Control Of Hypertension, Medication Adherence And Their Correlates In Chinese Hypertensive Outpatients In Tertiary Hospitals

PartⅠObjective:To investigate the blood pressure control rate and related influencing factors in hypertensive Outpatients.Methods:In this multicenter, cross-sectional registration survey, hypertensive outpatients were recruited from department of cardiology, nephrology and endocrinology of92tertiary hospitals in22cities across China-Each center enrolled more than50hypertensive outpatients aged18years or older between20April2009and31May2009. Outpatients were surveyed by clinical interview with BP measurement and questionnaire.Results:A total of5086subjects were enrolled.2032in department of cardiology.1510in department of endocrinology and1544in department of nephrology,27.1%and25.3%patients were in Grade2or Grade3hypertension,37.2%patients were complicated with diabetes.22.4%with coronary artery disease. and18.4%with renal dysfunction. Overall controlled BP was achieved in30.6%patients. The control rate was45.9%in uncomplicated hypertensive patients.31.3%in hypertensive parents with coronary artery disease,14.9%in patients with diabetes, and13.2%in patients with renal dysfunction. Calcium channel blocker (56.6%) and angiotensin II receptor blockers (32.0%) were the most frequently used medication. The mean number of antihypertensive agents prescribed per patient was1.73. Over54.1%patients were treated with more than2antihypertensive drugs. Combination therapy or single pill combination with various anti-hypertensive components was prescribed to8.3%and12.7%hypertensive patients in initial therapy. Multiple logistic regression analysis showed that lower BMI, no alcohol intake, free medical Care, no diabetes, no renal-dysfunction, lipid-lowering therapy, shorter interval of visiting physicians, regular taking antihypertensive medications, physical activity were the factors related to satisfactory blood pressure control rate in hypertensive outpatients.Conclusions:Blood pressure control rate among Chinese hypertensive outpatients was increased compared with epidemiological survey in2002. BMI, comorbidities, lower combination treatment rate, poor compliance were the key reasons for lower BP control rate. Increased use of combination therapy instead of mono-therapy should be encouraged to hypertensive outpatients to improve BP control rate. Part IIBackground:Patients tend to go to senior hospitals for medical care in mainland China. Although hypertension is a major risk factor for cardiovascular disease and stroke morbidity and mortality, poor adherence to antihypertensive pharmacotherapy reduces the effect of the blood pressure (BP) control efforts. The purpose of this multicenter, cross-sectional registration survey was to assess the adherence status in hypertensive patients in Chinese tertiary hospitals and figure out the subsets of patients with more serious non-adherence.Methods:We conducted a multicenter, cross-sectional registration survey to recruit outpatients from92tertiary hospitals in22cities across China. A self-reported questionnaire was used as a measurement of medication adherence."Never" forgetting to take medication or reducing medication was defined as appropriate medication. Multiple and multinomial logistic regression model was conducted to figure out the correlates of medication adherence.Results:A total of5,005patients were included as study subjects. Fifty three point seven percent patients reported appropriate adherence, and14.9%of the study population had moderate-to-high non-adherence. Female gender had a higher probability of appropriate medication adherence [odds ratio (OR),1.14;95%confidence interval (CI),1.00-1.30]. Patients in the40s were at the risk of low-to-high medication non-adherence. Elementary and junior middle school education level, covered by commercial insurance,6-12months medication duration, more than1month interval between hospital visits, absence of home BP measurement, lack of knowledge of BP control target were associated with different levels of antihypertensive medication adherence.Conclusions:Our study identifies some correlates of antihypertensive drug medication adherence among hypertensive patients in Chinese tertiary hospitals.