Association Study Of Psychosocial Characteristics, Compliance And Blood Pressure Control Among Hypertensive Patients

Objectives To explore the impact of psychosocial factors and compliance on blood pressure control in hypertensive patients, in order to provide some basic data for health education and psychological intervention work to promote blood pressure control more effectively.Materials and methods Community-based study was employed through cross-sectional epidemiology survey. A total of1202hypertensive patients selected from12communities in Minhang District by simple random method completed the self-administered paper questionnaire survey and electronic questionnaire(CIDI3.0) survey, whose information was collected through face-to-face interview. The questionnaires cover information on social demographics, hypertension status, coping style, social support, life quality and satisfaction, living event, anxiety/depression, and compliance in patient with anti-hypertension therapy. Chi-square test, F-test, spearman rank correlation analysis, and multivariate logistic analysis was conducted for quantitative data with SPSS18.0.Results There were811respondents with the blood pressure under140/90mmHg, and the rate of blood pressure control among hypertensive patients reached to67.5%. In order to comprehensively evaluate the relationship between blood pressure control and relevant factors, social demographics and hypertension characteristics were taken as moderator variables, and furthermore, psychosocial factors (including coping style, social support, anxiety/depression, life quality and satisfaction) as well as compliance in patient with anti-hypertension therapy (CPAT) were independently analyzed by multivariate logistic regression(0=uncontrolled blood pressure,l=controlled blood pressure). The results showed that higher positive coping style(OR=1.47,95%CI:1.06-2.04), better support utilization(OR=1.89,95%CI:1.29-2.75), higher life satisfaction(OR=1.32,95%CI:1.01-1.72) and good compliance(OR=1.53,95%CI:1.14-2.05) were protective factors. Besides, statistical differences were found in gender, hypertension course and grade. Female (OR=1.61,95%CI:1.22-2.11) owned better blood pressure control, while respondents who suffered longer hypertension course (OR=0.62,95%CI:0.45-0.85) and higher hypertension grade(OR=0.33,95%CI:0.16-0.67) had worse blood pressure control. Afterwards, these statistically significant psychosocial factors treated as composite variables were simultaneously involved in the multivariate logistic analysis for blood pressure control, and the results indicated that positive coping style (OR=1.45,95%CI:1.02-2.05), social support (OR=1.81,95%CI:1.22-2.67) and life satisfaction(OR=1.32,95%CI:1.01-1.74) still had statistical significance. In addition to gender, hypertension course and grade, statistical difference was also found in employment status. Unemployed respondents (OR=0.67,95%CI:0.46-0.95) had worse blood pressure control. The same multivariate logistic analysis was conducted to probe into the combined impact of psychosocial characteristics and CPAT on blood pressure control, and the results indicated that the impact of social support and life satisfaction were not detected statistical significance. Multivariate logistic analysis of CPAT(0=bad CPAT,1=good CPAT) was also conducted in order to discriminate preliminarily whether it was the relationship between psychosocial characteristics and CPAT that resulted in the non-statistical significant impact on blood pressure control. The results showed that negative coping style and support utilization were relevant to CPAT. Lower negative coping style (OR=1.59,95%CI:1.11-2.26) and better support utilization (OR=2.01,95%CI:1.34-3.02) were protective factors. Besides, respondents with higher per capita monthly family income(OR=1.87,95%CI:1.17-2.99) and greater literacy (OR=1.69,95%CI:1.03-2.78) had better compliance. However, whether CPAT is the mediating factor between psychosocial characteristics and blood pressure control, it still needs further study.Conclusion It may increase the rate of normal blood pressure that to establish a comprehensive and effective social support system, to improve utilization the level of social support, to guide the patients performing more positive coping style and raise the level of CPAT in future intervention project. It may help promote the level of CPAT that to improve the social support utilization, to adjust the negative coping style.