Drug adherence and psychosocial characteristics of patients presenting with hypertensive urgency at the emergency department

Abstract

Objective: To identify potentially targetable psychosocial factors associated with nonadherence to prescribed antihypertensive medications in patients presenting with hypertensive urgencies at an emergency department. Methods: This prospective study included patients treated with antihypertensive drugs who presented with hypertensive urgencies (SBP 180 mmHg and/or DBP 110 mmHg) at the emergency department of a tertiary referral clinic between April 2018 and April 2019. Health literacy was assessed using the Newest Vital Sign test. The Hospital Anxiety and Depression Scale (HADS) was used to quantify symptoms of anxiety and depression. Patients were classified nonadherent if less than 80% of the prescribed antihypertensive drugs were detectable in urine or plasma using liquid chromatography-high-resolution mass spectrometry. Results: A total of 104 patients (62% women) presenting with hypertensive urgencies with a median SBP of 200 mmHg (IQR 190–212) and DBP of 97.5 mmHg (IQR 87–104) were included. Twenty-five patients (24%) were nonadherent to their antihypertensive medication. Nonadherent patients were more often men (66 versus 23%, P ¼ 0.039), prescribed higher numbers of antihypertensive drugs (median 3, IQR 3–4 versus 2, IQR 1–3; P < 0.001), and more often treated with calcium channel blockers (76 versus 25%; P < 0.001) and/or diuretics (64 versus 40%; P ¼ 0.030). There was no difference in health literacy (P ¼ 0.904) or the scores on the HADS subscales for depression (P ¼ 0.319) and anxiety (P ¼ 0.529) between adherent and nonadherent patients. Conclusion: Male sex, higher numbers of antihypertensive drugs, and treatment with diuretics and/or calcium channel blockers were associated with nonadherence. We did not identify a specific psychosocial characteristic associated with nonadherence.