study aimed to test the effects of depressive symptoms and self-efficacy in the relationship between activities of daily living (ADLs) and medication adherence using a serial mediation model. This cohort study was conducted among 797 elderly with chronic diseases in Hunan Province of China. Their ADLs, medication adherence, self-efficacy, and depressive symptoms were assessed by the Barthel Index (BI), the Morisky Medication Adherence Scale (MMAS-8), the Self-Efficacy for Appropriate Medication Use Scale (SEAMS), and the 20-item Center for Epidemiologic Studies Depression Scale (CES-D), respectively. The PROCESS SPSS Macro version 4.1, model 6, was used to test the serial mediation model of ADLs affecting medication adherence through self-efficacy and depressive symptoms. From baseline to follow-up, the elderly had a significant increase in depressive symptoms (from 15.3 ± 11.3 to 19.1 ± 13.1) and significant decreases in ADLs (from 71.4 ± 19.8 to 64.9 ± 17.61), self-efficacy (from 21.5 ± 5.4 to 20.4 ± 6.2), and medication adherence (from 6.7 ± 1.8 to 6.0 ± 1.5), all with p < 0.001. The serial mediation model demonstrated a robust association between ADLs and medication adherence, which was serially mediated by depressive symptoms and self-efficacy (total effect c = 0.499, 95% CI = 0.393 to 0.605; direct effect c' = 0.379, 95% CI = 0.281 to 0.477; total indirect effect ab = 0.120, 95% CI = 0.073 to 0.168). This study elucidates the association between ADL and medication adherence, clarifying the mediating roles of depressive symptoms and self-efficacy. Our findings suggest that future medication adherence intervention programs among the elderly with chronic illness may be effective by focusing on decreasing depressive symptoms and improving self-efficacy.

Assessment of Compliance Status and Its Determinants Among Hypertensive Patients From County Areas in Zhejiang, China: A Cross-Sectional Study

OBJECTIVES

Compliance is crucial for patients to control and manage their high blood pressure. This study assesses the compliance levels of hypertensive patients in China and explores the factors influencing compliance.

DESIGN

A descriptive, cross-sectional design was conducted.

SAMPLE

A total of 371 hypertensive patients were recruited from six County hospitals and 12 township health centers in Zhejiang Province, China.

MEASURE

Patient compliance was measured using the Hypertensive Patient Scale (CHPS). Independent-sample T-test or variance analysis was applied to analyze CHPS scores by sociodemographic factors, and linear regression was used to explore the significant correlates of the total CHPS score.

RESULTS

The total score of CHPS was 50.18 ± 6.12. Among the seven domains, drug treatment and lifestyle had the highest and lowest average scores, 3.59 ± 0.87 and 2.74 ± 0.73, respectively. The total score of CHPS positively associated with age (β = 0.075, p = 0.028), > 7 years of hypertension (β = 1.896, p = 0.022; Ref: < 3 years), and negatively associated with males (β = -2.224, p = 0.001; Ref: female) and rural area (β = -2.008, p = 0.007; Ref: urban area).

CONCLUSION

These findings highlight the importance of related measurements of the local "health-oriented" healthcare system. Primary health professionals should strengthen their health behavior intervention capacity and improve hypertension management among their patients.

Subjective memory complaints and medication adherence among hypertensive Korean older adults with multimorbidity: mediating effect of depression and social support

BACKGROUND & AIM(S)

Medication adherence (MA) is a key factor in maintaining adequate blood pressure and preventing complications. However, some older adults experience difficulties in taking medicine properly due to declines in cognitive function. Although subjective memory complaints (SMC) are recognized as early markers of cognitive impairment, previous studies concerning the relationship between MA and cognitive function have focused only on objective cognitive function. Furthermore, while depression has a high correlation with SMC, low MA, and social support, there is limited evidence on their relationship. This study aims to understand the effect of SMC on MA and the mediating effect of depression and social support.

METHOD(S)

This study is a descriptive cross-sectional investigation. A sample of 195 community-dwelling hypertensive older adults with multimorbidity from 3 community senior centers in Gwangju, South Korea were recruited through convenience sampling. Data was collected through face-to-face survey from January to March 2018. The PROCESS macro v4.2 program [Model 6] was used to analyze the mediating effect of depression and social support in the relationship between SMC and MA. Data analysis was performed using SPSS/WIN 26.0 and STATA MP 17.0.

RESULTS

The average MA was 6.74. There were significant differences in MA according to awareness of prescribed drugs, awareness of side effects, insomnia, and healthcare accessibility. SMC was positively correlated with depression, while social support and MA were negatively correlated. While depression was a significant mediator of the effect of SMC on MA, the mediating effect of social support was not significant. The multiple mediation effect of depression and social support was not significant.

CONCLUSION

The results suggest that medication management of older adults in community settings should be accompanied by a comprehensive health assessment of associated factors. Health professionals should explore strategies to improve memory as well as prevent and alleviate depression to increase MA among hypertensive older adults with multimorbidity.

Examining the relationship between depression and medication adherence among elderlies suffering from cardiovascular disease referring to the clinics affiliated with Kermanshah University of Medical Sciences: A cross-sectional study

Background

In recent years, around 30% of all mortalities worldwide has been related to cardiovascular disease (CVD). The most important predictor solution of cardiovascular events is enhancing medication adherence. Meanwhile, the main reason behind development of physical disorders among the elderly is depression. In this regard, the present research was performed to determine the relationship between depression and medication adherence among the elderly suffering from CVD.

Methods

A cross-sectional study was done via an analytical approach on 188 elderlies fulfilling the inclusion criteria. The participants were chosen through convenience nonrandomized sampling from March to July 2022. The data were collected through demographic and healthcare information form plus Madanloo chronic disease medication adherence and geriatric depression scale. The analysis of the data was done by SPSS 26 plus Stata 14.2.

Results

The mean depression score was 5.6(4.3) and the mean score of medication adherence in the elderlies was 168.03(23.85). The prevalence of depression was higher in women than in men (p = 0.015), and the elderlies differing from heart failure reported the minimum extent of medication adherence. The findings obtained from analysis of variance showed that age, level of education, and monthly level of income were among the effective demographic factors in the extent of depression and medication adherence (p < 0.05). Meanwhile, 26% of changes in medication adherence can be attributed to depression. Further, the results of the multiple linear regression model reported that depression, age, and polypharmacy are among the predictors of medication adherence.

Discussion and Conclusion

A weak to moderate relationship existed between depression and medication adherence among these elderlies. Given the growing elderly population, the importance of depression, and lack of medication adherence in incidence of CVD events, it is recommended to train the healthcare team to monitor the elderly regarding depression symptoms.

Effects of communication style, anthropomorphic setting and individual differences on older adults using voice assistants in a health context

Background

Voice assistants enable older adults to communicate regarding their health as well as facilitate ageing in place. This study investigated the effects of communication style, anthropomorphic setting, and individual differences on the trust, acceptance, and mental workload of older adults using a voice assistant when communicating health issues.

Methods

This is a mixed-methods study utilising both quantitative and qualitative methods. One hundred and six older adults (M = 71.8 years, SD = 4.6 years) participated in a 2 (communication style: social- vs. task-oriented; between-subject)$$\times$$ × 2 (anthropomorphic setting: ordinary profession vs. medical background; within-subject) mixed design experiment. The study used multivariate analysis of variance (MANOVA) to examine the effects of communication style, anthropomorphic setting of the voice assistant, and participants’ use frequency of digital devices on the trust, technology acceptance, and mental workload of older adults using a voice assistant in a health context. End-of-study interviews regarding voice assistant use were conducted with participants. Qualitative content analyses were used to assess the interview findings about the communication content, the more trustworthy anthropomorphic setting, and suggestions for the voice assistant.

Results

Communication style, anthropomorphic setting, and individual differences all had statistically significant effects on older adults’ evaluations of the voice assistant. Compared with a task-oriented voice assistant, older adults preferred a social-oriented voice assistant in terms of trust in ability, integrity, and technology acceptance. Older adults also had better evaluations for a voice assistant with a medical background in terms of trust in ability, integrity, technology acceptance, and mental workload. In addition, older adults with more experience using digital products provided more positive evaluations in terms of trust in ability, integrity, and technology acceptance.

Conclusions

This study suggests that when designing a voice assistant for older adults in the health context, using a social-oriented communication style and providing an anthropomorphic setting in which the voice assistant has a medical background are effective ways to improve the trust and acceptance of older adults of voice assistants in an internet-of-things environment.

Evaluation of Newly Designed Blister Packs for Easier Handling to Prevent Pill Dropping

BACKGROUND

Blister packs with paperboard backing, which is useful for displaying instructions and information, are the most popular type of packaging for osteoporosis drugs in Japan. However, the main users of drugs are the aged, who often find blister packs difficult to open or drop their pills during opening. In this study, we compared different types of blister packs in terms of usability and handling.

METHODS

We conducted a subjective and objective study to compare commonly used blister packs with newly designed ones that have a jagged notch designed to hold a pill temporarily and a perforated line that enables the pack to be held easily in one hand. Regarding subjective data, packaging and sensory tests were performed. The participants in the sensory test were healthy older adults and patients with rheumatoid arthritis (RA). We also measured the pinch power of all participants.

RESULTS

A comparison of several items, including opening status, prevention of pill dropping, and understanding of the instructions, using a numerical rating scale revealed no significant differences between ordinary (type A) and newly designed (type B) packaging. However, the scores for type B were the same or better than those for type A for every evaluation item. In addition, more than 85% of the participants reported preferring to use type B. More than 80% of the participants in both groups reported dropping pills using type A, which seemed to be related to their preference for type B. In the evaluation by the examiner (objective study), all participants could successfully remove their pills without dropping using type B, including those in the RA group who had difficulty handling packages.

CONCLUSION

These findings suggest that the new type of blister pack assessed in this study (type B) is preferable among older and shows promise for a universal design.

Association between cognitive function and self-reported antihypertensive medication adherence among middle-aged and older hypertensive women

DESIGN

This study applied a cross-sectional, descriptive correlational design.

AIMS AND OBJECTIVES

The purpose of the study was to examine the relationship between cognitive function and self-reported antihypertensive medication adherence in middle-aged and older hypertensive women.

BACKGROUND

Although medication adherence is an essential key for preventing complications from hypertension, poor medication adherence is common among middle-aged and older hypertensive women. Taking medications involves a cognitive process. Little is known about the contribution of cognitive function to adherence to antihypertensive medication in middle-aged and older women.

METHODS

This study used a convenience sample of 137 women aged ≥50 years recruited from a medical centre in southern Taiwan. Participants completed a survey of demographic and clinical information and self-reported medication adherence, and received cognitive function tests. Hierarchical regression analyses were used to evaluate the association between cognitive function and medication adherence. This study followed the STROBE guidelines.

RESULTS

More than one-fourth of the women (27%) reported poor adherence. Women with poor adherence appeared to have a significantly lower memory than women with good adherence. Memory was positively associated with antihypertensive medication adherence after controlling for age, blood pressure and duration of hypertension. Working memory, executive function and psychomotor speed were not significantly related to antihypertensive medication adherence.

CONCLUSIONS

Reduced memory function was associated with poorer antihypertensive medication adherence among middle-aged and older women. Middle-aged and older women with hypertension and poor memory performance are at risk of poor medication adherence. Future prospective studies examining the causal relationship between cognitive function and antihypertensive medication adherence are warranted.

RELEVANCE TO CLINICAL PRACTICE

Nurses could evaluate the memory of middle-aged and older hypertensive women when assessing antihypertensive medication adherence in clinical practice and provide relevant interventions.

The Effect of Social Support on Treatment Adherence in Hypertension in China

OBJECTIVE

Treatment nonadherence is a major problem in the management of hypertension. There are many factors influencing the treatment adherence of hypertensive patients. The aim of this study was to examine the effect of social support on the treatment adherence in hypertension in China.

PATIENTS AND METHODS

A total of 453 patients with hypertension hospitalized in a tertiary hospital in Xi'an, China were invited to participate in this cross-sectional study. Data were collected by "modified Chinese Hill-Bone compliance to high blood pressure therapy scale" and "Chinese Family Support Scale".

RESULTS

It was found that 31.1% of patients were adherent with their antihypertensive treatments. Gender, duration of antihypertensive drug used, number of antihypertensive drugs used and social support were independently associated with hypertensive treatment adherence. Social support was strongly and positively associated with the hypertensive treatment adherence (P<0.001, OR = 0.752, 95% CI: 0.678-0.833). Family social support was provided to hypertensive patients mainly through their nuclear family, that is spouses, partner or children. Treatment adherence of hypertensive patients was positively correlated to the three subgroups of social support. It was found that social support provided to patients from social resource (r=0.568) had greater impact on treatment adherence than that from kinship (r=0.364) and nuclear family (r=0.262).

CONCLUSION

Treatment adherence of patients with hypertension was found to increase positively as their social support increased. In addition to the support given to patients from nuclear family members, other social support especially professional agencies and community organizations should also be promoted and strengthened.

Patient-reported outcomes for diabetes and hypertension care in low- and middle-income countries: A scoping review

INTRODUCTION

Patient-reported outcome measures (PROMs) assess patients' perspectives on their health status, providing opportunities to improve the quality of care. While PROMs are increasingly used in high-income settings, limited data are available on PROMs use for diabetes and hypertension in low-and middle-income countries (LMICs). This scoping review aimed to determine how PROMs are employed for diabetes and hypertension care in LMICs.

METHODS

We searched PubMed, EMBASE, and ClinicalTrials.gov for English-language studies published between August 2009 and August 2019 that measured at least one PROM related to diabetes or hypertension in LMICs. Full texts of included studies were examined to assess study characteristics, target population, outcome focus, PROMs used, and methods for data collection and reporting.

RESULTS

Sixty-eight studies met the inclusion criteria and reported on PROMs for people diagnosed with hypertension and/or diabetes and receiving care in health facilities. Thirty-nine (57%) reported on upper-middle-income countries, 19 (28%) reported on lower-middle-income countries, 4 (6%) reported on low-income countries, and 6 (9%) were multi-country. Most focused on diabetes (60/68, 88%), while 4 studies focused on hypertension and 4 focused on diabetes/hypertension comorbidity. Outcomes of interest varied; most common were glycemic or blood pressure control (38), health literacy and treatment adherence (27), and acute complications (22). Collectively the studies deployed 55 unique tools to measure patient outcomes. Most common were the Morisky Medication Adherence Scale (7) and EuroQoL-5D-3L (7).

CONCLUSION

PROMs are deployed in LMICs around the world, with greatest reported use in LMICs with an upper-middle-income classification. Diabetes PROMs were more widely deployed in LMICs than hypertension PROMs, suggesting an opportunity to adapt PROMs for hypertension. Future research focusing on standardization and simplification could improve future comparability and adaptability across LMIC contexts. Incorporation into national health information systems would best establish PROMs as a means to reveal the effectiveness of person-centered diabetes and hypertension care.

Impact of an Education Program for Caregivers of Patients with Alzheimer's Disease on Treatment Discontinuation and Compliance in Korea

BACKGROUND AND PURPOSE

Reportedly 30-50% of patients being treated for chronic illnesses do not adhere to their medication regimen. We assessed the impact of a nurse-led education program for caregivers of Korean de novo Alzheimer's disease patients who had newly been prescribed donepezil.

METHODS

This multicenter study analyzed 93 participants in a caregiver education group and 92 participants in a caregiver no-education group. At every visit up to the end of the study (1 year), caregivers in the education group were given educational brochures regarding Alzheimer's disease and the efficacy and adverse events of donepezil treatment. The primary endpoint was the discontinuation rate of donepezil treatment during the 1-year observation period. The secondary endpoints included the effect of education on compliance with donepezil treatment assessed at each visit using a clinician rating scale (CRS) and visual analog scale (VAS), and changes from baseline in cognitive assessment tests.

RESULTS

The donepezil discontinuation rates at 1 year were 5.38% (5/93) and 6.52% (6/92) in the caregiver education and no-education groups, respectively (p=0.742). No significant between-group differences in donepezil compliance rates on the CRS and VAS were observed, but significant changes were observed in some cognitive tests from baseline to the end of the study.

CONCLUSIONS

Caregiver education had no significant effect on treatment discontinuation, but this may have been due to the low severity of cognitive impairment among the included population at baseline. In addition, the low discontinuation rates meant that no significant difference in treatment compliance was observed.

Impact of satisfaction with physician-patient communication on self-care and adherence in patients with hypertension: cross-sectional study

BACKGROUND

Hypertension (HT) requires patients to continuously monitor their blood pressure, strictly adhere to therapeutic recommendations, and self-manage their illness. A few studies indicate that physician-patient communication and the patient's satisfaction with the therapeutic relationship may affect the course and outcomes of the treatment process. Research is still lacking on the association between satisfaction with physician-patient communication and adherence to treatment or self-care in chronically ill patients. The aim of the study was to evaluate the relationship between satisfaction with physician-patient communication and self-care and adherence in patients with HT undergoing chronic treatment.

METHODS

The following instruments were used: the Adherence to Refills and Medication Scale (ARMS) for evaluating adherence (12-48 points), the Self-Care of Hypertension Inventory (SCHI) for self-care level (0-100 points), and the Communication Assessment Tool (CAT) for evaluating satisfaction with physician-patient communication. Socio-demographic and clinical data were obtained from patients' medical records. The research has a cross-sectional and observational study design. Inclusion criteria were as follows: age > 18 years, hypertension diagnosed per European Society of Hypertension (ESH) guidelines, treatment with at least one antihypertensive drug for the past 6 months, and informed consent. Cognitively impaired patients unable to complete the surveys without assistance were excluded (MMSE ≤18). Correlations between quantitative variables were analyzed using Pearson's or Spearman's correlation coefficient. Linear regression was performed. Variable distribution normality was verified using the Shapiro-Wilk test.

RESULTS

The study included 250 patients (110 male, mean age 61.23 ± 14.34) with HT, treated at a hypertension clinic. In the CAT questionnaire individual questions pertaining to satisfaction with physician communication (on the CAT) were rated "excellent" 28.4-50.4% of the time. The best-rated aspects of communication included: letting the patient talk without interruptions (50.4% "excellent" ratings), speaking in a way the patient can understand (47.6%), and paying attention to the patient (47.2%). According to patient reports, physicians most commonly omitted such aspects as encouraging the patient to ask questions (28.4%), involving them in decisions (29.2%), and discussing the next steps (35.2%). The respondents had a low level of adherence to pharmaceutical treatment (16.63 ± 4.6). In terms of self-care, they scored highest in self-care management (64.17 ± 21.18), and lowest in self-care maintenance (56.73 ± 18.57). In correlation analysis, satisfaction with physician-patient communication (total CAT score) was positively correlated with all SCHI domains (self-care maintenance β = 0.276, self-care management β = 0.208, self-care confidence β = 0.286, p < 0.05), and negatively correlated with ARMS scores (indicating better adherence).

CONCLUSIONS

Satisfaction with physician-patient communication has a significant impact on self-care and pharmaceutical adherence in patients with hypertension. The more satisfied the patient is with communication, the better their adherence and self-care.

TRIAL REGISTRATION

SIMPLE: RID.Z501.19.016.

Urban-rural disparity in the utilization of national community-based hypertension monitoring service-results from the China Health and Retirement Longitudinal Study, 2015

Background

Since 2009, community-based hypertension monitoring service (CBHMS) has been provided free of charge by the Chinese government as part of the national Essential Public Health Services (EPHS) policy. This study aimed to examine the disparity in the utilization of CBHMS between urban and rural community-dwelling middle-aged and older adults with hypertension.

Methods

Subjects were 3,479 community-residing hypertensive patients, identified from the China Health and Retirement Longitudinal Study (CHARLS), 2015, a nationally representative survey of Chinese residents aged 45 years and older. The utilization of CBHMS was defined as having one’s blood pressure (BP) examined at least once a season by community or village doctors. Rates of CBHMS use of urban and rural residents with hypertension were compared by using chi-square test. Multiple logistic regression analyses were conducted to examine factors associated with the utilization of CBHMS of hypertensive patients.

Results

CBHMS was significantly more likely to be used by rural than urban middle-aged and older residents with hypertension (38.6% vs. 25.1%, P < 0.001). Results from multiple logistic regression analyses showed that urban patients who were living in central (OR = 0.37) and western (OR = 0.48) regions (vs. eastern region), had an educational attainment of middle school (OR = 0.33) and college and above (OR = 0.48) (vs. illiterate), and were not taking antihypertensive agents (OR = 0.26) were less likely to use CBHMS, while rural patients who had no medical insurance (OR = 0.56), and were not taking antihypertensive agents (OR = 0.31) were less likely to use CBHMS.

Conclusions

The national CBHMS is more likely to be used by rural middle-aged and older adults with hypertension in China. The urban-rural difference in the utilization of CBHMS may be resulted from the different demographics of urban and rural middle-aged and older residents and uneven distributions of health services resources between urban and rural areas. Urban-rural disparities in characteristics of CBHMS use should be taken into consideration when promoting the utilization of CBHMS in China.

Hypertension prevalence alteration in 92 815 nurses based on the new standard by 2017 ACC/AHA hypertension guideline: observational cross-sectional study from China

OBJECTIVES

This study aimed to elucidate the status of hypertension and to analyse the hypertension changes in prevalence, awareness, treatment and control rate among the portion of Chinese nursing staff based on the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) High Blood Pressure Guideline and the 2010 Chinese Guideline for the Management of Hypertension.

DESIGN

Cross-sectional study.

SETTING

512 medical institutions in 13 cities in Hebei Province.

PARTICIPANTS

The candidates of registered nurses from 512 medical institutions in 13 cities in Hebei Province (N=143 772) were invited to participate in the survey, and few of them who refused to participate were excluded from the research group based on the reasons that 93 603 incumbent nurses at the age of 18-65 accepted to the survey and submitted questionnaires online. Undoubtedly, a response rate of 65.11% was achieved. After excluding 788 individuals with incomplete information in the questionnaires, 92 815 participants were included in the final analysis.

MAIN OUTCOME MEASURES

The prevalence, awareness, treatment and control rates of hypertension.

RESULTS

92 815 participants were included in the final analysis, among which consisted of 3677 men (3.96%) and 89 138 women (96.04%). The mean age of the participants was 31.65 (SD=7.47) years.We demonstrated that 26 875 nursing staff were diagnosed as having hypertension according to the new standard by the 2017 ACC/AHA guideline, more than 20 551 cases compared with the previous threshold on the 2010 Chinese guideline. The prevalence of hypertension among nursing staff was 28.96% in the context of the 2017 ACC/AHA guideline, 3.25 times higher than that (6.81%) evaluated by the criteria of the 2010 Chinese guideline. However, the awareness, treatment and control rate (13.50%, 10.73% and 0.81%) were 3.25, 3.22 and 17.48 times lower than those (57.37%, 45.30% and 14.97%) based on the 2010 Chinese guideline, respectively.

CONCLUSIONS

This research illustrated that it was crucial to improve the awareness rate, drug treatment rate and control rate of hypertension for nurses. Meanwhile, according to the 2017 ACC/AHA guideline, the prevalence of hypertension in China will increase significantly, which poses a more severe challenge to the management of hypertension in China.

A Chinese and Western medication adherence scale in patients with Chronic Kidney Disease

OBJECTIVE

The self-reported scale is a widely used method to assess patients' medication adherence in clinical practice, but there is still a lack of medicine adherence measurement scale for patients with Chronic Kidney Disease (CKD). Therefore, this study aimed to develop a medication adherence measurement scale of traditional Chinese medicine and Western medicine, providing a tool for evaluating medicine adherence of CKD patients.

METHODS

In the preliminary stage, we formed the prediction scale after three rounds Delphi method and it was filled by 20 patients, who were selected randomly. After pre-investigation and language adaption, we adjusted the prediction measurement scale which included 31 items based on Knowledge-Attitude-Belief Theory. Then, 222 CKD patients in Guangdong Hospital of traditional Chinese Medicine were investigated by this 31-item scale. We screened 31 items by Items analysis theory, including critical ratio, item correlation analysis, internal consistency analysis, principal component analysis and other methods. The left 26 items made up a formal scale. We collected and analyzed data of the 26-item scale and Chinese version of MGL scale, and took their scores correlation analysis as the criterion validity of the 26-item scale. At the same time, we evaluated content validity, Cronbach alpha coefficient and retest reliability of the 26-item scale.

RESULTS

We developed a scale with 26 items and 5 dimensions finally. In the validation analysis, the scale had good construct validity and content validity. The Pearson relation index between respective scores of the scale and Chinese version of MGL scale was 0.426, P<0.01. The scale also had good reliability as its 0.915 in Cronbach alpha, 0.753 in retest reliability and P<0.01.

CONCLUSION

The scale revealed great reliability and validity, which could be used as a measurement tool to evaluate the medication adherence of patients with CKD.

Utilisation of national community-based blood pressure monitoring service among adult Chinese and its association with hypertension treatment and blood pressure control-a mediation analysis

Background

Community-based blood pressure (BP) monitoring plays an important role in national hypertension management in China. However, the utilisation of this service, together with its associations on hypertension treatment and BP control has not been fully investigated.

Methods

The study population was from the China Health and Retirement Longitudinal Study (CHARLS) in 2015. Cross-sectional data of 2487 hypertensive persons were included as subjects. Stratified sample households were selected from 450 villages or communities of 150 counties from 28 provinces. Finally, 21,097 individuals were interviewed successfully. The main outcome was hypertension control (having average BP under 140-90 mmHg). The main independent variable was utilisation of community-based BP monitoring service (having BP examination once a season or more). The mediators were hypertension treatment (currently taking any antihypertensive medicine) and lifestyle factors (alcohol intake, physical activity, smoke). We performed chi-square and binary logistic regression to analyse associations of BP monitoring with hypertension treatment and blood pressure control. The mediation model was examined by the Sobel test.

Results

Mean age of the population was 64.2 (0.24). The percentage of males was 42.8%. Prevalence of community-based BP monitoring was 32.1%. Patients who used this service had higher odds of hypertension treatment (β = 1.259, P < 0.01, OR = 3.52, CI = 2.467–5.030), and BP control (β = 0.220, P < 0.05, OR = 1.246, CI = 1.035–1.499). Medication treatment played a complete mediating role between monitoring and hypertension control in this study (t = 4.51, P < 0.001). Those who underwent BP monitoring tended to be those who did not finish primary school education (χ2 = 30.300, P < 0.001), had poorer household income (χ2 = 18.298, P < 0.05), and lived in rural areas rather than in urban areas (χ2 = 40.369, P < 0.001).

Conclusions

Although the use of BP monitoring service had no direct effect on BP control, it had a positive effect on BP control through the full mediation effect of hypertension treatment. Termly BP monitoring by community-based health expertise among hypertensive persons, for instance, once a season, can be recommended to public health policymakers for BP control through instructions on medication treatment and health behaviours.

Medication Adherence and Its Association with Health Literacy and Performance in Activities of Daily Livings among Elderly Hypertensive Patients in Islamabad, Pakistan

Background and Objective: Medication non-adherence is a preventable reason for treatment failure, poor blood pressure control among hypertensive patients and the geriatric population owing to poor physical activity is more vulnerable strata. The objective of this study is to investigate medication adherence and its associated factors among Pakistani geriatric hypertensive patients. Methods: A cross-sectional survey-based study was conducted at the out-patient department of the cardiac center from May 2018 to August 2018. A universal sampling technique was used to approach patients and 262 eligible consented patients were interviewed to collect information about socio-demographics, health, and disease-related characteristics using a structured questionnaire. The Morisky Levine Green test was used for the assessment of medication adherence. The Barthel index and single item literacy screener (SILS) was used to measure performance in activities of daily living and health literacy respectively. Chi-square tests and multivariate binary logistic regression analysis were performed to find factors by using SPSS version 20. Results: Of the total 262 participants, about 38.9% (n = 102) were scored 4 and considered adherent while 61.1% (n = 160) were considered as non-adherent. In logistic regression analysis, self-reported moderate (OR = 3.538, p = 0.009) and good subjective health (OR = 4.249, p = 0.008), adequate health literacy (OR = 3.369, p < 0.001) and independence in performing activities of daily living (OR = 2.968, p = 0.002) were found to be independent predictors of medication adherence among older hypertensive patients. Conclusion: Medication adherence among the older hypertensive population in Pakistan is alarmingly low. This clearly requires patient-centered interventions to overcome barriers and educating them about the importance of adherence.

Self-management and blood pressure control in China: a community-based multicentre cross-sectional study

OBJECTIVES

This study explored the relationship between self-management and blood pressure (BP) control in China.

DESIGN

A cross-sectional study.

SETTING

Eight community health centres from four cities in the Northeast (Shenyang), Northwest (Xi'an), Southwest (Chengdu) and South (Changsha) of China.

PARTICIPANTS

A total of 873 adults with hypertension, including 360 men and 513 women. Hypertension was defined as systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg.

OUTCOME MEASUREMENTS

BP control was the primary outcome variable. This was categorised as good control if individuals with hypertension reduced their BP to <140/90 mm Hg, otherwise, it was categorised as poor control. Secondary outcomes included self-management, defined as: (1) context or condition-specific factors or physical/social environments (eg, age, sex, marital status, education, personal income and health insurance) and (2) process or knowledge/beliefs, self-regulation skills/abilities and social facilitation (eg, treatment, diet, exercise and risk factor management). Data were analysed using logistic regression models using SPSS V.20.

RESULTS

A total of 67.1% (n=586) participants had poor BP control. Limited outpatient care benefits in mainly rural residents (OR 2.26, 95% CI 1.06 to 4.81) and longer disease duration (OR 1.03, 95% CI 1.01 to 1.04) were associated with poor BP control. Self-management practices reduced the odds of having poor BP control (OR 0.98, 95% CI 0.97 to 0.99).

CONCLUSIONS

The individual and family self-management theory can serve as an effective theory for understanding the key contexts, processes and outcomes essential for BP control in China. Future research should evaluate the effect of a self-management intervention (eg, self-monitoring, medication adherence, regular and routine doctor visits, and social supports) for BP control in China using a multisite cluster randomised controlled trial. Sex and gender difference, cost and patient-reported outcomes should also be examined.

Blood pressure and low-density lipoprotein cholesterol control status in Chinese hypertensive dyslipidemia patients during lipid-lowering therapy

ᅟ

The present study comprised 17,096 Chinese hypertensive dyslipidemia patients who received lipid-lowering treatment for > 3 months in order to investigate blood pressure (BP) as well as low-density lipoprotein cholesterol (LDL-C) goal attainment rates in Chinese hypertensive dyslipidemia patients on antidyslipidemia drugs. The factors that interfered with BP, or BP and LDL-C goal attainment rates and antihypertensive treatment patterns, were analyzed. In total, 89.9% of the 17,096 hypertensive dyslipidemia patients received antihypertensive medications mainly consisting of a calcium channel blocker (CCB) (48.7%), an angiotensin receptor antagonist (ARB) (25.4%) and an angiotensin-converting enzyme inhibitor (ACEI) (15.1%). In cardiology departments, usage rates of β-blockers (19.2%) were unusually high compared to other departments (4.0–8.3%), whereas thiazide diuretics were prescribed at the lowest rate (0.3% vs 1.2–3.6%). The overall goal attainment rates for combined BP and LDL-C as well as BP or LDL-C targets were 22.9, 31.9 and 60.1%, respectively. The lowest BP, LDL-C and BP combined with LDL-C goal attainment rates were achieved in endocrine departments (19.9, 48.9 and 12.4%, respectively). Combination therapies showed no benefit particularly for BP goal achievement. A multivariate logistic regression analysis showed that age < 65 years, alcohol consumption, diabetes, coronary heart disease (CHD), cerebrovascular disease (CVD), chronic kidney disease (CKD), body mass index (BMI) ≥ 28 kg/m² and not achieving total cholesterol goals were independent predictors for achieving BP, LDL-C or combined BP and LDL-C goals. In summary, the BP and LDL-C goal achievement rates in Chinese dyslipidemia outpatients with hypertension were low, especially in endocrine departments. Combination therapies were not associated with improvement of the goal achievement rates.

Trial registration

Clinical trial registration number NCT01732952

Electronic supplementary material

The online version of this article (10.1186/s12944-019-0974-y) contains supplementary material, which is available to authorized users.

Effectiveness of low-cost reminder package combined with case-based health education to improve hypertensive patients' medication adherence: a clustered randomized controlled trial

PURPOSE

Medication adherence (MA) is a key factor for hypertensive patients' blood pressure control and forgetfulness is one of the main reasons that cause medication non-adherence. If effective, low-cost reminder package (LCRP) has great potentials for large-scale promotion. Therefore, this study aims to evaluate the effectiveness of combining LCRP and health education to improve MA among hypertensive patients.

PATIENTS AND METHODS

A clustered randomized controlled trial was performed in Beijing. A total of 518 hypertensive patients recruited from 8 community health care centers were randomized to receive LCRP combined with case-based health education or usual care. Randomization was performed at community level. Multilevel modeling was used to evaluate the study effect.

RESULTS

MA scores did not differ significantly at baseline between the intervention group and the control group. The results of multilevel modeling indicated that MA scores increased more in the intervention group, and the intervention effect on MA was 0.287 (95% CI: [0.103, 0.471], P=0.002). Patients' systolic blood pressure (SBP) and diastolic blood pressure (DBP) were not improved (SBP: difference=0.536, 95% CI [-3.207, 4.278]; DBP: difference=-0.927, 95% CI [-3.283, 1.428]).

CONCLUSION

LCRP combined with case-based health education could significantly improve hypertensive patients' MA.

Conceptual Model of Medication Adherence in Older Adults with High Blood Pressure-An Integrative Review of the Literature

BACKGROUND

Medication adherence (MA) is the most important controlling factor of high blood pressure (HBP). There are a few MA models, but they have not been successful in predicting MA completely. Thus, this study aimed to expand a conceptual model of MA based on an ecological approach.

METHODS

An integrative review of the literature based on theoretical and empirical studies was completed. Data source comprised: Medline (including PubMed and Ovid), ISI, Embase, Google scholar, and internal databases such as Magiran, Google, SID, and internal magazines. Primary English and Persian language studies were collected from 1940 to 2018. The steps of study included: (a) problem identification, (b) literature review and extracting studies, (c) appraising study quality, (d) gathering data, (e) data analysis using the directed content analysis, (f) concluding.

RESULTS

Thirty-six articles were finally included and analyzed. After analysis, predictors of MA in older adults with hypertension were categorized into personal, interpersonal, organizational, and social factors. Although the personal factors have the most predictors in sub-categories of behavioral, biological, psychological, knowledge, disease, and medication agents, social, organizational and interpersonal factors can have indirect and important effects on elderly MA.

CONCLUSION

There are many factors influencing MA of elderly with HBP. The personal factor has the most predictors. The designed model of MA because of covering all predictor factors, can be considered as a comprehensive MA model. It is suggested that future studies should select factors for study from all levels of the model.

Factors affecting medication adherence in community-managed patients with hypertension based on the principal component analysis: evidence from Xinjiang, China

PURPOSE

The analysis of factors affecting the nonadherence to antihypertensive medications is important in the control of blood pressure among patients with hypertension. The purpose of this study was to assess the relationship between factors and medication adherence in Xinjiang community-managed patients with hypertension based on the principal component analysis.

PATIENTS AND METHODS

A total of 1,916 community-managed patients with hypertension, selected randomly through a multi-stage sampling, participated in the survey. Self-designed questionnaires were used to classify the participants as either adherent or nonadherent to their medication regimen. A principal component analysis was used in order to eliminate the correlation between factors. Factors related to nonadherence were analyzed by using a χ2-test and a binary logistic regression model.

RESULTS

This study extracted nine common factors, with a cumulative variance contribution rate of 63.6%. Further analysis revealed that the following variables were significantly related to nonadherence: severity of disease, community management, diabetes, and taking traditional medications.

CONCLUSION

Community management plays an important role in improving the patients' medication-taking behavior. Regular medication regimen instruction and better community management services through community-level have the potential to reduce nonadherence. Mild hypertensive patients should be monitored by community health care providers.

Independent predictors of medication adherence among Singaporean patients following an ischaemic stroke or transient ischaemic attack

OBJECTIVES

To investigate the independent predictors of medication adherence among Singaporean patients following an ischaemic stroke or transient ischaemic attack.

BACKGROUND

Secondary prevention of stroke includes optimal control over modifiable risk factors, and medication adherence is important in controlling the effect of comorbidities. However, there is a paucity of published literature on the topics of medication adherence among stroke patients, especially in the Asian population.

DESIGN

A cross-sectional, descriptive, correlational study.

METHODS

One hundred and twenty-one patients with ischaemic stroke or transient ischaemic attack were recruited from a tertiary hospital in Singapore. Data collection included the Morisky Medication Adherence Scale-8 (MMAS-8), General Self-Efficacy Survey (GSES) and Medical Outcome Study Social Support Survey. Multiple linear regression analyses were used to evaluate predictors of medication adherence, measured by MMAS-8.

RESULTS

The mean score of the MMAS-8 was 5.07 (SD = 2.20, range 0-8), and more than 80% of the participants had low (n = 65, 53.7%) or medium (n = 34, 28.1%) levels of medication adherence. Multivariate linear regression analysis showed that two factors, namely "understanding the benefits of medications" (β = 0.238, p = .010) and "having suffered from stroke twice or more" (β = 0.235, p = .014), were identified as independent predictors of medication adherence in stroke patients while the other variables were adjusted. These two factors accounted for 12.4% of the variance.

CONCLUSION

Medication adherence was poor in Singaporean patients following an ischaemic stroke or transient ischaemic attack. The independent predictors identified in this study will support healthcare professionals to develop tailored intervention to improve medication adherence among this group of patients.

RELEVANCE TO CLINICAL PRACTICE

Nurses play an important role in promoting patients' medication adherence. Helping stroke patients understand the long-term benefits of their medications is essential to enhance patients' medication adherence and results in better health outcomes.

Determinants of antihypertensive adherence among patients in Beijing: Application of the health belief model

OBJECTIVES

This study was aimed to determine the factors associated with antihypertensive adherence based on the Health Belief Model (HBM).

METHODS

A cross-sectional study was conducted in a rural area of China in 2014. The questionnaire included information about demographics, a scale based on the HBM, and the four-item Morisky Medication Adherence Scale.

RESULTS

745 hypertensive patients participated in the study (345 men, 400 women). Patients' mean age was 56.4±10.8years. The prevalence of adherence was 43.5%. Structural equation modeling showed that men, older participants, and those with greater knowledge of hypertension showed better medication adherence than did other participants. Based on the HBM, higher levels of self-efficacy and perceived severity and a lower level of perceived barriers were associated with better antihypertensive adherence. Self-efficacy was one of the most important mediating variables affecting antihypertensive adherence.

CONCLUSIONS

Antihypertensive adherence was not optimal among patients in Beijing. Given that many factors are associated with medication adherence, individualized intervention strategies should be carried out in Beijing, China, especially in community settings.

PRACTICE IMPLICATIONS

Medication adherence can be improved by enhancing patients' self-efficacy because it was the most important influence and mediating variable.

Characteristics Associated With Antihypertensive Treatment and Blood Pressure Control: A Population-Based Follow-Up Study in Peru

BACKGROUND

Over one-quarter of the world's adult population has hypertension, yet achieving adequate treatment or control targets remains a challenge.

OBJECTIVE

This study sought to identify, longitudinally, characteristics associated with antihypertensive treatment and blood pressure (BP) control among individuals with hypertension.

METHODS

Data from individuals enrolled in the population-based CRONICAS Cohort Study (adults ≥35 years, living in 4 different rural/urban and coastal/high-altitude Peruvian settings) with hypertension at baseline were used. Antihypertensive treatment and BP control were assessed at baseline and at 15 months. Multinomial logistic regressions were used to estimate relative risk ratios (RRR) and 95% confidence intervals (95% CI) of factors associated with antihypertensive treatment and BP control at follow-up.

RESULTS

At baseline, among 717 individuals with hypertension (53% women, mean age 61.5 ± 12.4 years), 28% were unaware of their hypertension status, 30% were aware but untreated, 16% were treated but uncontrolled, and 26% were treated and controlled. At follow-up, 89% of unaware and 82% of untreated individuals persisted untreated, and only 58% of controlled individuals remained controlled. Positive predictors of receiving treatment and being controlled at follow-up included age (RRR: 0.81; 95% CI: 0.73 to 0.91 for every 5 years) and family history of a chronic disease (RRR: 0.53; 95% CI: 0.31 to 0.92 vs. no history); whereas Puno rural site (RRR: 16.51; 95% CI: 1.90 to 143.56 vs. Lima) and male sex (RRR: 2.59; 95% CI: 1.54 to 4.36) were risk factors. Systolic BP at baseline (RRR: 1.27; 95% CI: 1.16 to 1.39 for every 5 mm Hg) and male sex (RRR: 1.75, 95% CI: 1.02 to 2.98) were risk factors for being treated but uncontrolled at follow-up.

CONCLUSIONS

Large gaps in treatment of hypertension were observed. Targeting specific populations such as men, younger individuals, or those without family history of disease may increase coverage of antihypertensive treatment. Also, targeting male individuals or those with higher systolic BP could yield better rates of BP control in the short term.

Medication adherence among patients with chronic conditions in Italy

BACKGROUND

The aims of the cross-sectional study were to measure the extent of adherence to prescribed medications among patients affected by chronic diseases and to identify the predictors of the adherence.

METHODS

The study was conducted between March and December 2014 among 633 outpatients in four hospitals in Italy. Data were collected using a face to face interview at the time of their visit to the hospital. The Morisky Medication Adherence 4-item Scale was used to measure patients' self-reported adherence.

RESULTS

The majority of the patients were male (51.7%), the mean age was 63.2 years, one-third had at least a high school diploma or equivalent, 34.6% was employed, and the main diseases were hypertension, diabetes, and chronic obstructive pulmonary disease. A total of 39.3% patients reported themselves as being adherent to medications over the 4 weeks preceding their medical specialist's visit. Patients were more likely to adhere to medications if they had a college degree or higher level of education, a higher score of the Katz index, took a lower number of total pills per day, and did not use pill organizers. Patients who have never forgotten to take medications over the 4 weeks preceding their medical specialist's visit were 46.1%.

CONCLUSIONS

The findings emphasize the need for improving information for the individuals affected by chronic diseases concerning the risks of non-adherence in order to encourage responsible behaviour to prescribed medications.

Adherence to Treatment in Hypertension

The lack of adherence to treatment in hypertension affects approximately 30 % of patients. The elderly, those with several co-morbidities, social isolation, low incomes or depressive symptoms are the most vulnerable to this problem. There is no ideal method to quantify the adherence to the treatment. Indirect methods are recommended in clinical practice. Any intervention strategy should not blame the patient and try a collaborative approach. It is recommended to involve the patient in decision-making. The clinical interview style must be patient-centered including motivational techniques. The improvement strategies that showed greater effectiveness in the compliance of hypertension treatment were: treatment simplification, appointment reminders systems, blood pressure self-monitoring, organizational improvements and nurse and pharmacists care. The combination of different interventions are recommended against isolated interventions.

Systematic review of the barriers affecting medication adherence in older adults

Medication adherence is a crucial part in the management of chronic diseases. As older adults form a greater proportion of the population with chronic diseases and multiple morbidities, understanding medication adherence in older adults becomes important. In the present article, we aimed to systematically review the literature for the factors associated with medication adherence in the geriatric population. We carried out a literature search using electronic databases and related keywords. 17 391 articles were reviewed in total. 65 articles were found to be relevant to our objective. A total of 80 factors of five different categories were found to be associated with medication adherence in older adults. The factors, the types of studies and the number of studies that agreed or disagreed were presented. A flower model for medication adherence was also presented to allow clinicians to better understand the complex nature of medication adherence in this population. The 80 factors reviewed were categorized into five main categories; namely, patient factors, medication factors, physician factors, system-based factors and other factors as factors affecting poor medication adherence in older adults. Clinicians need to be mindful of the complex nature of factors affecting medication adherence in this population to optimize therapeutic outcomes. Clinicians have to be more skillful to discover and to optimize the medication adherence factors in geriatric patients. The flower model is presented as a framework for clinicians to better understand the various factors affecting medication adherence in older adults. Geriatr Gerontol Int 2016; 16: 1093-1101.

Translation and validation of the Greek version of the hypertension knowledge-level scale

AIMS AND OBJECTIVES

To translate and validate a Greek version of the Hypertension Knowledge-Level Scale.

BACKGROUND

The major barrier in the management of hypertension is the lack of adherence to medications and lifestyle adjustments. Patients' knowledge of the nature of hypertension and cardiovascular risk factors is a significant factor affecting individuals' adherence. However, few instruments have been developed to assess patients' knowledge level and no one has been translated into Greek.

DESIGN

This study used a case control study design.

METHODS

Data collection for this research occurred between February 7, 2013 and March 10, 2013. The sample included both hypertensives and non-hypertensives. Participants simultaneously completed the version of the Hypertension Knowledge-Level Scale. A total of 68 individuals completed the questionnaire.

RESULTS

Coefficient alpha was 0·66 for hypertensives and 0·79 for non-hypertensives. The difference for the mean scores in the entire scale between the two samples was statistically significant. In addition, significant differences were observed in many sub-dimensions and no correlation was found between level, knowledge and age, gender and education level.

CONCLUSIONS

Findings provide support for the validity of the Greek version of the Hypertension Knowledge-Level Scale.

RELEVANCE TO CLINICAL PRACTICE

The translation and validation of an instrument evaluating the level of knowledge of hypertension contribute to assessing the provided educational intervention. Low knowledge level should lead to the development of new methods of education, therefore nurses will have the opportunity to amplify their role in patients' education and develop relationships based on honesty and respect.

Clinical use of azelnidipine in the treatment of hypertension in Chinese patients

BACKGROUND

Hypertension is the most common chronic disease and the calcium channel antagonist is the most popularly used antihypertensive drug in Chinese patients. Azelnidipine is a third generation and long-acting dihydropyridine calcium channel antagonist. A series of research has demonstrated that azelnidipine produced an effective antihypertensive effect in patients with essential hypertension. Now it is need to summarize clinical use of azelnidipine in the treatment of hypertension in Chinese patients.

METHODS

Relevant literature was identified by performing searches in PubMed and CNKI (China National Knowledge Infrastructure), covering the period from January 2003 (the year azelnidipine was launched) to July 2014. We included studies that described pharmacology of azelnidipine, especially the pharmacokinetics, clinical efficacy, and safety and tolerability of azelnidipine in a Chinese population. The full text of each article was strictly reviewed, and data interpretation was performed.

RESULTS

In Chinese healthy volunteers, a single-dose oral administration of azelnidipine 8-16 mg had a peak plasma concentration of 1.66-23.06 ng/mL and time to peak plasma concentration was 2.6-4.0 hours and the area under the plasma concentration versus time curve from time 0 hour to 96 hours was 17.9-429 ng/mL·h and elimination half-life was 16.0-28.0 hours. A number of clinical trials have demonstrated that azelnidipine produced a significant reduction in blood pressure in Chinese patients with mild-to-moderate hypertension, which was similar to that of other effective antihypertensive drugs such as amlodipine, zofenopril, and nifedipine. In addition to its antihypertensive effect, azelnidipine had other cardiovascular protective effects as well, like anti-oxidative action, decreasing heart rate, and improving systolic and diastolic function. Azelnidipine was generally well tolerated in Chinese patients and no severe adverse events were observed.

CONCLUSION

Azelnidipine is effective and safe in the treatment of hypertension in Chinese patients.