Research paper
What do people with hypertension use to reduce blood pressure in addition to conventional medication – Is this related to adherence?

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Abstract

Introduction

Patients with chronic diseases may sometimes prefer to use alternative approaches to improve their health. Such approaches may be used solely or in combination with their conventional western medication. This survey in a primary care setting aimed to evaluate dietary substances used by patients with hypertension and to explore whether there was a relationship with adherence to conventional drug treatment.

Methods

The study group was composed of 465 patients who were registered with the Family Medicine Center in the city center in the period between April 2016 and June 2016. Socio-demographic characteristics of the patients and substances they used in addition to the drugs were recorded.

Results

The dietary substances most commonly preferred were lemon, garlic, yoghourt, and combinations of these. Medication adherence among patients with hypertension was moderate to high with 72.25% of patients using their medications. Patients forgetting to take their antihypertensive medications were more likely to use these substances.

Conclusions

Patients reported high adherence to their use of conventional medication. The most important problem was "forgetting" in low adherent patients and they mainly used lemon, garlic, and yoghourt at times of sudden blood pressure elevations. Physicians should inform the patients who struggle with hypertension about the risk of nonadherence which can result in serious morbidity and possibly mortality.

Introduction

Hypertension is a common disease worldwide which may affect about one-third of the adult population as well as one tenth of children [1], [2], [3], [4], [5]. It can be effectively treated with lifestyle changes and a strong adherence to drug treatment [6]. The World Health Organization (WHO) defines treatment adherence as ‘the level of adherence with recommendations concerning individual behavior, including medication, appointments, diet and lifestyle’ [7]. The reason for the failure of blood pressure control is often non-adherence to drug treatment [8]. Patients using antihypertensive drugs often only continue to use them for a few months and most patients use the drugs irregularly. For about 50% of patients diagnosed with hypertension, within one year they stop using their medication and after 5 years 75% have completely stopped [9].

Alternative approaches tend to be used by people who have lost hope, especially those with chronic illnesses (e.g. diabetes mellitus, hypertension) and for diseases where there is a poor chance of recovery, such as cancer [10], [11], [12], [13], [14]. Such approaches are often regarded as Complementary and Alternative Medicine which is defined by WHO as ‘The sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness’ [15]. Harris et al. in a systematic review of 16 different countries reported that usage of alternative approaches ranges from 9.8% to 76% in the general population [16]. It has also been reported that 62% of Americans used at least one kind of complementary therapy [17].

The types of alternative approaches used may differ between different regions of the world. According to WHO’s Global Atlas of Complementary and Alternative Methods use, there is a widespread use of Herbal/Traditional Medicine all over the world. Acupuncture and Chinese Medicine are more often tried in European countries, Canada and Western Pacific Region than other parts of the world, osteopathy in Western Europe and homeopathy in the whole of Europe [18]. Hijamat (wet cupping) where blood is drawn by vacuum from a small skin incision for therapeutic reasons is an application which was suggested by the prophet Muhammad so it is commonly used by Muslims [19].

The aim of this crossectional survey conducted in a primary care setting was to evaluate whether dietary substances were being used by patients currently being treated for hypertension and to explore their relationship with adherence to conventional drug treatment.

Section snippets

Methods

The Ethics Committee of the Bursa Yuksek Ihtisas Training and Research Hospital approved the study (Approval number: 2011-KAEK-25 2016/06-06). Patients were given information about the study in advance and signed a consent form. It took 10 min (average) for the participants to consider information related to the study.

This study was conducted on 465 hypertensive patients living in a settlement very close to a tertiary hospital who participated voluntarily in a survey at a Family Health Center in

Statistical analysis

An IBM SPSS 20.0 package program was used to evaluate the data. One hundred and thirteen patients whose data were missing were excluded from the study, so data analysis was based on results from 465 participants. Descriptive statistics such as frequency, percentage, arithmetic mean and standard deviation were used to analyze the data. Dependent-t test was used to assess the data related to systolic blood pressure and diastolic blood pressure values ​​measured in the examination room and

Results

The mean age of the participants was 61.02 ± 10.55 years (range: 26–91). Socio-demographic characteristics of the participants are shown in Table 1 and comorbid diseases of the participants are shown in Table 2. Diabetes mellitus was found to be a co existing condition in 31% of patients and cardiovascular disease in 22.6% of patients. 92.7% of the hypertensive patients participating in the study reported that they used their antihypertensive drugs. The most commonly used antihypertensive

Discussion

According to the results, the use of alternative dietary substances used by hypertension patients to improve their blood pressure was 55.7%. In this sample, the most preferred were the use of lemon, garlic, and yoghourt. Adherence to antihypertensive drug use was moderate or good at 72.25%. Patients who forgot to use their medication were more often using alternative dietary substances.

There are many studies on the use of alternative approaches used by patients with hypertension. Efe et al.

Authors

All research done by the authors.

Financial support

No.

Conflict of interest

None.

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