Adherence to prescribed antihypertensive medication among patients with depression in the United States

Associations between Life's Essential 8 and abdominal aortic calcification among US Adults: a cross-sectional study

BACKGROUND

Cardiovascular health (CVH) and abdominal aortic calcification (AAC) are closely linked to cardiovascular disease (CVD) and related mortality. However, the relationship between CVH metrics via Life's Essential 8 (LE8) and AAC remains unexplored.

METHODS

The study analyzed data from the 2013-2014 National Health and Nutrition Examination Survey (NHANES) cohort, which included adults aged 40 or above. The research used the LE8 algorithm to evaluate CVH. Semi-quantitative AAC-24 scoring techniques were employed to assess AAC, categorized into no calcification, mild to moderate calcification, and severe calcification.

RESULTS

The primary analysis involved 2,478 participants. Following adjustments for multiple factors, the LE8 score exhibited a significant association with ACC risk (Mild-moderate ACC: 0.87, 95% CI: 0.81,0.93; Severe ACC: 0.77, 95% CI: 0.69,0.87, all P < 0.001), indicating an almost linear dose-response relationship. Compared to the low CVH group, the moderate CVH group showed lower odds ratios (OR) for mild-moderate and severe calcification (OR = 0.78, 95% CI: 0.61-0.99, P = 0.041; OR = 0.68, 95% CI: 0.46-0.99, P = 0.047, respectively). Moreover, the high CVH group demonstrated even lower ORs for mild-moderate and severe calcification (OR = 0.46, 95% CI: 0.31, 0.69, P < 0.001; OR = 0.29, 95% CI: 0.14, 0.59, P = 0.001, respectively). Interactions were found between chronic kidney disease (CKD) condition, history of CVD, marital status and CVH metrics to ACC. Participants without CKD exhibited a more pronounced negative association between the CVH metric and both mild-moderate and severe ACC. Those lacking a history of CVD, and never married/widowed/divorced/separated showed a stronger negative association between the CVH metric and severe ACC.

CONCLUSIONS

The novel CVH metrics demonstrated an inverse correlation with the risk of AAC. These findings suggest that embracing improved CVH levels may assist in alleviating the burden of ACC.

Unveiling the Nexus: Depressive Symptoms and Medication Adherence in Hypertensive Patients' Self-care: A Systematic Review

Background

Hypertension, a significant public health concern, is frequently linked to emotional disorders like depression. Research shows a reciprocal link between depression and hypertension, potentially influencing patients' adherence to self-care routines.

Objective

This systematic review aimed to examine the association between depressive symptoms and aspects of self-care, with a focus on medication adherence in individuals diagnosed with hypertension.

Methods

Following PRISMA guidelines, a systematic review was conducted by searching PubMed, PsycINFO and Scopus until March 17, 2023. The included studies involved quantitative primary research conducted in English, focusing on adults (≥18 years) diagnosed with hypertension and experiencing depressive symptoms. Observational studies were assessed using the Newcastle-Ottawa Scale, and randomized controlled trials were evaluated using the revised Cochrane Risk of Bias Tool (RoB 2.0). Due to the great diversity of these studies, a narrative synthesis of the results was undertaken. Results: A total of 18 studies involving 6,131 people with hypertension, that met our eligibility criteria were ultimately included. The reported rates of depressive symptoms ranged from 4% to 43%. Of these studies, nine reported a statistically significant association, showcasing an adverse impact of depressive symptoms on medication adherence. The remaining nine did not confirm the above.

Conclusion

This systematic review highlights the diverse body of research exploring depressive symptoms and medication adherence among individuals with hypertension. The review suggests a need for increased attention to self-care practices, particularly in relation to adherence to antihypertensive medication. However, it recommends the conduction of more robust longitudinal studies to comprehensively explore this relationship.

Self-Reported Medication Adherence Among Older People Admitted to Hospital: A Descriptive Study

BACKGROUND

Poor medication adherence is prevalent among older people. To optimize therapeutic outcomes, it is crucial to understand the underlying causes and perceptions.

OBJECTIVE

We aimed to investigate the extent of self-reported medication adherence and associated factors among older people admitted to hospital.

METHODS

Individuals living at home aged ≥ 75 years with an emergency admission at a university hospital between September 2018 and September 2021 were included. Participants answered the Medication Adherence Report Scale (MARS-5) questionnaire upon admission regarding their prescribed long-term medications. Participants with a MARS-5 score of 23-25 were defined as adherent and with a score of 5-22 as nonadherent. A multivariable logistic regression analysis was performed to investigate possible factors independently associated with self-reported medication adherence.

RESULTS

A total of 261 individuals were included. The mean age was 84 years (standard deviation 5.7) and the mean MARS-5 score was 23.9 (standard deviation 1.8). Overall, 227 (87%) participants were classified as adherent to their prescribed treatment, while 34 (13%) participants were classified as nonadherent. Participants with cognitive impairment (odds ratio = 0.40, 95% confidence interval 0.18-0.90, p = 0.027) and depression (odds ratio = 0.29, 95% confidence interval 0.10-0.87, p = 0.028) had a lower odds of reporting adherence to their medications.

CONCLUSIONS

The majority of individuals aged ≥ 75 years who were recently hospitalized rated themselves as adherent to their prescribed medications according to MARS-5. Future studies would benefit from adding more possible explanatory factors and combining a self-reported assessment with a more objective measurement of medication adherence.