Uncontrolled blood pressure (BP) has been associated with increased risk of cardiovascular events including heart failure. This study aimed to explore the factors associated with poor BP control among patients with heart failure at two major outpatient cardiology clinics in Jordan. Variables including socio-demographics, biomedical variables, in addition to disease and medication characteristics were collected using medical records and custom-designed questionnaire. The validated 4-item Medication Adherence Scale was used to assess medication adherence. Binary logistic regression analysis was conducted to explore the significant and independent predictors of poor BP control. Regression analysis results revealed that being not satisfied with the prescribed medication (OR = 2.882; 95% CI: 1.458–5.695; P < 0.01), reporting moderate medication adherence (OR = 0.203; 95% CI: 22 0.048–0.863; P < 0.05), not receiving digoxin (OR = 3.423; 95% CI: 1.346–8.707; P < 0.05), and not receiving aldosterone antagonist (OR = 2.044; 95% CI: 1.038-4.025; P < 0.05) were associated with poor BP control. Future interventions should focus on increasing medication satisfaction and enhancing medication adherence, in order to improve BP control among patients with heart failure.
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The data generated and/or analyzed during the present study are available from the corresponding author on reasonable request.
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, et al. ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128:e240–327.
GBD. Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1789–858.
World Health Organization. Noncommunicable diseases country profiles 2018. 2018. https://apps.who.int/iris/handle/10665/274512.
Heidenreich PA, Albert NM, Allen LA, Bluemke DA, Butler J, Fonarow GC, et al. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail. 2013;6:606–19.
Stevens G, Mascarenhas M, Mathers C. Global health risks: progress and challenges. Bull World Health Organ. 2009;87:646.
Levy D, Larson MG, Vasan RS, Kannel WB, Ho KKL. The Progression From Hypertension to Congestive Heart Failure. JAMA. 1996;275:1557–62.
Wolf-Maier K, Cooper RS, Banegas JR, Giampaoli S, Hense HW, Joffres M, et al. Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States. JAMA. 2003;289:2363–9.
Lloyd-Jones DM, Larson MG, Leip EP, Beiser A, D’Agostino RB, Kannel WB, et al. Lifetime risk for developing congestive heart failure: the Framingham Heart Study. Circulation. 2002;106:3068–72.
Whelton PK, He J. Blood pressure reduction. In: Hennekens CH, Buring JE, Manson JE, Ridker PM, editors. Clinical trials in cardiovascular disease. A companion to Braunwald’s heart disease. Philadelphia: WB Saunders; 1999:341–359.
Neal B, MacMahon S, Chapman N, Blood Pressure Lowering Treatment Trialists’ Collaboration. Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Lancet. 2000;356:1955–64.
Ong KL, Cheung BM, Man YB, Lau CP, Lam KS. Prevalence, awareness, treatment, and control of hypertension among United States adults 1999-2004. Hypertension. 2007;49:69–75.
Cuspidi C, Valerio C, Negri F, Sala C, Masaidi M, Giudici V, et al. Prevalence and correlates of multiple organ damage in referred treated hypertensives: data from the ETODH study. J Hum Hypertens. 2008;22:801–3.
Whitworth JA. World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens. 2003;21:1983–92. 2003
Burt VL, Whelton P, Roccella EJ, Brown C, Cutler JA, Higgins M, et al. Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988-1991. Hypertension. 1995;25:305–13.
Hill MN, Bone LR, Kim MT, Miller DJ, Dennison CR, Levine DM. Barriers to hypertension care and control in young urban black men. Am J Hypertens. 1999;12:951–8.
Prugger C, Keil U, Wellmann J, de Bacquer D, de Backer G, Ambrosio GB, et al. Blood pressure control and knowledge of target blood pressure in coronary patients across Europe: results from the EUROASPIRE III survey. J Hypertens. 2011;29:1641–8.
Ham OK, Yang SJ. Lifestyle factors associated with blood pressure control among those taking antihypertensive medication. Asia Pac J Public Health. 2011;23:485–95.
Gaggin HK, Januzzi JL. Cardiac biomarkers and heart failure. American College of Cardiology; 2015. https://www.acc.org/%2Flatest-in-cardiology%2Farticles%2F2015%2F02%2F09%2F13%2F00%2Fcardiac-biomarkers-and-heart-failure.
Flack JM, Calhoun D, Schiffrin EL. The new ACC/AHA hypertension guidelines for the prevention, detection, evaluation, and management of high blood pressure in adults. Am J Hypertens. 2017;31:133–5.
Chapter 2. Measurement and clinical evaluation of blood pressure. Hypertens Res. 2009;32:11–23.
Elhenawy YI, Abdelmageed RI, Zaafar DK, Abdelaziz AW. Adherence to insulin therapy among children with type 1 diabetes: reliability and validity of the Arabic version of the 4-item Morisky Medication Adherence Scale. Patient Prefer Adherence. 2022;16:1415–21.
Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24:67–74.
Lee HSC, Lee HSC, Lee HSC, Lee HSC. Abstract P157: challenging blood pressure control in heart failure patients and related factors. Hypertension. 2020;76:AP157–AP.
Okaka EI, Ojeh-Oziegbe OE, Unuigbe EI. Factors associated with blood pressure control in predialysis chronic kidney disease patients: Short-term experience from a single center in Southern Nigeria. Niger J Clin Pr. 2017;20:537–41.
Mbwete GW, Kilonzo KG, Shao ER, Chamba NG. Suboptimal blood pressure control, associated factors, and choice of antihypertensive drugs among type 2 diabetic patients at KCMC, Tanzania. J Diabetes Res. 2020;2020:4376251.
Xu D, Chen W, Li X, Zhang Y, Li X, Lei H, et al. Factors associated with blood pressure control in hypertensive patients with coronary heart disease: evidence from the Chinese cholesterol education program. PLOS One. 2013;8:e63135.
Lip GY, Skjøth F, Overvad K, Rasmussen LH, Larsen TB. Blood pressure and prognosis in patients with incident heart failure: the Diet, Cancer and Health (DCH) cohort study. Clin Res Cardiol. 2015;104:1088–96.
Raphael CE, Whinnett ZI, Davies JE, Fontana M, Ferenczi EA, Manisty CH, et al. Quantifying the paradoxical effect of higher systolic blood pressure on mortality in chronic heart failure. Heart. 2009;95:56–62.
Schmid FA, Schlager O, Keller P, Seifert B, Huang R, Fröhlich GM, et al. Prognostic value of long‐term blood pressure changes in patients with chronic heart failure. Eur J Heart Fail. 2017;19:837–42.
Hoffmann TC, Lewis J, Maher CG. Shared decision making should be an integral part of physiotherapy practice. Physiotherapy. 2020;107:43–9.
DiMatteo MR. Variations in patients’ adherence to medical recommendations: a quantitative review of 50 years of research. Med Care. 2004;42:200–9.
Hamarneh D, Alkhatib N, Denhaerynck K, Vancayzeele S, Brié H, MacDonald K, et al. Gender-stratified hierarchical modeling of patient and physician determinants of antihypertensive treatment outcomes: pooled analysis of seven prospective real-world studies with 17,044 patients. Curr Med Res Opin. 2021;37:367–75.
Egede LE, Gebregziabher M, Echols C, Lynch CP. Longitudinal effects of medication nonadherence on glycemic control. Ann Pharmacother. 2014;48:562–70.
Murphy AC, Proeschal A, Brightling CE, Wardlaw AJ, Pavord I, Bradding P, et al. The relationship between clinical outcomes and medication adherence in difficult-to-control asthma. Thorax. 2012;67:751–3.
Fitzgerald AA, Powers JD, Ho PM, Maddox TM, Peterson PN, Allen LA, et al. Impact of medication nonadherence on hospitalizations and mortality in heart failure. J Car Fail. 2011;17:664–9.
Ambrosius WT, Sink KM, Foy CG, Berlowitz DR, Cheung AK, Cushman WC, et al. The design and rationale of a multicenter clinical trial comparing two strategies for control of systolic blood pressure: the Systolic Blood Pressure Intervention Trial (SPRINT). Clin Trials. 2014;11:532–46.
Haley WE, Gilbert ON, Riley RF, Newman JC, Roumie CL, Whittle J, et al. The association between self- reported medication adherence scores and systolic blood pressure control: a SPRINT baseline data study. J Am Soc Hypertens. 2016;10:857–64.
Centers for Disease Control and Prevention (CDC). Vital signs: awareness and treatment of uncontrolled hypertension among adults-United States, 2003-2010. MMWR Morb Mortal Wkly Rep. 2012;61:703–9.
About digoxin. 2020. https://www.nhs.uk/medicines/digoxin/about-digoxin/.
Kirch C, Grossmann M, Fischer S, Neumeister V, Kirch W. Effect of digoxin on circadian blood pressure values in patients with congestive heart failure. Eur J Clin Invest. 2000;30:285–9.
Grossmann M, Jamieson M, Kirch W. Effects of digoxin and digitoxin on circadian blood pressure profile in healthy volunteers. Eur J Clin Invest. 1998;28:701–6.
How do aldosterone antagonists work? 2022. https://my.clevelandclinic.org/health/treatments/22917-aldosterone-antagonists.
List of Aldosterone receptor antagonists. 2022. https://www.drugs.com/drug-class/aldosterone-receptor-antagonists.html.
Liu G, Zheng XX, Xu YL, Lu J, Hui RT, Huang XH. Effect of aldosterone antagonists on blood pressure in patients with resistant hypertension: a meta-analysis. J Hum Hypertens. 2015;29:159–66.
Marcy TR, Ripley TL. Aldosterone antagonists in the treatment of heart failure. Am J Health Syst Pharm. 2006;63:49–58.
The authors declare no competing interests.
Ethical approval was obtained from the Institutional Review Board (IRB) of KAUH at Jordan University of Science and Technology (Ref. # 32/141/2021) on July 1st, 2021.
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Jarab, A.S., Hamam, H.W., Al-Qerem, W.A. et al. Blood pressure control and its associated factors among patients with heart failure in Jordan. J Hum Hypertens (2023). https://doi.org/10.1038/s41371-023-00807-z