Factors associated to the adherence to the non-pharmachological treatment of hypertension in primary health care

Adherence to Antihypertensive Therapy and Its Determinants: A Systematic Review

Hypertension is a globally prevalent condition, and low adherence to antihypertensive therapy is considered one of the main causes of poor blood pressure (BP) control. Non-adherence to antihypertensive treatment is a complex issue that can arise from various factors; however, gaining an understanding of this provides key targets for intervention strategies. This study aimed to provide an overview of the current status and recent developments regarding our understanding of the determinants of patients' adherence to antihypertensives. A systematic review was performed using the electronic databases MEDLINE/PubMed, Web of Science, Scientific Electronic Library Online (SciELO), and "Índex das Revistas Médicas Portuguesas", which included studies published between 2017 and 2021 following the PICOS model: (P) Adult patients with the diagnosis of primary hypertension, using at least one antihypertensive agent; (I) all interventions on both pharmacological and non-pharmacological level; (C) patient's adherence against their non-adherence; (O) changes in adherence to the therapeutic plan; and (S) any study design (except review articles) written in English, French, Spanish or Portuguese. Articles were reviewed by two researchers and their quality was assessed. Subsequently, determinants were classified according to their consistent or inconsistent association with adherence or non-adherence. Only 45 of the 635 reports identified met the inclusion criteria. Adherence was consistently associated with patient satisfaction with communication, patient-provider relationship, their treatment, and use of eHealth and mHealth strategies; a patient's mental and physical health, including depression, cognitive impairment, frailty, and disability, previous hospitalization, occurrence of vital events; drug treatment type and appearance; and unwillingness due to health literacy, self-efficacy, and both implicit and explicit attitudes towards treatment. There were discrepancies regarding the association of other factors to adherence, but these inconsistent factors should also be taken into account. In conclusion, the barriers to adherence are varied and often interconnected between socioeconomic, patient, therapy, condition, and healthcare system levels. Healthcare teams should invest in studying patients' non-adherence motives and tailoring interventions to individual levels, by using a multifaceted approach to assess adherence. Further research is needed to analyze the impact of implicit attitudes, the use of new technological approaches, and the influence of factors that are inconsistently associated with non-adherence, to understand their potential in implementing adherence strategies.

Individual Characteristics, Adherence, and Barriers to Medication Adherence of Hypertensive Patients at the Indonesia - Timor Leste Border

Background: Until the last decade, the incidence of hypertension has increased sharply. It has been reported that individuals with hypertension show a low level of adherence to their therapy management. Moreover, there has been no previous research evaluating individual characteristics, adherence, and barriers to medication adherence among people with hypertension at the border of Indonesia and Timor Leste.Purpose: This study aimed to identify individual characteristics, adherence, and barriers to medication adherence among hypertensive patients.Methods: A total of 112 hypertensive patients recruited using a quota sampling method at the border of Indonesia and Timor Leste participated in this cross-sectional study. Data were collected using the Hill-Bone Questionnaire to identify adherence and the Adherence Barrier Questionnaire (ABQ) to identify barriers to medication adherence. Individual characteristics were also collected. To confirm the hypertension condition at the time of data collection, measurements of blood pressure were retaken. Descriptive statistics and Chi-square analysis were used for data analysis.  Results: The average of systolic blood pressure was 163.85(18.24) mmHg, and the diastolic blood pressure was 99.30(11.57) mmHg. The Chi-square test showed that education and occupation had a significant relationship with adherence (p<0.05) and barriers to medication adherence (p=0.000). Meanwhile, other characteristics, including age, gender, and marital status, were not significantly related to adherence (p>0.05) and barriers to medication adherence (p>0.05).Conclusion: There is a relationship between education and occupation with adherence and barriers to medication adherence, but there is no relationship when viewed from such individual characteristics as age, gender, and marital status. Further research is needed to identify effective educational methods to increase the knowledge, motivation, and self-efficacy of hypertensive patients to improve blood pressure control.

Lipids: a Potential Molecular Pathway Towards Diastolic Dysfunction in Youth-Onset Type 2 Diabetes

PURPOSE OF THE REVIEW

Obesity and type 2 diabetes (T2D) with onset in youth are emerging public health concerns. Youth with obesity and T2D are at risk for the development of heart failure with preserved ejection fraction (HFpEF) due to diabetes-related cardiomyopathy with evidence of precursor stages, namely diastolic dysfunction, present in youth. We review the literature regarding diastolic dysfunction in youth with obesity and T2D; discuss the potential mechanisms including the role of lipids, contractile proteins and their post-translational modifications, and conclude with studies to guide future treatments.

RECENT FINDINGS

The diabetes milieu namely hyperglycemia, hyperinsulinemia, and lipotoxicity favor development of diastolic dysfunction and HFpEF. Recent studies show HFpEF is associated with slow left ventricular relaxation and sarcomere stiffness induced by reduced calcium (Ca2+) and β-adrenergic responses. There are currently no effective therapies available for treating HFpEF. Targeting the sarcomere is an area of ongoing research.