ADHERENCE TO ANTIHYPERTENSIVE TREATMENT IN COGNITIVELY IMPAIRED AGED: A SYSTEMATIC REVIEW

Luz, Alyne Leal de Alencar; Griep, Rosane Harter; Landim, Maurício Batista Paes; Alencar, Delmo de Carvalho; Macedo, Juliana Bezerra; Leal, Antonia Lucimary de Sousa

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Articles • Cogit. Enferm. 26 • 2021 • https://doi.org/10.5380/ce.v26i0.70402 copy

ADHERENCE TO ANTIHYPERTENSIVE TREATMENT IN COGNITIVELY IMPAIRED AGED: A SYSTEMATIC REVIEW

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to verify the influence of cognitive impairment on adherence to antihypertensive treatment in the aged.

Method:

systematic review, with the inclusion of original articles, available in full, in Portuguese, English and Spanish, published between the years 2007 and 2021. The search was made in SCIELO, PUBMED, LILACS and MEDLINE, with the following descriptors: “Cognitive Dysfunction”; “Medication Adherence”; “Hypertension”; “Aged”.

Results:

of the 216 studies found, five were selected. Four showed a negative relationship between cognitive impairment and adherence of the aged to antihypertensive treatment. It was evidenced that aged with cognitive impairment were more likely to have inadequate blood pressure control.

Conclusion:

it is observed that cognitive impairment is an important risk factor for poor adherence to treatment in hypertensive aged. Early detection becomes essential, aiming to adapt care to the cognitive conditions of the aged and optimize medication management to achieve adequate control of blood pressure levels.

DESCRIPTORS
Cognitive Dysfunction; Medication Adherence; Hypertension; Aged; Systematic Review

Authors and year	Title	Prevalence of SAH, according to gender	Adhesion Measure	Adhesion Measure	Main results
Aiolfi et al.25, 2015	Adherence to medication use among aged hypertensive individuals.	67.7% female	Portuguese version of the Morisky Medication Adherence Scale (MMAS-8)	MEEM	The cognitively impaired aged were more likely to adhere to drug treatment than the non-cognitively impaired aged.
Vinyolis et al.32, 2008	Cognitive function and blood pressure control in hypertensive patients over 60 years of age: COGNIPRES study	55,6% female	Morisky-Green Test (TMG)	MEEM	Significant association between cognitive impairment and low adherence to antihypertensive treatment.
Cho et al.30, 2018	Association between cognitive impairment and poor antihypertensive medication adherence in elderly hypertensive patients without dementia	54,3% female	Cumulative Medication Adherence (CMA)	Prescreening Korean Dementia Screening Questionnaire (KDSQ-P)	Cognitive deficit was associated with poor medication adherence. medication. Cognitive deficit is a possible risk factor associated with low adherence to antihypertensive medication antihypertensive medication, even in patients without dementia.
Chudiak et al.31, 2018	Relation between cognitive impairment and treatment adherence in elderly hypertensive patients	55,7% female	High Blood Pressure Compliance Scale (HBCS)	Mini-Mental State Examination (MEEM)	Cognitive impairment was negatively associated with treatment. We also observed male gender associated with low treatment adherence in hypertensive aged compared with women.
Piotrowicz et al.33, 2016	Subclinical Mood and Cognition Impairments and Blood Pressure Control in a Large Cohort of Elderly Hypertensives	65,6% female	Classification criteria: (1) patients who took regularly, as prescribed; (2) omitted medications 1 to 3 days per month; (3) omitted on 4 to 7 days per month; (4) omitted on 8 to 10 days; (5) omitted on 11 to 14 days: (6) took medications occasionally; (7) did not adhere to treatment in its entirety.	Cognitive Abbreviated Mental Test Score (AMTS) and the Clock Drawing Test (CDT)	Low adherence was related to cognitive deficits. Limitations in the activities of daily living negatively influence medication on medication adherence, which in turn translates into higher BP values.

First Author	Year	Study Location	Language	Type of study	Number of participants
Cho et al.⁽³⁰30 Cho MH, Shin DW, Chang SA, Lee JE, Jeong SM, Kim SH, et al. Association between cognitive impairment and poor antihypertensive medication adherence in elderly hypertensive patients without dementia. Sci Rep [Internet]. 2018 [acesso em 24 abr 2019]; 8. Disponível em: https://doi.org/10.1038/s41598-018-29974-7. https://doi.org/10.1038/s41598-018-29974... ⁾	2018	Korea	English	Retrospective Cohort Study	20,071
Chudiak et al.⁽³¹31 Chudiak A, Uchmanowicz I, Mazur G. Relation between cognitive impairment and treatment adherence in elderly hypertensive patients. Clin Interv Aging [Internet]. 2018 [acesso em 06 mar 2019]; 13. Disponível em: https://doi.org/10.2147/CIA.S162701. https://doi.org/10.2147/CIA.S162701... ⁾	2018	Poland	English	Cross-Sectional Study	300
Piotrowicz et al.⁽³³33 Piotrowicz K, Prejbisz A, Klocek M, Topór-Madry R, Szczepaniak P, Kawecka-Jaszcz K, et al. Subclinical Mood and Cognition Impairments and Blood Pressure Control in a Large Cohort of Elderly Hypertensives. JAMDA [Internet]. 2016 [acesso em 16 mar 2019]; 17(9). Disponível em: https://doi.org/10.1016/j.jamda.2016.06.021. https://doi.org/10.1016/j.jamda.2016.06.... ⁾	2016	Poland	English	Cross-Sectional Study	1988
Aiolfi et al.⁽²⁵25 Aiolfi CR, Alvarenga MRM, Moura C de S, Renovato RD. Adesão ao uso de medicamentos entre idosos hipertensos. Rev. Bras. Geriatr. Gerontol [Internet] 2015 [acesso em 09 abr 2019]; 18(2): 397-404. Disponível em: https://doi.org/10.1590/1809-9823.2015.14035. https://doi.org/10.1590/1809-9823.2015.1... ⁾	2015	Brazil	Portuguese	Cross-Sectional Study	124
Vinyolis et al.⁽³²32 Vinyoles E, Figuera MD la, Gonzalez-Segura D. Cognitive function and blood pressure control in hypertensive patients over 60 years of age: COGNIPRES study. Current Med Research Opinion [Internet]. 2008 [acesso em 22 abr 2019]; 24(12). Disponível em: https://www.tandfonline.com/doi/abs/10.1185/03007990802538724?journalCode=icmo20. https://doi.org/10.1185/0300799080253872... ⁾	2008	Spain	English	Cross-Sectional Study	1,569

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[1] Role of Authors:

Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work - Luz AL de A, Alencar D de C, Macedo JB; Drafting the work or revising it critically for important intellectual content - Luz AL de A, Griep RH, Landim MBP, Alencar D de C, Leal AL de S; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved - Luz AL de A. All authors approved the final version of the text.