关键词: 高血压, 血压控制率, 单片复方制剂, 服药依从性, 结构方程模型

Abstract: Background: Single-pill combination (SPC) for hypertension is an intensive treatment that can improve a patient’s adherence to medication and antihypertensive efficiency. However, few studies have been conducted on the present status and factors that affect adherence to medication and blood pressure control rate in hypertensive patients in the community, who are taking SPC therapy in China. Objective: The present study aims to determine the medication adherence and blood pressure control rate of community hypertension patients using SPC drugs in Huai’an, Jiangsu Province. Methods: The present cross-sectional study was conducted by performing a questionnaire survey to investigate 387 hypertensive patients who took SPC antihypertensive drugs in Huai’an, Jiangsu Province, from June 2022 to December 2022. Multivariate logistic regression was performed to analyze the factors for blood pressure control, and Pearson’s correlation analysis was conducted to determine the relationship among medication adherence, self-efficacy, and medication satisfaction. A structural equation model was established for medication adherence and blood pressure control rate, with self-efficacy and medication satisfaction, in this population (SEM), in order to determine the path relationships among variables. Results: The blood pressure control rate for the 387 hypertensive patients who took SPC drugs was 32.30%. Furthermore, the proportion of patients who were unmarried/divorced/widowed, and overweight or obese was significantly lower in the blood pressure controlled group, when compared to the blood pressure uncontrolled group (all, P<0.05). The questionnaire survey results revealed that the medication compliance, self-efficacy, and medication satisfaction scores were significantly higher for patients in the blood pressure controlled group, when compared to those in the blood pressure uncontrolled group (6.45 ± 1.10 vs. 6.00 ± 1.50, 32.10 ± 6.65 vs. 30.65 ± 6.66, and 52.45 ± 8.83 vs. 48.27 ± 11.85, respectively; all, P<0.001). Furthermore, the multivariate logistic regression analysis results indicated that overweight or obese (OR = 1.717, 95%CI = 1.058~2.787), medication adherence (OR = 1.461, 95% CI:1.202~1.775), self-efficacy (OR = 1.052, 95%CI = 1.011-1.095), and medication satisfaction (OR = 1.025, 95%CI = 1.000-1.051) were the factors that affected the blood pressure control rate (all, P<0.05). The Pearson’s correlation analysis results revealed a positive correlation among treatment adherence, self-efficacy, and medication satisfaction (r-values = 0.294, 0.226 and 0.280, respectively; all, P<0.05). The SEM results revealed that both self-efficacy and medication satisfaction were positively correlated to adherence (path coefficient = 0.29 and 0.13; both, P<0.05), and that adherence was positively correlated to the blood pressure control rate (path coefficient = 0.15, P<0.05). Conclusion: The blood pressure control rate for community hypertensive patients who take SPC drugs remains low. Factors, such as overweight or obese, medication adherence, self-efficacy and medication satisfaction, can influence the blood pressure control rate. Improving the self-efficacy and medication satisfaction of community hypertensive patients who take SPC drugs can effectively improve the medication adherence of patients, and in turn, improve the blood pressure control rate.

Key words: Hypertension, Blood pressure control rate, Single-pill combination, Medication compliance, Structural equation modeling