Evaluación del control de la presión arterial y la adherencia terapéutica en hipertensos seguidos en el programa de salud cardiovascular (PSCV): asociación con características clínicas, socioeconómicas y psicosociales / Assessment of blood pressure control and adherence in hypertensive patients followed in the cardiovascular health program (CHP): association with clinical, socioeconomic and psychosocial characteristics

RESUMEN

Antecedentes Inadecuado control de presión arterial (PA) y baja adherencia a tratamiento farmacológico (Rx) en hipertensos son problemas persistentes globales y en Chile. Factores socioeconómicos y psicosociales han sido frecuentemente mencionados, pero escasamente en Chile. Objetivo: Evaluar control de la PA y adherencia a Rx en hipertensos seguidos en el Programa de Salud Cardiovascular (PSCV) y su asociación con factores clínicos, socioeconómicos y psicosociales. Métodos: Muestra randomizada de 1.794 hipertensos seguidos por 1 año en PSCV en Región Metropolitana. Se evaluó la asociación de edad, sexo, educación, ingreso familiar, Rx, diabetes, obesidad, tabaquismo, consumo problemático de alcohol y actividad física con el control de la PA (<140/90 mmHg) y adherencia. Además, en 600 pacientes, se evaluó la asociación con estrés emocional/depre-sión, relación médico-paciente y apoyo social. Se obtuvieron Odds Ratio (OR) mediante análisis de regresión logística multivariante. Resultados: PA controlada se comprobó en 56,5% y adherencia en 37,3% sin documentarse asociación entre ambas (OR 1,01 [IC 95% 0,78 - 1,32]). Factores asociados a PA no controlada y no adherencia fueron edad, bajo ingreso familiar, inadecuada relación medico-paciente y alto nivel de estrés emocio-nal/depresión. Rx múltiple y obesidad se asociaron a PA no controlada; sexo masculino y baja educación a no adherencia. Conclusiones: El control de la PA (56,5%) fue similar a resultados de países desarrollados y supera ampliamente cifras de la Encuesta Nacional de Salud 2010 (16,9%). Estos resultados y la falta de asociación entre el control de la PA y la adherencia, sugieren la favorable influencia de otros factores posiblemente relacionados al PSCV.

ABSTRACT

Background: Unsatisfactory blood pressure (BP) control and low adherence to antihypertensive pharmacotherapy (Rx) in hypertensive populations are persistent problems worldwide and also in Chile. Socioeconomic and psychosocial factors have been frequently mentioned, but with limited contributions from Chile. Objective: The assessment of BP control and adherence to Rx in hypertensive patients followed in the Cardiovascular Health Program (CVHP) and to determine their association with clinical, socioeconomic and psychosocial characteristics. Methods: A randomized sample of 1,794 hypertensive patients followed for 1 year under the CVHP in Metropolitan Region. Association of BP control (<140/90 mmHg) and adherence with age, gender, education, income, Rx, diabetes, obesity, smoking, alcohol use problem and physical activity were analyzed. In a subgroup of 600 patients additional analysis included the association with emotional stress and depression, patient-physician relation and social support. Odds Ratio (OR) were obtained by multivariate logistic regression. Results: BP control was achieved in 56.5% and adherence in 37.3%. No association was found between them (OR 1.01 [CI 95% 0.78-1.32]). Uncontrolled BP and no adherence were associated to advanced age, low income, poor patient-physician relation and high stress-depression. Obesity and multiple Rx were associated to uncontrolled BP. Male gender and low education, were associated to no adherence. Conclusions: BP control (56.5%) was similar to results obtained in developed countries and is strikingly higher than the results reported in the 2010 Chilean National Health Survey (16.9%). These results and the lack of association between BP control and adherence suggest the favorable influence of unaccounted factors, possibly related to the CVHP.