Skip to main content Skip to main navigation menu Skip to site footer
Published: 2016-09-10

Patient adherence to antihypertensive therapy and its individual psychological factors

Bogomolets National Medical University
Bogomolets National Medical University
compliance individual-psychological factors arterial hypertension type of subjective control intensity of attitude to health personality type

Abstract

Background. In the treatment of chronic, especially asymptomatic pathology one of the main problem is the adherence to therapy. Patients with arterial hypertension need long-term, often lifelong medication, and how strictly they adhere to prescriptions often determines the course of the disease and the medical measures effectiveness. According to statistics, more than half of patients with hypertension are characterized by low compliance, which leads to complications of this disease. The objective of the research is to identify and analize the individual psychological factors that determine patient adherence to antihypertensive therapy.

Methods and materials. This study was conducted during 2011-2013 at the cardiology departments of the Kyiv Alexander Hospital, polyclinics number 2 Shevchenko district in Kyiv, Desnyanskiy clinic №3 district in Kyiv, medical center "Adonis plus". We examined 203 patients with arterial hypertension (average age 53,5 ± 4,5 years). Methods: socio-demographic, clinical, clinical and psychological, psychodiagnostical, mathematical and statistical methods. Psychodiagnostical method included: 8-item Morisky medical adherence scale (Morisky D. E., 2008); self-assessment anxiety scale Charles D. Spielberger – Y.L Hanin (A.V. Batarshev, 2005); the Minnesota Multiphasic Personality Inventory questionnaire (MMRI) (F.B. Berezin, 1994); "The level of subjective control" (A.A. Rean, 2001); "Index of attitudes to health" (S.D. Deryabo, VA Yasvin, 2000).

Results. According to the results of 8-item Morisky medical adherence scale patients were divided into 3 groups according to the level of compliance - with high (26.11%), average (24.14%) and low (49.75%) levels of adherence to antihypertensive therapy. The individual-psychological predictors of poor adherence to antihypertensive therapy include the following personal characteristics of patients: a low level of intensity of attitude to health, internal type of subjective control, a low endurance to stress, strain of defense mechanisms, emotional instability and self-esteem, impulsivity, nonconformnism, tendency to independence, stability of attitudes, commitment to relying on their own experience, conflict behavior, rigidity, self-centeredness, introversion, the need for updating their own individuality, lack of deepening into serious problems. Designed psychocorrective program, aimed at transformation of lifestyle of patients and formation of a conscious aspiring to health, showed high efficacy.

Conclusions. Adherence to antihypertensive therapy in patients with arterial hypertension depends on such individual psychological factors as personality characteristics, type of subjective control, anxiety level and the level of intensity of attitudes to health, that should also be considered during treatment of hypertension to predict the level of compliance. It is reasonable to involve medical psychologists in counseling and correction of patients with hypertension in cardiology departments and clinics to diagnose personality compliance factors, intensity of attitude to health, identifying patients at risk of low adherence to antihypertensive therapy and, if necessary, adjust the level of compliance.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

Full-text of the article is available for this locale: Українська.

References

  1. Mant J, McManus RJ. Does it matter whether patients take their antihypertensive medication as prescribed? The complex relationship between adherence and blood pressure control. J Hum Hypertens. 2006; 20 :551-553 http://www.ncbi.nlm.nih.gov/pubmed/16710290
  2. Gluzman S. OsnovnI prichini visokogo rivnya smertnosti v Ukrayini. Novosti meditsinyi i farmatsii v Ukraine. 2010;22(350):8-11. http://www.mif-ua.com/archive/article/15170
  3. Arterialna gipertenziya. Onovlena ta adaptovana klinichna nastanova, zasnovana na dokazah (2012 rIk): praktichni rekomendatsiyi; proekt. Robocha grupa z arterialnoyi gipertenziyi. Arterialnaya gipertenziya. 2012;1:96-152. http://www.dec.gov.ua/mtd/reestr.html
  4. Chobanian AV. Impact of nonadherence to antihypertensive therapy. Circulation 2009 Oct 20; 120:1558-60 http://www.ncbi.nlm.nih.gov/pubmed/19805645
  5. Ahmed N, Abdul Khaliq M, Shah SH, Anwar W. Compliance to anti-hypertensive drugs, salt restriction, exercise and control of systemic hypertension in hypertensive patients at Abbottabad. J Ayub Med Coll Abbottabad 2008;20(2):66–9. http://www.ncbi.nlm.nih.gov/pubmed/19385461
  6. Golovchenko Yu. I. Patogeneticheskie osobennosti razvitiya tsirkulyatornoy gipoksii mozga pri arterialnoy gipertenzii. Novosti meditsinyi i farmatsii v mire. 2012;10(416):11-13. http://www.mif-ua.com/archive/article/18018
  7. Vaskes Abanto H. E. Arterialnaya gipertenziya: zabolevanie ili faktor riska? Meditsina neotlozhnyih sostoyaniy. 2015;7:7-12. http://nbuv.gov.ua/UJRN/Medns_2015_7_4
  8. Sokolova L. I. Arterialna gipertenziya yak faktor riziku rozvitku ishemichnogo insultu vertebralno-bazilyarnogo baseynu. ShidnoEvropeyskiy zhurnal gromadskogo zdorov’ya. Materiali Mizhnarodnoyi naukovo-praktichnoyi konferentsiyi, prisvyachenoyi Vsesvitnomu dnyu zdorov’ya 2013. 2013;1(21):252-253.
  9. Bezsheyko V.G. Effektivnost ingibitorov renin-angiotenzin-aldosteronovoy sistemyi pri arterialnoy gipertenzii. Ukr.med. chasopis. 2015 http://www.umj.com.ua/article/84019/effektivnost-ingibitorov-renin-angiotenzin-aldosteronovoj-sistemy-pri-arterialnoj-gipertenzii?lang=ua
  10. Chaban O.S., Haustova O.O. Depresivni rozladi u patsientiv pohilogo viku: problemi diagnostiki i terapiyi. Neyronews. 2014;2/1 http://neuronews.com.ua/page/depresivni-rozladi-u-pacientiv-pohilogo-viku-problemi-diagnostiki-i-terapiyi
  11. Sirenko Yu. M. Dosvid likuvannya patsientiv z arterIalnoyu gipertenzieyu za dopomogoyu vitchiznyanih likiv. Ukrayinskiy kardiologichniy zhurnal. 2010;1:27-39. http://www.eurolab.ua/encyclopedia/565/43657/
  12. Ocheretyanaya N. XIII Natsionalnyiy kongress kardiologov Ukrainyi: kvintessentsiya znaniy, dostizheniy, opyita. Zdorov’ya Ukrayini. 2011;5(25):8-10. http://health-ua.com/pics/pdf/ZU_2012_Cardio_5/08-10.pdf
  13. Chaban O.S., Haustova O.O. Metabolichniy sindrom H: psihosomatichniy pidhid do diagnostiki ta likuvannya. Therapia. 2008;3(24):66-70. http://therapia.ua/therapia/2008/03/metabolichnyy-syndrom-kh-psykhosomatychnyy-pidkhid-do-diahnostyky-ta-likuvannya
  14. Kressin NR, Wang F., Long J., et al. Hypertensive patients’ race, health beliefs, process of care, and medication adherence. J Gen Intern Med. 2007;22:768-74. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2219848/
  15. Wang PS, Bohn RL, Knight E et al. Noncompliance with antihypertensive medications: the impact of depressive symptoms and psychosocial factors. J Gen Intern Med. 2002 Jul;17(7):504-11. http://www.ncbi.nlm.nih.gov/pubmed/12133140
  16. Bursten B. Medication nonadherence due to feelings of loss of control in “biological depression”. Am J Psychiatry. 1985;142(2):244-6. http://www.ncbi.nlm.nih.gov/pubmed/3970249
  17. Bosworth HB, Weinberger M, Oddone EZ. Introduction. In: Bosworth HB, Oddone EZ, Weinberger M, editors. Patient treatment adherence: concepts, interventions, and measurement. Mahwah, NJ: Lawrence Erlbaum Associates; 2006. pp. 3–12. https://uncch.pure.elsevier.com/en/publications/patient-treatment-adherence-concepts-interventions-and-measuremen
  18. Korzh A. N. Problema priverzhennosti v profilaktike i lechenii arterialnoy gipertenzii. Novosti meditsinyi i farmatsii v Ukraine. 2012;19(436):3-4. http://www.mif-ua.com/archive/article/34414
  19. Gellad WF, Grenard J, McGlynn EA. A review of barriers to medication adherence: a framework for driving policy options. RAND Corporation; 2009. http://www.rand.org/content/dam/rand/pubs/technical_reports/2009/RAND_TR765.pdf
  20. Okken VS, Niemeijer MG, Dijkstra A et al. The effect of physical, social and psychological factors on drug compliance in patients with mild hypertension. Neth Heart J. 2008;16(6):197-200. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2442662/