Adewuya O A, Ajayi E A, Adetiloye A O, Atiba A S, Dada S A, Areo O O
Cardiology Unit, Department of Internal Medicine, Ekiti State University Teaching Hospital (EKSUTH) Ado Ekiti, Nigeria.
Nephrology Unit, Department of Internal Medicine, Ekiti State University Teaching Hospital (EKSUTH) Ado Ekiti, Nigeria.
West Afr J Med. 2020 Jul-Aug;37(3):225-230.
Hypertension is a major risk factor for cardiovascular morbidity and mortality. Optimum adherence to medication is still a perplexing matter for hypertensive patients in Nigeria and serum markers use as predictor for medication adherence has not been conclusive.
To define the level of antihypertensive medication adherence, its possible correlation with serum uric acid (SUA) levels and other predictors of antihypertensive medication adherence among Nigerian patients.
Patients were recruited from the University Teaching Hospital Cardiology Clinic. Blood was drawn for SUA levels. Validated 8-item MMAS-8 was administered to hypertensives to measure adherence, and correlations analysed between SUA levels and the MMAS-8 score, with SPSS-23. SUA is defined as elevated in men with concentrations of =430µmols/l, normal range 200-430µmols/l, and =360µmol/l in women, normal range140-360µmol/l. Linear regression analysis of the predictors of antihypertensive medication adherence was done. A statistical p value of <0.05 was considered significant.
The total number and mean age of the cases were 271 and 60.8±12.3years respectively. MMAS-8 revealed that about half of the hypertensives (131 cases, 48.3%) had low adherence (MMAS-8 score 4), 81 cases (29.5%) had medium adherence (MMAS-8 score 2) while 59 cases (22.1%) showed high adherence (MMAS-8 score 0). Bivariate Correlation between SUA levels in hypertensives and antihypertensive medication adherence was of moderate degree and significant (r=0.396, p<0.001) suggesting that SUA levels increased with increasing non-adherence to antihypertensive medications. This correlation remained significant after adjusting for singular confounding variables like age (r=0.371 fair relationship, p=<0.001), DM (r=0.382 fair relationship, p<0.001); blood pressure (BP) duration and class r=0.356, 0.306, fair relationship p<0.001 respectively). The correlation between SUA levels and adherence to antihypertensive medications was weakened (r=0.209, p<0.001) after adjusting for combined confounding variables. Linear regression revealed that SUA levels is a predictor of antihypertensive medication adherence.
Antihypertensive medication adherence was unsatisfactory, elevated SUA levels correlated with low antihypertensive adherence, and this correlation was influenced by several singular and combined confounding variables in our patient population. Hence SUA levels can be a predictor and a marker of antihypertensive medication adherence.
高血压是心血管疾病发病和死亡的主要危险因素。在尼日利亚，高血压患者对药物的最佳依从性仍然是一个令人困惑的问题，并且血清标志物作为药物依从性的预测指标尚无定论。
确定尼日利亚患者抗高血压药物的依从水平，及其与血清尿酸（SUA）水平的可能相关性以及抗高血压药物依从性的其他预测因素。
从大学教学医院心脏病诊所招募患者。采集血液检测SUA水平。使用经过验证的8项MMAS-8量表对高血压患者进行测量以评估依从性，并使用SPSS-23分析SUA水平与MMAS-8评分之间的相关性。SUA在男性中浓度≥430µmols/l时定义为升高，正常范围为200-430µmols/l；在女性中≥360µmol/l时定义为升高，正常范围为140-360µmol/l。对抗高血压药物依从性的预测因素进行线性回归分析。统计学p值<0.05被认为具有显著性。
病例总数和平均年龄分别为271例和60.8±12.3岁。MMAS-8显示，约一半的高血压患者（131例，48.3%）依从性低（MMAS-8评分≤4），81例（29.5%）依从性中等（MMAS-8评分=2），而59例（22.1%）依从性高（MMAS-8评分=0）。高血压患者的SUA水平与抗高血压药物依从性之间的双变量相关性为中等程度且具有显著性（r=0.396，p<0.001），表明SUA水平随着抗高血压药物依从性的降低而升高。在调整年龄（r=0.371，中等关系，p=<0.001）、糖尿病（r=0.382，中等关系，p<0.001）；血压（BP）病程和分级（r=0.356、0.306，中等关系，p<0.001）等单一混杂变量后，这种相关性仍然显著。在调整综合混杂变量后，SUA水平与抗高血压药物依从性之间的相关性减弱（r=0.209，p<0.001）。线性回归显示SUA水平是抗高血压药物依从性的一个预测因素。
抗高血压药物依从性不理想，SUA水平升高与抗高血压依从性低相关，并且这种相关性受我们患者群体中几个单一和综合混杂变量的影响。因此，SUA水平可以作为抗高血压药物依从性的一个预测指标和标志物。
