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August 9, 2011PLoS ONEOpen Access

The Influence of Cognition, Anxiety and Psychiatric Disorders over Treatment Adherence in Uncontrolled Hypertensive Patients

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Key result

Unsatisfactory MMSE scores linked to ~5.8-fold higher risk of antihypertensive non-adherence.

  • RR 5.8
  • 95% CI 1.6-20.8
  • P=0.007
  • n=56

Why the study?

Does an unsatisfactory score in the Mini-mental increase the risk of non-adherence to drug treatment in adult patients with uncontrolled hypertension?

Population

56 adult patients with uncontrolled hypertension who participated in all meetings of a pharmaceutical…

Comparison

Unsatisfactory score in the Mini Mental State… vs Normal score in the Mini Mental State Examination

Design

Cohort

Authors

UJU. JacobsMCMauro S. De CastroFFFlávio Danni Fuchs

Discussion

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Overview

May flag adherence risk via cognitive screening in hypertension; hypothesis-generating and should not yet change practice.

Key Points

  • To evaluate the associations between cognitive function, anxiety, and psychiatric disorders and pharmacological treatment adherence in adults with uncontrolled hypertension.
  • Assessed 56 adult patients with uncontrolled hypertension participating in a pharmaceutical care randomized clinical trial.
  • Evaluated cognition using the Mini-Mental State Examination, memory via span and narrative tests, and anxiety/psychiatric disorders using STAI and SRQ.
  • Classified medication adherence objectively by measuring plasma levels of hydrochlorothiazide.
  • All non-adherent patients (12/12, 100%) and 79.5% of adherent patients (35/44) demonstrated at least one altered memory test score (P = 0.180).
  • Patients with unsatisfactory Mini-Mental State Examination scores had a significantly elevated risk of non-adherence compared to those with normal scores (RR = 5.8, 95% CI: 1.6–20.8, P = 0.007).
  • Scores assessing anxiety and general psychiatric disorders were not significantly associated with pharmacological adherence.

Study Design

Type

Cohort (n=56)

Multicenter

No

Structured PICO

Does an unsatisfactory score in the Mini-mental increase the risk of non-adherence to drug treatment in adult patients with uncontrolled hypertension?

P
Population
56 adult patients with uncontrolled hypertension treated with hydrochlorothiazide, followed for 6 months to assess the association between cognitive function and treatment adherence.
E
Exposure
Unsatisfactory score in the Mini Mental State Examination (Mini-mental)
C
Comparator
Normal score in the Mini Mental State Examination
O
Outcome
Adherence to drug treatment, measured by identification of plasma levels of hydrochlorothiazidesurrogate

Main Result

Relative Risk: 5.8 (95% CI 1.6–20.8)

p-value: p=0.007

Cognitive deficit is strongly associated with non-adherence to antihypertensive therapy, suggesting cognitive screening could help identify patients at risk for poor adherence.

Limitations

  • Small sample size
  • Selection criteria requiring understanding of consent diminished the probability of enrolling participants with relevant psychiatric disorders or high anxiety
  • Possible beta error for absent associations

Cite This Study

Jacobs et al. (2011) conducted a cohort in Uncontrolled hypertension (n=56). Cognitive deficit (unsatisfactory Mini-Mental score) vs. Normal cognitive function (normal Mini-Mental score) was evaluated on Non-adherence to pharmacological treatment (absence of hydrochlorothiazide in plasma) (RR 5.8, 95% CI 1.6-20.8, p=0.007). Patients with an unsatisfactory score on the Mini-Mental State Examination had a 5.8-fold higher risk of non-adherence to antihypertensive treatment compared to those with a normal score.

synapsesocial.com/papers/6aa5ff1ebc2c7db7488e4fdchttps://doi.org/10.1371/journal.pone.0022925
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Symptoms of depression and anxiety and adherence to antihypertensive medication2012 · 144 citations
  2. 2Relation between cognitive impairment and treatment adherence in elderly hypertensive patients2018 · 75 citations
  3. 3Association between cognitive function and self‐reported antihypertensive medication adherence among middle‐aged and older hypertensive women2021 · 9 citations
  4. 4Depression, Anxiety, Stress, and Their Association with Hypertension Treatment Adherence in the Elderly2025
  5. 5Drug adherence and psychological factors in patients with apparently treatment‐resistant hypertension: Yes but which ones?2022 · 8 citations