Hypertension Treatment Adherence: Literature Review

Introduction

Nurses play a big part in tending to hypertension patients, starting with measuring and monitoring blood pressure (BP), explaining the importance of following prescriptions for the patients and their families, and education. However, despite all the work being done in this field of study, the rates of people suffering from high BP still remain dangerously high. Due to the vast range of factors to which patients with high BP rates are exposed in the home setting, home BP monitoring should be applied as a precautionary measure for preventing the aggravation of the vulnerable group’s condition…

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PICOT Question

In adults aged 50 and older suffering from hypertension for 5 years or longer, does daily home blood pressure monitoring allow for an improvement in health compared to the ambulatory BP monitoring within the first year of observations?

Methods

The study was based on quantitative analysis and implied using innovative tools for data collection. An electronic search was used to find articles researching the impact of home BP monitoring and intervention for hypertension adults over 50 years of age. The sources found mostly deal with the statistics on how many patients adhere to medications prescribed and how the figures differ for control and intervention groups.

Results

The outcomes of the study indicate the strong need for introducing the BP home monitoring technique since it allows for a significant improvement in health outcomes and patient education. The purpose of the study by Tzourio, Hanon, Godin, Soumaré, and Dufouil was to find whether monitoring BP at home influences its reduction and improves hypertension control for elderly people. During a 24-month period patients aged 73–97 were split into control and intervention groups, the results for each were acquired through the office and home BP measurement.

According to the trial, “the primary outcome was the difference in means office BP over 24 months in hypertensive patients. Secondary outcomes included differences in mean home BP over follow-up in hypertensive patients” (Tzourio et al., 2017, p. 612).

A Systematic Review of the Impact of Interventions on Medication Adherence and BP Control carried out by a special interest group focuses on articles dealing with this question. By way of analyzing 97 relevant sources, they identified that “interventions aimed at improving patients’ knowledge of medications are of potential clinical value in improving adherence with antihypertensive therapy” (Gwadry-Sridhar et al., 2013 p. 868). Interventions included patients and their families and were arranged in sessions and with different informational materials.

The article “Improving Medication Adherence in Patients with Hypertension: A Randomized Trial” investigates how effective can be a pharmacist intervention to enhance medication adherence in hypertensive patients. Participants were randomized to usual care and a 6-month pharmacist intervention, which also included motivational talks and phone follow-ups. The researchers state that “the combined clinical endpoint was reached by 1.3% in the intervention group and 3.1% in the control group” (Hedegaard et al., 2015, p. 1357).

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The data for the cross-sectional study on Treatment adherence in hypertensive patients was acquired from 106 patients who filled in a questionnaire during a medical appointment. The statistics show that the majority of hypertensive patients with the duration of illness for over five years do not comply with the treatment that is 73.6% vs.26.4% (Amaral et al., 2015, p. 1292). Among those who follow the prescriptions only half of them admit high adherence, and the rest are divided into moderate and poor.

The article Expanding the Role of Nurses to Improve Hypertension Care and Control Globally explores the place nurses take in the treatment of patients with high BP, and why expanding their role may improve the situation. The authors outline nurses’ scope of responsibilities, stating that they “involve all aspects of care, including

  1. detection, referral, and follow up;
  2. diagnostics and medication management;
  3. patient education, counseling, and skill-building;
  4. coordination of care;
  5. clinic or office management;
  6. population health management;
  7. performance measurement and quality improvement” (Dennison, Commodore-Mensah, & Hill, 2016, p. 243).

Strengths and Weaknesses

The main strengths of the literature reviewed above are the effective management of data and the logical conclusions made at the end. Specifically, the methodological approach toward handling the vast range of information offered by the participants can be deemed as quite impressive and very important for the further design of an appropriate solution.

The conclusions made by the authors, however, demonstrate a different advantage. Although each of the studies described above focuses on a very specific issue, they all manage to introduce conclusions that embrace multiple perspectives. Consequently, the foundation for introducing a comprehensive solution to the problem is built (Gwadry-Sridhar et al., 2013).

The provided method of handling the available data is especially important when managing the problem of compliance with the prescribed instructions and the consumption of the designated medications. Particularly, social, economic, and cultural factors determining the reasons for patients to fail in meeting the provided guidelines are embraced in the studies. Thus, a valuable tool for handling the issue can be created by integrating the available information and changing the patients’ perspective of the issue.

However, the studies also have several weaknesses, most of which concern the research design. For instance, the choice of the sample size, which is rather small in most studies analyzed above, seems to be rather questionable. While it is important to restrict a quantitative analysis to a group of selected participants, the specified strategy may also lead to underrepresenting the target demographic. Consequently, the outcomes of the framework for handling the problem in question may prove to lack an effect.

In addition, some of the studies refuse to explore the role that nurses play in the management of hypertension levels and, instead, focus solely on external factors impeding the specified process (Amaral et al., 2015). Therefore, the problem of patient-nurse communication and the further education of the vulnerable group is not discussed properly. Hus, follow-up studies should be seen as the next logical step in answering the questions raised in the specified articles.

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Conclusion

By increasing the levels of compliance with the prescribed medication directly through patient education, one is likely to lead to a gradual improvement of health levels among the target population. According to the results of the studies discussed above, patients require substantial education and the provision of the necessary information regarding hypertension management. Consequently, the specified demographic will develop an understanding of the significance of complying with the prescribed medication and the guidelines provided by the therapist. A nurse must ensure that all guidelines are followed precisely, which is why communication with the target demographic needs to be maintained with the help of modern media. As a result, a gradual change in patients’ behaviors will occur.

References

Amaral, O., Chaves, C., Duarte, J., Coutinho, E., Nelas, P., & Preto, O. (2015). Treatment adherence in hypertensive patients – A cross-sectional study. Procedia – Social and Behavioral Sciences, 171, 1288–1295.

Dennison, C., Commodore-Mensah, Y., Hill, M. (2016). Expanding the role of nurses to improve hypertension care and control globally. Annals of Global Health, 82(2), 243-253.

Gwadry-Sridhar, F., Manias, E., Lal, L., Salas, M., Hughes, D., Ratzki-Leewing, A., & Grubisic, M. (2013). Impact of interventions on medication adherence and blood pressure control. Value in Health, 16(7), 863-871.

Hedegaard, U., Kjeldsen, J., Pottegård, A., Henriksen, E., Lambrechtsen, J., Hangaard, & J., Hallas, J. (2015) Improving medication adherence in patients with hypertension: A randomized trial. The American Journal of Medicine, 128(12), 1351-1361.

Tzourio, C., Hanon, O., Godin, O., Soumaré, A., & Dufouil, C. (2017). Impact of home blood pressure monitoring on blood pressure control in older individuals: A French randomized study. Journal of Hypertension, 35(3), 612-620.

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