Adherence to pharmacological treatment as a predictor of blood pressure control in hypertensive patients treated in a Family Health Program facility in inner of São Paulo state, Brazil
METHODS: Longitudinal cohort study, with permanently recruitment of adult outpatients with essential arterial hypertension (EAH), receiving pharmacologic treatment, in a small city in the Midwest of Brazil. Inclusion criteria comprised: (a) patients aged ≥18 years; (b) diagnosis of EAH and had been using antihypertensive medications; (c) did not have antecedents on alcoholism; (d) did not have difficulty of communication or intellectual deficit. Excluded patients with suspected secondary hypertension or pregnancy or included in clinical trials. Data collected from March/2011 to December/2013. Patients were interviewed under blind conditions. The 7-items' Measure-Treatment-Adherence(MTA) scale were applied to establish treatment compliance to EAH. The measurement of BP and anthropometric data were standardized, and variables collected through records and interviews. A bivariate analysis identified the variables correlated to BP control. We used logistic regression to calculate adjusted odds ratios, statistical significance (p≤0.05).
RESULTS: 435 patients were analyzed, 281(64.6%) were enrolled and 279 composed the cohort at the end of the follow-up. The mean follow-up time was 15.61months(±7.72), for a total of 92767.5 persons/year. The mean age was 57.23(±12.87) years, 61.2% being women. At baseline 18.1%(n=51) was considered non-adherent. In the end of the follow-up period, 40.6% (n=114) had uncontrolled hypertension. Bivariate analysis identified as significantly correlated to BP control: number of medications, weight, body mass index (BMI), MTA and the difference between BMI at baseline to BMI at the end. In the logistic regression model, MTA and BMI were identified as predictors of EAH control rate, with an OR of 2.589 (CI-95%:1.384–4.844) and OR=1.037 (CI-95%:1.001–1.074), respectively.
CONCLUSIONS: Non-compliance to EAH pharmacologic treatment and BMI index are predictors of uncontrolled hypertension.