Document Type : Original Article(s)
1 MSc Student, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
2 MSc Student, Global Studies Institute, University of Geneva, Geneva, Switzerland
3 Professor, Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
4 Professor, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
5 Assistant Professor, Nursing and Midwifery Care Research Center AND Department of Intensive Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
BACKGROUND: Hypertension (HTN) is the key risk factor for cardiovascular diseases (CVDs). The purpose of this study was to determine the effect of a multifaceted intervention on blood pressure (BP) control and medication adherence (MA) among patients with uncontrolled HTN.METHODS: A randomized controlled clinical trial study was conducted on 72 patients in the emergency ward who were selected through convenience sampling method. They were randomly divided into intervention and control groups. The studied multifaceted intervention includes motivational interviews and 90 minutes of training sessions, use of a drug reminder box, family support, and 4 phone call follow-ups. The8-Item Morisky Medication Adherence Scale (MMAS-8) was used before and after the intervention. BP was measured in both groups before and after the intervention and compared between them.RESULTS: No significant difference existed between the two groups in terms of MA and systolic and diastolic BP before the study. The differences between the mean changes in post-intervention systolic (-25.75 ± 19.39 vs. -2.88 ± 11.92 mmHG; P < 0.001) and diastolic (-6.18 ± 8.87 vs. -1.06 ± 8.70 mmHg; P = 0.010) BP in the intervention and control groups were statistically significant. The mean changes in post-intervention MA in the intervention and control group was 2.91 ± 1.64 and -0.36 ± 1.15, respectively; this difference was statistically significant (P < 0.001).CONCLUSION: The studied multifaceted intervention promoted MA and reduced systolic and diastolic BP. Thus, the use of this method as a supplementary treatment is recommended after patient discharge.
- Kendir C, van den Akker M, Vos R, Metsemakers J. Cardiovascular disease patients have increased risk for comorbidity: A cross-sectional study in the Netherlands. Eur J Gen Pract 2018; 24(1): 45-50.
- Talaei M, Sadeghi M, Mohammadifard N, Shokouh P, Oveisgharan S, Sarrafzadegan N. Incident hypertension and its predictors: The Isfahan Cohort Study. J Hypertens 2014; 32(1): 30-8.
- Rosendorff C, Lackland DT, Allison M, Aronow WS, Black HR, Blumenthal RS, et al. Treatment of hypertension in patients with coronary artery disease: A scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension. J Am Coll Cardiol 2015; 65(18): 1998-2038.
- Patel P, Ordunez P, DiPette D, Escobar MC, Hassell T, Wyss F, et al. Improved blood pressure control to reduce cardiovascular disease morbidity and mortality: The Standardized Hypertension Treatment and Prevention Project. J Clin Hypertens (Greenwich) 2016; 18(12): 1284-94.
- Burnier M, Wuerzner G, Struijker-Boudier H, Urquhart J. Measuring, analyzing, and managing drug adherence in resistant hypertension. Hypertension 2013; 62(2): 218-25.
- Conn VS, Ruppar TM, Chase JA, Enriquez M, Cooper PS. Interventions to improve medication adherence in hypertensive patients: Systematic review and meta-analysis. Curr Hypertens Rep 2015; 17(12): 94.
- Esmaili Zabihi R, Ashktorab T, Banaderakhshan H, Zaeri F. Adherence to therapeutic regimens in patients with hypertension. ARYA Atheroscler 2012; 8(Special Issue in National Hypertension Treatment): S190-S194.
- Erdine S, Arslan E. Monitoring treatment adherence in hypertension. Curr Hypertens Rep 2013; 15(4): 269-72.
- Tedla YG, Bautista LE. Drug side effect symptoms and adherence to antihypertensive medication. Am J Hypertens 2016; 29(6): 772-9.
- Jafari F, Shahriari M, Sabouhi F, Khosravi FA, Eghbali Babadi M. Effects of a Lifestyle modification program on knowledge, attitude and practice of hypertensive patients with angioplasty: A randomized controlled clinical trial. Int J Community Based Nurs Midwifery 2016; 4(4): 286-96.
- Ritchey M, Chang A, Powers C, Loustalot F, Schieb L, Ketcham M, et al. Vital signs: Disparities in antihypertensive medication nonadherence among medicare part D beneficiaries-United States, 2014. MMWR Morb Mortal Wkly Rep 2016; 65(36): 967-76.
- Eghbali M, Khosravi A, Feizi A, Mansouri A, Mahaki B, Sarrafzadegan N. Prevalence, awareness, treatment, control, and risk factors of hypertension among adults: A cross-sectional study in Iran. Epidemiol Health 2018; 40: e2018020.
- Arabzadeh S, Sadeghi M, Rabiei K, Sarrafzadegan N, Taheri L, Golshahi J. Determinants of uncontrolled hypertension in an Iranian population. ARYA Atheroscler 2014; 10(1): 25-31.
- Masror Roudsari D, Dabiri Golchin M, Parsa Yekta Z, Haghani H. Relationship between adherence to therapeutic regimen and health related quality of life in hypertensive patients. Iran J Nurs 2013; 26(85): 44-54. [In Persian].
- Daniel AC, Veiga EV. Factors that interfere the medication compliance in hypertensive patients. Einstein (Sao Paulo) 2013; 11(3): 331-7.
- Sadeghi R, Mohseni M, Khanjani N. The effect of an educational intervention according to hygienic belief model in improving care and controlling among patients with hypertension. J Rafsanjan Univ Med Sci 2014; 13(4): 383-94. [In Persian].
- Alhaddad IA, Hamoui O, Hammoudeh A, Mallat S. Treatment adherence and quality of life in patients on antihypertensive medications in a Middle Eastern population: adherence. Vasc Health Risk Manag 2016; 12: 407-13.
- Virgolesi M, Pucciarelli G, Colantoni AM, D'Andrea F, Di Donato B, Giorgi F, et al. The effectiveness of a nursing discharge programme to improve medication adherence and patient satisfaction in the psychiatric intensive care unit. J Clin Nurs 2017; 26(23-24): 4456-66.
- Pascal Iloh GU, Amadi AN. Treatment satisfaction, medication adherence, and blood pressure control among adult Nigerians with essential hypertension. International Journal of Health & Allied Sciences 2017; 6(2): 75-81.
- Shepherd J, Goodman KS, George B. Open accessproposed framework for examining ancillary benefits of patient education: A practical application tool for health services administrators. J Health Adm Educ 2018; 35(1): 81-94.
- Daskalopoulou SS, Rabi DM, Zarnke KB, Dasgupta K, Nerenberg K, Cloutier L, et al. The 2015 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Can J Cardiol 2015; 31(5): 549-68.
- Noohi F, Sarrafzadegan N, Khosravi A, Andalib E. The first Iranian recommendations on prevention, evaluation and management of high blood pressure. ARYA Atheroscler 2012; 8(3): 97-118.
- Leiva A, Aguilo A, Fajo-Pascual M, Moreno L, Martin MC, Garcia EM, et al. Efficacy of a brief multifactorial adherence-based intervention in reducing blood pressure: A randomized clinical trial. Patient Prefer Adherence 2014; 8: 1683-90.
- Dehghan Nayeri N, Mohammadi S, Pedram Razi S, Arazi T, Kazemnejad A. Effectiveness of family empowerment program on level of adherence to treatment regimens in stroke patients; a randomized controlled trial. Evidence Based Care, 2015; 5(1): 57-66.
- Shen Y, Peng X, Wang M, Zheng X, Xu G, Lu L, et al. Family member-based supervision of patients with hypertension: A cluster randomized trial in rural China. J Hum Hypertens 2017; 31(1): 29-36.
- Lyles CR, Sarkar U, Schillinger D, Ralston JD, Allen JY, Nguyen R, et al. Refilling medications through an online patient portal: Consistent improvements in adherence across racial/ethnic groups. J Am Med Inform Assoc 2016; 23(e1): e28-e33.
- Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich) 2008; 10(5): 348-54.
- Moharamzad Y, Saadat H, Nakhjavan Shahraki B, Rai A, Saadat Z, Aerab-Sheibani H, et al. Validation of the Persian Version of the 8-Item Morisky Medication Adherence Scale (MMAS-8) in Iranian Hypertensive Patients. Glob J Health Sci 2015; 7(4): 173-83.
- Hanus KM, Prejbisz A, Gasowski J, Klocek M, Topor-Madry R, Lesniak W, et al. Relationship between gender and clinical characteristics, associated factors, and hypertension treatment in patients with resistant hypertension. Kardiol Pol 2017; 75(5): 421-31.
- Fakhri A, Morshedi H, Mohammadi Zeidi I. Effectiveness of theory based education on medication adherence in older adults with hypertension. Jundishapur Sci Med J 2017; 16(2): 161-74. [In Persian].
- Williams A, Manias E, Walker R, Gorelik A. A multifactorial intervention to improve blood pressure control in co-existing diabetes and kidney disease: A feasibility randomized controlled trial. J Adv Nurs 2012; 68(11): 2515-25.
- Babaei-Sis M, Ranjbaran S, Mahmoodi H, Babazadeh T, Moradi F, Mirzaeian K. The effect of educational intervention of life style modification on blood pressure control in patients with hypertension. J Educ Community Health 2016; 3(1): 12-9. [In Persian].
- Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, et al. Blood pressure lowering for prevention of cardiovascular disease and death: A systematic review and meta-analysis. Lancet 2016; 387(10022): 957-67.
- Al-Ramahi R. Adherence to medications and associated factors: A cross-sectional study among Palestinian hypertensive patients. J Epidemiol Glob Health 2015; 5(2): 125-32.