Chronic and asymptomatic diseases influence the control of hypertension treatment in primary care

Pierin, Angela Maria Geraldo; Silva, Stael Silvana Bagno Eleutério da; Colósimo, Flávia Cortez; Toma, Gabriela de Andrade; Serafim, Talita de Souza; Meneghin, Paolo

doi:10.1590/S0080-623420160000600008

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Artigo Original • Rev. esc. enferm. USP 50 (05) • Sep-Oct 2016 • https://doi.org/10.1590/S0080-623420160000600008 copy

Chronic and asymptomatic diseases influence the control of hypertension treatment in primary care

Cronicidad y enfermedad asintomática influencian el control de los hipertensos en tratamiento en la atención básica

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

OBJECTIVE

To identify the association between blood pressure control and the following variables: a) bio-social and lifestyle characteristics of hypertensive patients; and b) factors related to the antihypertensive treatment.

METHODS

This is an exploratory study with 290 people with hypertension from primary care. We used a specific instrument, self-administered, with 21 questions on factors that can hinder treatment, divided into four dimensions: medication, socioeconomic, institutional and personal beliefs. We adopted a significance level of p <0.05.

RESULTS

The control of blood pressure was associated (p <0.05) with female gender, Caucasian ethnicity, primary/secondary education, not drinking alcohol, higher income and regular physical activity. Regarding the factors that can hinder treatment, there was association of hypertension control with only two questions: "feel nothing" and "have to do treatment for life".

CONCLUSION

Sociodemographic variables and beliefs concerning the absence of symptoms and chronicity of the disease influenced the control of hypertension and should be considered in the adherence process to the treatment.

Descriptors
Hypertension; Medication Adherence; Therapeutics; Life Style; Public Health Nursing

	Hypertensives
Variables	Controlled		Uncontrolled
	n	%	n	%
Age (years) p=0.123
≤ 60	85	48.9	46	39.7
> 60	89	51.1	70	60.3
Gender p = 0.048
Male	58	33.3	52	44.8
Female	116	66.7	64	55.2
Ethnicity p = 0.020
White	104	62.3	54	48.2
Not white	63	37.7	58	51.8
Marital status p = 0.945
With partner	106	61.3	70	60.9
Without partner	67	38.7	45	39.1
Education p = 0.048
Illiterate/Read and write	33	47.1	37	52.9
Primary/secondary	126	64.0	71	36.0
Tertiary education	4	57.1	3	42.9
Ocuppation p = 0.514
Housewife	49	39.2	33	40.2
Unemployed	3	2.4	5	6.1
Retired	12	9.6	4	4.9
Self-employed	53	42.4	34	41.5
Employment bond	8	6.4	6	7.3
Family income (in minimum salary) p = 0.034
≤ 3	96	60.8	75	73.5
> 3	62	39.2	27	26.5
Physical activity practice p = 0.023
No	108	62.1	84	75.0
Yes	66	37.9	28	25.0
Smoking p = 0.998
No	155	89.1	98	89.1
Yes	19	10.9	12	10.9
Alcohol intake p = 0.013
No	112	70.4	54	54.5
Drink or stopped drinking for at least a year	47	28.6	45	45.4

	HYPERTENSIVES
	Controlled			Uncontrolled
Factor that can hinder treatment	Agree (1) n %	Undecided (2) n %	Disagree (3) n %	Agree (1) n %	Undecided (2) n %	Disagree (3) n %
MEDICINES
- The drugs cause adverse events p = 0.965	55 58.5	5 50.0	95 59.7	39 41.5	5 50.0	64 40.3
- I forget to take my medicine p = 0.772	96 60.4	1 50.0	59 56.2	63 39.6	1 50.0	46 43.8
- I need help to take medicine p = 0.775	35 57.4	3 75.0	116 58.3	26 42.6	1 25.0	83 41.7
- I have too many medicines to take p = 0.224	64 62.7	5 83.3	85 55.6	38 37.3	1 16.7	68 44.4
- I do not know how to take the medicines p = 0.283	66 64.1	3 75.0	86 55.1	37 35.9	1 25.0	70 44.9
- Treatment is complicated, hard p = 0.842	48 58.5	6 75.0	103 59.5	34 41.5	2 25.0	70 40.5
SOCIOECONOMIC
- I have no money to buy medicines p = 0.645	71 60.2	1 100.0	84 57.5	47 39.8	0 0.0	62 42.5
- I have no one to watch my children/grandchildren p = 0.462	48 62.3	2 50.0	106 57.3	37.7	50.0	42.7
- I need company to go to consultations p = 0.535	31 54.4	2 100.0	124 59.6	26 45.6	0 0.0	84 40.4
- I miss work to go to consultations p = 0.706	45 54.2	2 28.6	105 61.8	38 45.8	5 71.4	65 38.2
- Distance to consultation site p = 0.934	47 58.8	1 50.0	106 59.2	33 41.3	1 50.0	73 40.8
- Lack money for transportation p = 0.140	29 55.8	1 33.3	124 59.6	23 44.2	2 66.7	84 40.4
INSTITUTIONAL
- The waiting time is too long p = 0.965	88 58.3	2 66.7	65 59.1	63 41.7	1 33.3	45 40.9
- I did not get along with the staff team p = 0.596	64 60.4	4 50.0	90 58.8	42 39.6	4 50.0	63 41.2
- The service time is inconvenient p = 0.239	52 54.2	1 50.0	104 61.9	44 45.8	1 50.0	64 38.1
- Lack of physician for consultation p = 0.362	117 57.9	0 0.0	42 62.7	85 42.1	1 100.0	25 37.3
PERSONAL BELIEFS
- I do not feel anything p = 0.029	72 63.7	1 14.3	83 58.5	41 36.3	6 85.7	59 41.5
- Being treated for life p = 0.013	82 66.1	2 100.0	71 50.7	42 33.9	0 0.0	69 49.3
- I do not feel the need to get treatment p = 0.734	47 58.0	5 45.5	106 59.9	34 42.0	6 54.5	71 40.1
- I do not feel I am getting better p = 0.638	77 62.0	4 50.0	77 57.0	46 38.0	4 50.0	58 43.0
- I only take medicines when I feel bad p = 0.630	56 56.6	4 66.7	94 59.1	43 43.4	2 33.3	65 40.9

	Hypertensives
	Controlled Mean (standard deviation)		Uncontrolled Mean (standard deviation)
DIMENSIONS
Medication p = 0.729	15.54	(4.97)	15.36	(5.34)
Socioeconomic p = 0.975	8.88	(3.57)	9.03	(3.70)
Institutional p = 0.677	11.125	(3.81)	11.36	(3.63)
Personal beliefs p = 0.219	7.43	(2.7)	7.009	(2.53)

Variables	Hypertensives						P value
Morisky and Green Test	Controlled		Uncontrolled		Total		0.715
	n	%	n	%	n	%
Non adhrence	118	60.8	76	39.2	194	100
Adherence	60	62.5	36	37.5	96	100

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Angela Maria Geraldo Pierin. Av. Dr. Enéas de Carvalho Aguiar 419 - Cerqueira César. CEP 05403-000 - São Paulo, SP, Brazil. pierin@usp.br