Background of the Problem
Hypertension is a chronic disease prevalent among older adults, which requires blood pressure to be controlled to reduce the risks of complications, such as cardiovascular illnesses. According to CDC, the incidence of hypertension increases with age; in 2015-2016, about 33% of people aged 40-59 and 63% of those aged over 60 suffer from high blood pressure (Fryar et al., 2017). Yet, only about 50% of patients with hypertension belonging to these age groups had their blood pressure controlled (Fryar et al., 2017). Since hypertension is a prevalent disease leading to serious health risks, it is worth the attention of researchers.
Hypertension is associated with multiple morbid conditions that manifest themselves in case blood pressure is not controlled. High blood pressure in older adults leads to increased risks of cardiovascular diseases and mortality, as well as chronic kidney disease and dementia, and these risks are several times higher than those in younger patients with the same blood pressure (Burnier et al., 2020). Adherence to antihypertensive drugs reduces risks related to hypertension in both elderly and very elderly (aged over 85 years) patients compared to those with low adherence to medications (Corrao et al., 2017). However, a large number of older patients do not comply with antihypertensive therapy for various reasons, such as pill burden, complex treatment regimen, depression, and fear of side effects (Burnier et al., 2020). Therefore, there is a strong need for the promotion of adherence to antihypertensive drugs in older patients to improve their health outcomes.
Identification of Stakeholders
Key stakeholders that should be involved in the process of promotion of medication adherence are physicians and pharmacists, as well as patients and their families. As a rule, interventions intended to increase adherence to antihypertension drugs are directed toward educating patients and shaping proper behaviors (Peacock & Krousel-Wood, 2017). Therefore, the role of physicians and pharmacists is to educate patients and their relatives about the importance of drug adherence and possible ways of facilitating pill burden. Physicians can provide patients with reminders, reward them for adherence, and simplify regimens by administrating combination pills or once-daily dosing (Peacock & Krousel-Wood, 2017). Furthermore, since low incomes are one of the most common reasons for nonadherence to drugs, healthcare organizations should partner with the business community, as well as encourage patients to make use of the Affordable Care Act, in order to reduce the cost of medications (Tong et al., 2016). Promoting adherence to antihypertensive drugs is likely to benefit healthcare organizations since it will decrease the burden on the healthcare system.
PICOT Question
Having identified the need to address the problem of nonadherence to antihypertensive medications, I have developed a PICOT question to guide my research. After getting feedback from my peer, I have refined my PICOT question. Now, it sounds as follows: “In patients aged 50 years and older (P), how does adherence to antihypertension drugs (I) compared to nonadherence to antihypertension drugs (C) decrease the incidence of hypertension (O) when done consistently over six months (T)?” This question will help to study the effects of antihypertension drugs on patients with high blood pressure, and having a control group will ensure the quality and reliability of the results. Furthermore, there is a need to control for participants’ diet and physical activity to avoid their influence on research results. This PICOT question fits well with my graduate degree specialization.
Purpose and Objectives
The purpose of this project is to evaluate the decrease in the incidence of hypertension in older adults as a result of adherence to antihypertensive medications. The objectives include enhancing patients’ adherence to antihypertensive drugs, improving patients’ health outcomes, and reducing the risks of complications of hypertension. The education of participants and their family members will be used as an intervention to promote adherence. The systolic and diastolic blood pressure of participants in both the test group and control group will be measured before and after the evidence-based practice is introduced. The expected change is that participants in the test group will have reduced blood pressure and a lower incidence of hypertension compared to those in the control group.
Rationale
The problem of adherence to antihypertensive drugs is important for nurses to solve since the share of older patients not adhering to medications is high, which leads to high rates of cardiovascular morbidity and mortality. A systematic review of 28 studies covering 15 countries indicated that about 45% of patients with hypertension do not adhere to medications, and this percentage is even higher among patients with uncontrolled hypertension, 83.7% of whom fail to adhere to their drugs (Abegaz et al., 2017). Evidence shows that poor adherence to medications in elderly patients results in higher risks of cardiovascular events, as well as doubles the incidence of hospitalization and death (Burnier et al., 2020). It also leads to an increased risk of recurrent stroke, all-cause mortality, and myocardial infarction after hemorrhagic stroke (Kim et al., 2018). At the same time, various clinical trials demonstrated reduced risks of complications of hypertension in patients with high adherence to antihypertensive drugs, such as alpha-blockers, ACE inhibitors, calcium-channel blockers, and others (Yang et al., 2017). Thus, there is strong evidence that high adherence to antihypertensive drugs results in better patient outcomes.
Search Method
An electronic search was performed using such databases as PubMed and Google Scholar. The search included scholarly articles in English published between 2016 and 2020. It was conducted using the following keywords: antihypertensive drugs, adherence, systematic review, randomized control trial, older adults. Seven studies appeared to be relevant to the question of the effect of adherence and nonadherence to hypertensive medications. These articles included three systematic reviews, three cohort studies, and one quantitative study (see Appendix for the complete initial reference list).
References
Abegaz, T. M., Shehab, A., Gebreyohannes, E. A., Bhagavathula, A. S., & Elnour, A. A. (2017). Nonadherence to antihypertensive drugs. Medicine, 96(4), 1-9.
Burnier, M., Polychronopoulou, E., & Wuerzner, G. (2020). Hypertension and drug adherence in the elderly. Frontiers in Cardiovascular Medicine, 7(49), 1-9.
Corrao, G., Rea, F., Monzio Compagnoni, M., Merlino, L., & Mancia, G. (2017). Protective effects of antihypertensive treatment in patients aged 85 years or older. Journal of Hypertension, 35(7), 1432-1441.
Fryar, C. D., Ostchega, Y., Hales, C.M., Zhang, G., & Kruszon-Moran, D. (2017). Hypertension prevalence and control among adults: United States, 2015-2016. NCHS data brief, no 289. Hyattsville, MD: National Center for Health Statistics.
Kim, J., Bushnell, C. D., Lee, H. S., & Han, S. W. (2018). Effect of adherence to antihypertensive medication on the long-term outcome after hemorrhagic stroke in Korea. Hypertension, 72(2), 391-398.
Peacock, E., & Krousel-Wood, M. (2017). Adherence to antihypertensive therapy. Medical Clinics of North America, 101(1), 229-245.
Tong, X., Chu, E. K., Fang, J., Wall, H. K., Ayala, C. (2016). Nonadherence to antihypertensive medication among hypertensive adults in the United States. The Journal of Clinical Hypertension, 18(9), 892-900.
Yang, Q., Chang, A., Ritchey, M. D., & Loustalot, F. (2017). Antihypertensive medication adherence and risk of cardiovascular disease among older adults: A population‐based cohort study. Journal of the American Heart Association, 6(6), 1-26.