PURPOSE: This study was done to identify and test a model of the psychosocial variables that influence adherence to therapeutic regimens in patients with hypertension. METHOD: A convenience sample of 219 patients with hypertension who were enrolled in an outpatient clinic of a cardiovascular center in Korea participated in the study. They completed self-administered questionnaires anonymously. The questionnaire was based on the Social Action Theory model and a literature review. The explanatory model was constructed and tested using structural equation modeling in order to examine the effects within the model. RESULTS: The results of this study showed that perceived self-efficacy was the strongest factor influencing patient adherence in this sample. Adherence to therapeutic regimens in patients with hypertension was influenced by self-efficacy, patient-provider relationship, social support, and depression. CONCLUSIONS: Adherence to therapeutic regimens in patients with hypertension was most strongly influenced by self-efficacy. These findings suggest that nursing interventions to promote patient adherence should focus on the promotion of self-efficacy including improvement in patient-provider relationship and social support, and reduction in depression.
Social Support ; Self Efficacy ; Patient Compliance/*psychology ; Models, Psychological ; Middle Aged ; Male ; Korea ; Hypertension/*drug therapy ; Humans ; Health Knowledge, Attitudes, Practice ; Female ; Factor Analysis, Statistical ; Depression/psychology ; Aged

OBJECTIVE: To investigate the effect of antidepressant and psychological intervention on the blood pressure and quality of life in hypertensive patients with depression. METHODS: After evaluating 950 patients with essential hypertension by Hospital Anxiety and Depression Scale (HAD), patients with HAD positive results were evaluated with Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA). The positive subjects with HAMD were randomly divided into an antidepressant and psychological intervention group (n=30, including routine treatment, mental state intervention, and antidepressant treatment) and a control group (n=30, routine treatment alone). The blood pressure, quality of life, and level of depression were compared between the 2 groups. RESULTS: The depression symptoms were significantly improved in the antidepressant and psychological intervention group. The HAMD score fell from 30.03+/-1.83 at entrance to 17.43+/-1.96 at the end of study. The blood pressure control was more effective in the antidepressant and psychological intervention group than in the control group. The mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) decreased by 26.17 mmHg and 13.63 mmHg in the antidepressant and psychological intervention group, while there were only 14.32 mmHg and 7.18 mmHg decrease in SBP and DBP respectively in the control group. Patients in the antidepressant and psychological intervention group had a higher score in the quality of life. The total score of GQOLI-74 increased from 65.97+/-4.68 before the treatment to 71.20+/-5.13 after the treatment. CONCLUSION Psychological intervention and antidepressant can improve the blood pressure control and quality of life in hypertensive patients with depression.
Adult ; Antidepressive Agents ; therapeutic use ; Blood Pressure ; drug effects ; Depression ; complications ; therapy ; Female ; Humans ; Hypertension ; complications ; drug therapy ; psychology ; Male ; Middle Aged ; Psychotherapy ; Quality of Life

The present study was designed to evaluate the possible beneficial effects of biofeedback-assisted relaxation to pharmacotherapy on blood pressure and heart rate in patients with essential hypertension. Twenty patients with essential hypertension and without any complications or end-organ damage participated in the study. All the patients were using anti-hypertensive drugs. The study protocol consisted of an interview, 10 days baseline, 10 biofeedback-assisted relaxation sessions and a 10-day post-treatment period. Interview blood pressure (BP) and heart rate (HR) measurements, baseline mean values of systolic blood pressure (SBP), diastolic blood pressure (DBP) and HR recorded during the 1st, 10th and 20th minutes of each session and the post-treatment mean values were evaluated. Significant differences were found between the mean values of SBP, DBP and HR after the whole treatment protocol (Wilcoxon signed-ranks test). The mean values of SBP, DBP and HR measurements recorded during the 1st, 10th and 20th minutes of the biofeedback-assisted relaxation sessions, which were evaluated by repeated measures of ANOVA on ranks test, showed a significant decrease only for the 10th minute values at the end of the whole treatment program. Despite a short follow-up, it was suggested that these results were encouraging considering the fact that once the patients are thoroughly instructed in home practice of relaxation and encouraged to develop their own strategies for relaxation, the long term outcome may also be promising.
Adult ; Aged ; Biofeedback (Psychology)* ; Blood Pressure/drug effects* ; Female ; Follow-Up Studies ; Heart Rate/drug effects* ; Human ; Hypertension/therapy* ; Male ; Middle Age ; Relaxation Techniques*

OBJECTIVETo compare the efficacy of atenolol and diltiazem-SR and the effects on the quality of life in hypertensive patients.

METHODSSeventy-three patients with mild to moderate hypertension (DBP 90 - 109 mmHg) were allocated randomly to be administered with atenolol 25 mg/d (group A, n=37) and diltiazem-SR 90 mg/d (group B, n=36) for eight weeks. The changes of heart rate, office blood pressure(OBP), ambulatory blood pressure(ABP) and the quality of life were compared before and after treatment.

RESULTSHeart rate, OBP and ABP decreased after treatment in both groups. The effective rate of blood pressure was 88.2% in group A and 93.8% in group B. Twenty four hour mean daytime and nighttime BP,daytime and nighttime BP loads declined in both groups (P<0.05 - 0.01). The quality of life was significantly increased in group B (P<0.05). Side effects were 21.6% in group A and 11.1% in group B, respectively (P>0.05).

CONCLUSIONAtenolol and diltiazem-SR are more effective and tolerant in the treatment of the hypertension. Diltiazem improves the quality of life better than atenolol.

Adult ; Aged ; Atenolol ; adverse effects ; therapeutic use ; Blood Pressure ; drug effects ; Diltiazem ; adverse effects ; therapeutic use ; Female ; Heart Rate ; drug effects ; Humans ; Hypertension ; drug therapy ; psychology ; Male ; Middle Aged ; Quality of Life

PURPOSE: The purpose of this study was to examine the effect of a medication self-management education program on medication awareness, communication with health care provider, medication misuse behavior, and blood pressure in elders with hypertension. METHODS: The research design for this study was a non-equivalent control group quasi-experimental design. Participants were 23 elders for the control group, and 26 elders for the experimental group. The experimental group participated in the medication self-management education program which included the following, verbal education, 1:1 consultation, practice in medication self-management, and discussion over 5 sessions. Data were analyzed using the SPSS 18.0 program. RESULTS: There were statistically significant differences between the experimental and control group for medication awareness, medication misuse behavior, and communication with health care providers. However, no significant difference was found between the two groups for blood pressure. CONCLUSION: The results indicate that the education program is effective in improving medication awareness and communication with health care providers and in decreasing medication misuse behavior. Therefore, it is recommended that this education program be used as an effective intervention for improving medication self-management for elders with hypertension.
Aged ; Aged, 80 and over ; Antihypertensive Agents/therapeutic use ; Awareness ; Blood Pressure ; Female ; Humans ; Hypertension/drug therapy/*psychology ; Male ; Patient Education as Topic ; Prescription Drug Misuse ; *Program Evaluation ; Questionnaires ; *Self Care