Association of mental health and medication adherence with blood pressure control in primary care patients with hypertension: a cross-sectional study

Background
Uncontrolled blood pressure is associated with significant cardiovascular mortality and morbidity, and its management is often complicated by poor medication adherence and mental health disorders.

Objectives
This study aimed to evaluate the association of blood pressure control with psychological disorders and medication adherence among primary care patients with hypertension.

Material and methods
A cross-sectional study that included 478 hypertensive patients from five urban primary healthcare settings in Port Said governorate, Egypt. Socio-economic and clinical characteristics were collected, and all participants were screened for depression, generalised anxiety disorder, perceived stress and medication adherence using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Scale-7 (GAD-7), 10-item Perceived Stress Scale (PSS-10) and General Medication Adherence Scale (GMAS). Hierarchical logistic regression analysis was used to assess predictors of blood pressure control. P-values < 0.05 were considered significant.

Results
40.17% had uncontrolled blood pressure, and 44.8% had suboptimal adherence to antihypertensive medications. The prevalence estimates of depressive and anxiety symptoms were 33.7% and 28.9%, respectively. The mean PSS-10 score was 18.50 ± 6.34. Predictors of controlled blood pressure included optimal medication adherence (OR 2.518, p < 0.001), performing physical activity (OR 2.0, p = 0.004), having a higher number of tar-get organ damage (OR 1.514, p = 0.017), using combined antihypertensive medications, (OR 1.392, p = 0.006), having lower anxiety symptoms (OR 0.453, p = 0.013) and being younger (OR 0.970, p = 0.047).

Conclusions
Symptoms of anxiety, not depression, and suboptimal medication adherence were associated with uncontrolled blood pressure. A multidisciplinary team approach should be utilised in the management of hypertensive patients to address individual patients’ biopsychosocial factors.