Department of Medical Sciences, School of Medical and Live Sciences, Sunway University, Bandar Sunway, Selangor, Malaysia.
Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
J Clin Hypertens (Greenwich). 2021 Mar;23(3):638-645. doi: 10.1111/jch.14212. Epub 2021 Feb 14.
This study aimed to examine the relationship of adherence with blood pressure (BP) control and its associated factors in hypertensive patients. This cross-sectional nationwide BP screening study was conducted in Malaysia from May to October 2018. Participants with self-declared hypertension completed the Hill-Bone Compliance to High Blood Pressure Therapy Scale (Hill-Bone CHBPTS) which assesses three important domains of patient behavior to hypertension management namely medication taking, appointment keeping and reduced salt intake. Lower scores indicate better compliance while higher scores indicate otherwise. Participant's body mass index and seated BP were measured based on standard measurement protocol. Determinants of adherence to treatment were analyzed using multiple linear regression. Out of 5167 screened subjects, 1705 were known hypertensives. Of these, 927 (54.4%) answered the Hill-Bone CHBPTS and were entered into analysis. The mean age was 59.0 ± 13.2 years, 55.6% were female and 42.2% were Malays. The mean Hill-Bone CHBPTS score was 20.4 ± 4.4 (range 14-47), and 52.1% had good adherence. The mean systolic BP and diastolic BP were 136.4 ± 17.9 and 80.6 ± 11.6 mmHg, respectively. BP was controlled in 58.3% of those with good adherence compared to 50.2% in those with poor adherence (p = .014). Based on multiple linear regression analysis, female gender (β = -0.72, 95% confidence interval [CI] -1.30, -0.15, p = .014), older age (β = -0.05, 95% CI -0.07, -0.03, p < .001), and individuals with primary or lower educational level (β = -0.91, 95% CI -1.59, -0.23, p = .009) had better adherence to BP management. Interventional programs targeted at the less adherent groups are needed in order to improve their adherence and BP control.
本研究旨在探讨高血压患者的依从性与血压控制的关系及其相关因素。这项横断面全国性血压筛查研究于 2018 年 5 月至 10 月在马来西亚进行。参加者自行宣布患有高血压，完成了希尔-博恩对高血压治疗依从性量表（Hill-Bone CHBPTS），该量表评估了高血压管理中患者行为的三个重要领域，即服药、遵医嘱和减少盐的摄入。较低的分数表示更好的依从性，而较高的分数表示相反。根据标准测量方案测量参与者的体重指数和坐姿血压。使用多元线性回归分析治疗依从性的决定因素。在筛查的 5167 名受试者中，有 1705 名已知的高血压患者。其中，927 名（54.4%）回答了 Hill-Bone CHBPTS，并纳入分析。平均年龄为 59.0±13.2 岁，55.6%为女性，42.2%为马来人。平均 Hill-Bone CHBPTS 得分为 20.4±4.4（范围 14-47），52.1%的患者依从性良好。平均收缩压和舒张压分别为 136.4±17.9 和 80.6±11.6mmHg。在依从性良好的患者中，58.3%的患者血压得到控制，而依从性差的患者中，50.2%的患者血压得到控制（p=0.014）。基于多元线性回归分析，女性（β=-0.72，95%置信区间 [CI] -1.30，-0.15，p=0.014）、年龄较大（β=-0.05，95%CI -0.07，-0.03，p<0.001）和具有小学或以下教育水平的个体（β=-0.91，95%CI -1.59，-0.23，p=0.009）对血压管理的依从性更好。需要针对依从性较差的群体开展干预计划，以提高他们的依从性和血压控制水平。
