The association of emotional well-being and marital status with treatment adherence among patients with hypertension

  • Ranak B. Trivedi
  • Brian Ayotte
  • David Edelman
  • Hayden B. Bosworth
Article

Abstract

We were interested in examining the relationship between psychosocial factors and hypertension-related behaviors. We hypothesized that lower emotional well-being and unmarried status would be related to higher BP, poorer medication adherence, greater difficulty adhering to diet and exercise, and current smoking. In a cross-sectional design, 636 hypertensive patients completed the Mental Component Summary (MCS) Scale of the SF-12 and rated their difficulty with adherence to diet, exercise, and medication-taking. In logistic regression analyses, lower MCS scores were associated with difficulty adhering to diet (OR = 0.97, p < .05) and exercise (OR = 0.97, p < .01), and current smoking status (OR = 0.98, p < .05). Being married was associated with higher probability of medication adherence (OR = 1.66, p < .01) and a lower probability of being a current smoker (OR = 0.34, p < .0001). Neither MCS scores nor being married were related to BP levels in adjusted analyses. Results emphasize the importance of assessing psychosocial factors to optimize hypertension treatment.

Keywords

Adherence Hypertension Emotional well-being Marital status Lifestyle recommendations 

References

  1. Banegas, J. R., Guallar-Castillon, P., Rodriguez-Artalejo, F., Graciani, A., Lopez-Garcia, E., & Ruilope, L. M. (2006). Association between awareness, treatment, and control of hypertension, and quality of life among older adults in Spain. American Journal of Hypertension, 19(7), 686–693. doi:10.1016/j.amjhyper.2006.01.015.PubMedCrossRefGoogle Scholar
  2. Bardage, C., & Isacson, D. G. (2001). Hypertension and health-related quality of life. An epidemiological study in Sweden. Journal of Clinical Epidemiolog, 54(2), 172–181. doi:10.1016/S0895-4356(00)00293-6.CrossRefGoogle Scholar
  3. Becker, M. H., & Maiman, L. A. (1975). Sociobehavioral determinants of compliance with health and medical care recommendations. Medical Care, 13(1), 10–24. doi:10.1097/00005650-197501000-00002.PubMedCrossRefGoogle Scholar
  4. Bosworth, H. B., Bartash, R. M., Olsen, M. K., & Steffens, D. C. (2003). The association of psychosocial factors and depression with hypertension among older adults. International Journal of Geriatric Psychiatry, 18(12), 1142–1148. doi:10.1002/gps.1026.PubMedCrossRefGoogle Scholar
  5. Bosworth, H. B., Dudley, T., Olsen, M. K., Voils, C. I., Powers, B., Goldstein, M. K., et al. (2006). Racial differences in blood pressure control: Potential explanatory factors. American Journal of Medicine, 119(1), 70 e79–70 e15.CrossRefGoogle Scholar
  6. Bosworth, H. B., Olsen, M. K., Dudley, T., Orr, M., Neary, A., Harrelson, M., et al. (2007). The take control of your blood pressure (TCYB) study: Study design and methodology. Contemporary Clinical Trials, 28(1), 33–47. doi:10.1016/j.cct.2006.08.006.PubMedCrossRefGoogle Scholar
  7. Bosworth, H. B., Olsen, M. K., Neary, A., Orr, M., Grubber, J., Svetkey, L., et al. (2008). Take control of your blood pressure (TCYB) study: A multifactorial tailored behavioral and educational intervention for achieving blood pressure control. Patient Education and Counseling, 70(3), 338–347. doi:10.1016/j.pec.2007.11.014.PubMedCrossRefGoogle Scholar
  8. Burnier, M. (2006). Medication adherence and persistence as the cornerstone of effective antihypertensive therapy. American Journal of Hypertension, 19(11), 1190–1196. doi:10.1016/j.amjhyper.2006.04.006.PubMedCrossRefGoogle Scholar
  9. Burt, V. L., Whelton, P., Roccella, E. J., Brown, C., Cutler, J. A., Higgins, M., et al. (1995). Prevalence of hypertension in the US adult population. Results from the third national health and nutrition examination survey, 1988–1991. Hypertension, 25(3), 305–313.PubMedGoogle Scholar
  10. Caldwell, J. R., Theisen, V., Kaunisto, C. A., Reddy, P. J., Smythe, P. S., & Smith, D. W. (1983). Psychosocial factors influence control of moderate and severe hypertension. Social Science and Medicine, 17(12), 773–782. doi:10.1016/0277-9536(83)90028-X.PubMedCrossRefGoogle Scholar
  11. Chobanian, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Green, L. A., Izzo, J. L., Jr., et al. (2003). The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: The JNC 7 report. Journal of the American Medical Association, 289(19), 2560–2572. doi:10.1001/jama.289.19.2560.PubMedCrossRefGoogle Scholar
  12. Cobb, S. L., Brown, D. J., & Davis, L. L. (2006). Effective interventions for lifestyle change after myocardial infarction or coronary artery revascularization. Journal of the American Academy of Nurse Practitioners, 18(1), 31–39. doi:10.1111/j.1745-7599.2006.00096.x.PubMedCrossRefGoogle Scholar
  13. Cummings, K. M., Becker, M. H., Kirscht, J. P., & Levin, N. W. (1982). Psychosocial factors affecting adherence to medical regiments in a group of hemodialysis patients. Medical Care, 20(6), 567–580. doi:10.1097/00005650-198206000-00003.PubMedCrossRefGoogle Scholar
  14. Daly, J., Sindone, A. P., Thompson, D. R., Hancock, K., Chang, E., & Davidson, P. (2002). Barriers to participation in and adherence to cardiac rehabilitation programs: A critical literature review. Progress in Cardiovascular Nursing, 17(1), 8–17. doi:10.1111/j.0889-7204.2002.00614.x.PubMedCrossRefGoogle Scholar
  15. DiMatteo, M. R. (2004). Social support and patient adherence to medical treatment: A meta-analysis. Health Psychology, 23(2), 207–218. doi:10.1037/0278-6133.23.2.207.PubMedCrossRefGoogle Scholar
  16. DiMatteo, M. R., Hays, R. D., & Sherbourne, C. D. (1992). Adherence to cancer regimens: Implications for treating the older patient. Oncology, 6(2, Suppl), 50–57. Williston Park.PubMedGoogle Scholar
  17. DiMatteo, M. R., Lepper, H. S., & Croghan, T. W. (2000). Depression is a risk factor for noncompliance with medical treatment: Meta-analysis of the effects of anxiety and depression on patient adherence. Archives of Internal Medicine, 160(14), 2101–2107. doi:10.1001/archinte.160.14.2101.PubMedCrossRefGoogle Scholar
  18. Dimenas, E. S., Wiklund, I. K., Dahlof, C. G., Lindvall, K. G., Olofsson, B. K., & De Faire, U. H. (1989). Differences in the subjective well-being and symptoms of normotensives, borderline hypertensives and hypertensives. Journal of Hypertension, 7(11), 885–890. doi:10.1097/00004872-198911000-00006.PubMedCrossRefGoogle Scholar
  19. Elmer, P. J., Grimm, R., Jr., Laing, B., Grandits, G., Svendsen, K., Van Heel, N., et al. (1995). Lifestyle intervention: Results of the treatment of mild hypertension study (TOMHS). Preventive Medicine, 24(4), 378–388. doi:10.1006/pmed.1995.1062.PubMedCrossRefGoogle Scholar
  20. Fuertes, J. N., Mislowack, A., Bennett, J., Paul, L., Gilbert, T. C., Fontan, G., et al. (2007). The physician-patient working alliance. Patient Education and Counseling, 66(1), 29–36. doi:10.1016/j.pec.2006.09.013.PubMedCrossRefGoogle Scholar
  21. Gandek, B., Ware, J. E., Aaronson, N. K., Apolone, G., Bjorner, J. B., & Brazier, J. E. (1998). Cross-validation of item selection and scoring for the SF-12 health survey in nine countries: Results from the IQOLA project. International quality of life assessment. Journal of Clinical Epidemiolog, 51(11), 1171–1178. doi:10.1016/S0895-4356(98)00109-7.CrossRefGoogle Scholar
  22. Garfield, F. B., & Caro, J. J. (1999). Compliance and hypertension. Current Hypertension Reports, 1(6), 502–506. doi:10.1007/s11906-996-0022-y.PubMedCrossRefGoogle Scholar
  23. George, C. F., Peveler, R. C., Heiliger, S., & Thompson, C. (2000). Compliance with tricyclic antidepressants: The value of four different methods of assessment. British Journal of Clinical Pharmacology, 50(2), 166–171. doi:10.1046/j.1365-2125.2000.00244.x.PubMedCrossRefGoogle Scholar
  24. Glassman, A. H., Helzer, J. E., Covey, L. S., Cottler, L. B., Stetner, F., Tipp, J. E., et al. (1990). Smoking, smoking cessation, and major depression. Journal of the American Medical Association, 264(12), 1546–1549. doi:10.1001/jama.264.12.1546.PubMedCrossRefGoogle Scholar
  25. Hamilton, G. A. (2003). Measuring adherence in a hypertension clinical trial. European Journal of Cardiovascular Nursing, 2(3), 219–228. doi:10.1016/S1474-5151(03)00058-6.PubMedCrossRefGoogle Scholar
  26. He, J., Muntner, P., Chen, J., Roccella, E. J., Streiffer, R. H., & Whelton, P. K. (2002). Factors associated with hypertension control in the general population of the United States. Archives of Internal Medicine, 162(9), 1051–1058. doi:10.1001/archinte.162.9.1051.PubMedCrossRefGoogle Scholar
  27. Kim, M. T., Han, H. R., Hill, M. N., Rose, L., & Roary, M. (2003). Depression, substance use, adherence behaviors, and blood pressure in urban hypertensive black men. Annals of Behavioral Medicine, 26(1), 24–31. doi:10.1207/S15324796ABM2601_04.PubMedCrossRefGoogle Scholar
  28. Koertge, J., Weidner, G., Elliott-Eller, M., Scherwitz, L., Merritt-Worden, T. A., Marlin, R., et al. (2003). Improvement in medical risk factors and quality of life in women and men with coronary artery disease in the multicenter lifestyle demonstration project. The American Journal of Cardiology, 91(11), 1316–1322. doi:10.1016/S0002-9149(03)00320-5.PubMedCrossRefGoogle Scholar
  29. Kulkarni, S. P., Alexander, K. P., Lytle, B., Heiss, G., & Peterson, E. D. (2006). Long-term adherence with cardiovascular drug regimens. American Heart Journal, 151(1), 185–191. doi:10.1016/j.ahj.2005.02.038.PubMedCrossRefGoogle Scholar
  30. Kyngas, H., & Lahdenpera, T. (1999). Compliance of patients with hypertension and associated factors. Journal of Advanced Nursing, 29(4), 832–839. doi:10.1046/j.1365-2648.1999.00962.x.PubMedCrossRefGoogle Scholar
  31. Li, W. W., Wallhagen, M. I., & Froelicher, E. S. (2008). Hypertension control, predictors for medication adherence and gender differences in older Chinese immigrants. Journal of Advanced Nursing, 61(3), 326–335.PubMedGoogle Scholar
  32. Lichtenstein, A. H., Appel, L. J., Brands, M., Carnethon, M., Daniels, S., Franch, H. A., et al. (2006). Diet and lifestyle recommendations revision 2006: A scientific statement from the American heart association nutrition committee. Circulation, 114(1), 82–96. doi:10.1161/CIRCULATIONAHA.106.176158.PubMedCrossRefGoogle Scholar
  33. Lumley, J., Oliver, S·S., Chamberlain, C., & Oakley, L. (2004). Interventions for promoting smoking cessation during pregnancy. Cochrane Database of Systematic Reviews (Online : Update Software), (4), CD001055.Google Scholar
  34. McHorney, C. A., Ware, J. E., Jr., Rogers, W., Raczek, A. E., & Lu, J. F. (1992). The validity and relative precision of MOS short- and long-form health status scales and Dartmouth COOP charts. Results from the medical outcomes study. Medical Care, 30(5), MS253–MS265. doi:10.1097/00005650-199205001-00025.PubMedCrossRefGoogle Scholar
  35. Miller, E. R., III, Erlinger, T. P., Young, D. R., Jehn, M., Charleston, J., Rhodes, D., et al. (2002). Results of the diet, exercise, and weight loss intervention trial (DEW-IT). Hypertension, 40(5), 612–618. doi:10.1161/01.HYP.0000037217.96002.8E.PubMedCrossRefGoogle Scholar
  36. Morisky, D. E., Green, L. W., & Levine, D. M. (1986). Concurrent and predictive validity of a self-reported measure of medication adherence. Medical Care, 24(1), 67–74. doi:10.1097/00005650-198601000-00007.PubMedCrossRefGoogle Scholar
  37. Morris, A. B., Li, J., Kroenke, K., Bruner-England, T. E., Young, J. M., & Murray, M. D. (2006). Factors associated with drug adherence and blood pressure control in patients with hypertension. Pharmacotherapy, 26(4), 483–492. doi:10.1592/phco.26.4.483.PubMedCrossRefGoogle Scholar
  38. Moum, T., Naess, S., Sorensen, T., Tambs, K., & Holmen, J. (1990). Hypertension labelling, life events and psychological well-being. Psychological Medicine, 20(3), 635–646.PubMedCrossRefGoogle Scholar
  39. Pi-Sunyer, F. X. (2006). Use of lifestyle changes treatment plans and drug therapy in controlling cardiovascular and metabolic risk factors. Obesity (Silver Spring, Md.), 14(3), 135S–142S. doi:10.1038/oby.2006.293.CrossRefGoogle Scholar
  40. Psaty, B. M., Lumley, T., Furberg, C. D., Schellenbaum, G., Pahor, M., Alderman, M. H., et al. (2003). Health outcomes associated with various antihypertensive therapies used as first-line agents: A network meta-analysis. Journal of the American Medical Association, 289(19), 2534–2544. doi:10.1001/jama.289.19.2534.PubMedCrossRefGoogle Scholar
  41. Rehman, S. U., Hutchison, F. N., Hendrix, K., Okonofua, E. C., & Egan, B. M. (2005). Ethnic differences in blood pressure control among men at veterans affairs clinics and other health care sites. Archives of Internal Medicine, 165(9), 1041–1047. doi:10.1001/archinte.165.9.1041.PubMedCrossRefGoogle Scholar
  42. Rosenstock, I. M., Strecher, V. J., & Becker, M. H. (1988). Social learning theory and the health belief model. Health Education Quarterly, 15(2), 175–183.PubMedGoogle Scholar
  43. Rosenthal, T., & Oparil, S. (2000). Hypertension in women. Journal of Human Hypertension, 14(10–11), 691–704. doi:10.1038/sj.jhh.1001095.PubMedCrossRefGoogle Scholar
  44. Sacks, F. M., Svetkey, L. P., Vollmer, W. M., Appel, L. J., Bray, G. A., Harsha, D., et al. (2001). Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet. DASH-sodium collaborative research group. The New England Journal of Medicine, 344(1), 3–10. doi:10.1056/NEJM200101043440101.PubMedCrossRefGoogle Scholar
  45. Sherbourne, C. D., Hays, R. D., Ordway, L., DiMatteo, M. R., & Kravitz, R. L. (1992). Antecedents of adherence to medical recommendations: Results from the medical outcomes study. Journal of Behavioral Medicine, 15(5), 447–468. doi:10.1007/BF00844941.PubMedCrossRefGoogle Scholar
  46. Shumaker, S. A., & Hill, D. R. (1991). Gender differences in social support and physical health. Health Psychology, 10(2), 102–111. doi:10.1037/0278-6133.10.2.102.PubMedCrossRefGoogle Scholar
  47. Simonsick, E. M., Wallace, R. B., Blazer, D. G., & Berkman, L. F. (1995). Depressive symptomatology and hypertension-associated morbidity and mortality in older adults. Psychosomatic Medicine, 57(5), 427–435.PubMedGoogle Scholar
  48. Sobel, M. E. (1982). Asymptotic intervals for indirect effects in structural equations models. In S. Leinhart (Ed.), Sociological methodology (pp. 290–312). San Francisco: Jossey-Bass.Google Scholar
  49. Stewart, A., Noakes, T., Eales, C., Shepard, K., Becker, P., & Veriawa, Y. (2005). Adherence to cardiovascular risk factor modification in patients with hypertension. Cardiovascular Journal of South Africa, 16(2), 102–107.PubMedGoogle Scholar
  50. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. (2002). Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). Journal of the American Medical Association, 288(23), 2981–2997. doi:10.1001/jama.288.23.2981.CrossRefGoogle Scholar
  51. Wang, P. S., Bohn, R. L., Knight, E., Glynn, R. J., Mogun, H., & Avorn, J. (2002). Noncompliance with antihypertensive medications: The impact of depressive symptoms and psychosocial factors. Journal of General Internal Medicine, 17(7), 504–511. doi:10.1046/j.1525-1497.2002.00406.x.PubMedCrossRefGoogle Scholar
  52. Ware, J., Jr., Kosinski, M., & Keller, S. D. (1996). A 12-Item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220–233. doi:10.1097/00005650-199603000-00003.PubMedCrossRefGoogle Scholar
  53. Wells, K. B., Stewart, A., Hays, R. D., Burnam, M. A., Rogers, W., Daniels, M., et al. (1989). The functioning and well-being of depressed patients. Results from the medical outcomes study. Journal of the American Medical Association, 262(7), 914–919. doi:10.1001/jama.262.7.914.PubMedCrossRefGoogle Scholar
  54. Whelton, P. K., Appel, L. J., Espeland, M. A., Applegate, W. B., Ettinger, W. H., Jr., Kostis, J. B., et al. (1998). Sodium reduction and weight loss in the treatment of hypertension in older persons: A randomized controlled trial of nonpharmacologic interventions in the elderly (TONE). TONE collaborative research group. Journal of the American Medical Association, 279(11), 839–846. doi:10.1001/jama.279.11.839.PubMedCrossRefGoogle Scholar
  55. White, W. B. (2008). Improving blood pressure control and clinical outcomes through initial use of combination therapy in stage 2 hypertension. Blood Pressure Monitoring, 13(2), 123–129.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Ranak B. Trivedi
    • 1
  • Brian Ayotte
    • 2
  • David Edelman
    • 1
    • 2
  • Hayden B. Bosworth
    • 1
    • 2
  1. 1.Department of MedicineDuke University Medical CenterDurhamUSA
  2. 2.Durham Veterans Affairs Medical CenterDurhamUSA

Personalised recommendations