Department of Population Health Sciences, University of Wisconsin at Madison, USA.
Am J Hypertens. 2012 Apr;25(4):505-11. doi: 10.1038/ajh.2011.256. Epub 2012 Jan 19.
Nonadherence to drug treatment is a major contributor to antihypertensive treatment failure. Mood disorders could impair the patient's desire and ability to follow physician's recommendations. We evaluated the role of symptoms of depression and anxiety on adherence to antihypertensive drug treatment.
We conducted a longitudinal cohort study in 20-70 years old patients starting antihypertensive drug treatment, without other chronic conditions, and not taking mood-modifying drugs. Severity of symptoms of depression and anxiety were evaluated at enrollment and 3, 6, 9, and 12 months of follow-up, using the Beck depression inventory-II (BDI-II) and the psychological general well-being index (PGWB), respectively. Treatment adherence was measured by pill count. Nonadherence was defined as taking <80% of the prescribed number of pills. Poisson regression was used to model the association of the exposures with adherence.
We enrolled 178 patients (58% male; mean age: 50 years; 508 follow-up visits). The risk of nonadherence was 52.6% in 12 months (95% confidence interval (CI): 46.1, 59.1). After adjusting for other risk factors, individuals with at least mild depression (BDI-II ≥14) and those with at least mild anxiety (PGWB anxiety score <22) were 2.48 (95% CI: 1.47, 4.18) and 1.59 (95% CI: 0.99, 2.56) times more likely to become nonadherent in the following 3 months, respectively.
Patients with at least mild anxiety and depression symptoms are at increased risk of becoming nonadherent to antihypertensive medication. Screening for depression and anxiety symptoms could be used to identify high-risk patients. Further evidence is needed to elucidate whether interventions targeting these conditions improve adherence.
不遵医嘱服药是导致降压治疗失败的主要原因。情绪障碍可能会降低患者遵从医嘱的意愿和能力。我们评估了抑郁和焦虑症状对降压药物治疗依从性的影响。
我们对 20-70 岁开始服用降压药物、无其他慢性疾病且未服用情绪调节药物的患者进行了一项纵向队列研究。在入组时以及随访 3、6、9 和 12 个月时，分别使用贝克抑郁自评量表-II（BDI-II）和心理总体幸福感指数（PGWB）评估抑郁和焦虑症状的严重程度。治疗依从性通过药片计数测量。不遵医嘱定义为服用的药物数量少于规定数量的 80%。使用泊松回归模型来拟合暴露与依从性之间的关联。
我们共纳入了 178 名患者（58%为男性；平均年龄为 50 岁；共进行了 508 次随访）。12 个月时不遵医嘱的风险为 52.6%（95%置信区间：46.1，59.1）。在调整其他危险因素后，至少有轻度抑郁（BDI-II≥14）和至少有轻度焦虑（PGWB 焦虑评分<22）的个体在接下来的 3 个月内分别有 2.48 倍（95%置信区间：1.47，4.18）和 1.59 倍（95%置信区间：0.99，2.56）发生不遵医嘱的风险。
至少有轻度焦虑和抑郁症状的患者不遵医嘱服用降压药物的风险增加。筛查抑郁和焦虑症状可以识别高风险患者。需要进一步的证据来阐明针对这些情况的干预措施是否能提高依从性。
