Sathe NA (VA New York Harbor Healthcare System), Ulmer M
(VA New York Harbor Healthcare System), Robinaugh D , Friedberg JP
(VA New York Harbor Healthcare System, NYU School of Medicine), Mundy L
(VA New York Harbor Healthcare System), Natarajan S
(VA New York Harbor Healthcare System, NYU School of Medicine)
Improving health-related quality of life (HRQOL) is important in treating chronic conditions, as treatment is often lifelong. Hypertension is a common chronic condition treated through pharmacologic therapy, and non-pharmacologic methods such as aerobic exercise, dietary changes, and stress reduction. Adherence to treatment requires significant behavioral changes that may have physical and mental effects. We aimed to elucidate which treatment factors affect HRQOL in hypertensive patients.
General HRQOL was measured using the EuroQol. We also measured physical and mental components of HRQOL with Mental and Physical Component Summary (MCS and PCS) measures from the SF-36V. Separate questionnaires assessed diet, medication, exercise, and perceived stress (PS). We used robust regressions to analyze how behaviors aimed at controlling hypertension related to general HRQOL, MCS, and PCS, controlling for BMI and age.
The sample included 420 adults with uncontrolled hypertension. Each additional anti-hypertensive pill/day was associated with 0.75% lower EuroQol score (p < .005), while each unit increase in PS was associated with 0.9% lower EuroQol score (p < .0001). In contrast, older age (0.14%, p < .05) and each additional hour of exercise/week (0.3%, p < .002) were associated with higher EuroQol scores. Similarly, in examining PCS, each additional pill/day and unit increase in PCS were associated with lower PCS of 0.67 (p < .01) and 0.43 (p < .0001) points, respectively; each additional hour of exercise/week correlated positively with PCS (0.24 points, p < .005). Additionally, each mm Hg increase in diastolic blood pressure was positively associated with PCS (0.11 points, p < .05), and BMI was negatively correlated (-0.47 points, p < .0001); age was no longer significant. For MCS, age, BMI, and BP were insignificant. Each unit increase in PS (-1.13 points, p < .0001) and each additional pill/day (-0.49 points, p < .05) were associated lower MCS.
The findings offer insight on aspects of treatment and behavior that relate to each measure of HRQOL. Traditional clinical benchmarks like BMI, blood pressure, and age may have limited influence on HRQOL, while treatments requiring behavioral changes, like increasing aerobic exercise, reducing the number of pills taken, and reducing stress, may have greater impact on HRQOL.
Refining behavioral treatment may offer clinicians methods to improve HRQL in patients with hypertension and other chronic illnesses.