Causes of non-compliance in patients with hypertension

To understand the reasons why patients with hypertension do not follow the medical diet

I surveyed 190 patients with hypertension, and the results are reported as follows:

1. Eligibility conditions:

A. It meets the DIAGNOSTIC criteria of WHO for hypertension and has no cognitive dysfunction.

B. A total of 190 patients were enrolled, including 86 males and 104 females, aged 18-81 years.

C. Educational level: 53 cases were junior middle school, 77 cases were senior high school, and 60 cases were junior college or above;

D. Place of residence: 102 in cities, 88 in towns;

E. 118 cases with duration ≤10 years, > 72 cases at 10 years;

F. Access to health education: 62 cases had received systematic health education, 93 cases had learned some relevant information by reading newspapers and magazines and watching TV, and 35 cases had not received health education or only knew some simple knowledge.

2. Questionnaire survey 

The self-designed questionnaire was used for the survey.The questionnaire consists of two parts. 

• The first part is the general information of the patients, that is, gender, age, education level, and time of illness. Health education and compliance with the medical diet. 
• The second part is the questionnaire about the reasons why hypertensive patients do not follow the medical diet. 

The questionnaire includes 8 items, each item is answered by "yes" and "no". The full-time nursing staff will issue the questionnaire, and the patients will fill in the form independently or with the assistance of their family members under unified guidance. For those who cannot complete the form, the full-time nursing staff can ask each item listed in the questionnaire and fill it out. 190 questionnaires were issued, all of which were effectively recovered.

2. Questionnaire Survey Results
Among 190 patients with hypertension, 17 (8. 9%) followed the medical diet, 173 (91. 1%) did not follow the medical diet. The reasons for non-compliance are shown in the table below.

• Don't know the reasonable diet can prevent, treat high blood pressure ,87  patients, accounting for 50.3 %

• Not knowing that proper diet can eliminate potential risk factors for high blood pressure, 91 patients, accounting for 52.6 %
• They believe that changing diet has little effect on blood pressure and do not pay attention to dietary conditioning.  99 patients, accounting for 57.2 %
• Don't know that obesity is hypertension risk factors,49 patients, accounting for 28.3 %
• Family members can't or cooperate unconditionally diet ,74 patients, accounting for 42.8 %
• Poor eating habits, 118 patients, accounting for 68.2%.
• lack of self-control, 120 patients, accounting for 69.4%.
• Not receiving formal education on hypertensive diet,112 patients, accounting for 64.7%.

3. Analysis of causes of hypertension patients not complying with medical diet

The results showed 

17 (8. 9 %) patients with hypertension could follow the medical diet.

173 (91. 1 %) patients did not follow the medical diet. 

64.7 % of the patients did not receive diet education for hypertension. 50.3% of the patients did not know that a reasonable diet could prevent and treat hypertension, 

52.6% of the patients did not know that improper diet was a potential risk factor for hypertension, 

57.2% of the patients thought that changing diet had little effect on blood pressure and did not pay attention to diet conditioning, 

28.3% of the patients did not know that obesity was a risk factor for hypertension.

The follow reasons are  :

• 1. Factors of the cultural level of patients. Non-knowledge-based elderly patients have few information sources, weak awareness of health care, little demand for health, too much reliance on the medical staff, only require the relief of superficial pain. However, some young and middle-aged people with low education levels have poor acceptance ability and do not attach importance to the role of patients. In addition, the residents to the basic knowledge of diet and nutrition are still at a low level, the lack of important knowledge of basic nutrition and health care needs to cause widespread attention.
• 2. Lifestyle factors of patients. Most elderly patients develop bad habits of smoking, drinking, and a high-salt diet for a long time, which cannot be changed in a short time. Middle-aged and young people because of busywork, pressure, social engagements, and can not very well quit smoking, avoid alcohol, low salt, and low-fat diet, and adhere to long-term medication. At the same time, obesity is also a major cause of hypertension. There are many reasons for obesity, such as genetic factors, lack of exercise, overeating and intemperance. When the condition is stable, patients with hypertension tend to relax their requirements and satisfy their cravings for certain foods and do not control their appetite, which affects the control of blood pressure.
• 3. The patient's family was not involved. The family members of the patients lack knowledge of hypertension, lack of understanding of the disease, and lack of care for the patients, especially for the elderly patients. If the family members have mastered the knowledge of diet, activities, medication and so on, and played the role of cooperation and supervision, the patients are easier to grasp and accept.

4. Improved method

1. Establish a reasonable diet for patients with hypertension

A reasonable diet can promote a healthy life for patients. First of all, we should control the intake of energy, advocate eating complex sugars, such as starch, corn, and eat less glucose and sucrose, which are easy to cause elevated blood lipids and limit the intake of fat for patients. When cooking, choose vegetable oil, can eat more Marine fish, to increase the elasticity of microvascular, prevent vascular rupture, prevent hypertension complications have a certain effect. Eat protein in moderation. A daily protein intake of 1g per kilogram of body weight is recommended for patients with hypertension. Eating fish protein two to three times a week can improve the elasticity and permeability of blood vessels, increase the excrement of urinary sodium, and thus reduce blood pressure. If hypertension is combined with renal insufficiency, protein intake should be limited. Eat foods rich in potassium, calcium and low in sodium, such as potatoes and eggplant. Contain calcium high food: milk, sour milk. Limit salt intake: it should be reduced gradually to <6g a modest reduction in sodium intake can help lower blood pressure. Eat more fresh vegetables and fruits.

            

2. The patients are required to change their unhealthy lifestyle and dietary habits.

The diet diagnosis and treatment of hypertension patients should pay attention to filling calcium and potassium, eating more vegetables and fruits, quitting smoking and drinking alcohol, and drinking water scientifically.

 

3. To improve the participation of patients' family members in the disease control of patients with hypertension, which should be completed jointly by the family members and patients.

Let the family members of the patient understand the knowledge of hypertension, cooperate with the patient to arrange life reasonably, pay attention to the combination of work and rest. Family members are required to regularly measure the patient's blood pressure and keep it close to normal to prevent further damage to the organs. Do not add or discontinue medications at will. Supervise proper rest to eliminate excessive stress. Improve social adaptability, maintain psychological balance, avoid the influence of various adverse stimuli, patients can not wear tights, neckline or tie too tight, will compress the jugular sinus, so that the blood pressure rise. Prevent constipation, hold breath defecate can make abdomen pressure rise, can cause blood pressure to rise sharply, when necessary take purging agent. Proper participation in activities such as walking, walking, cycling and swimming can lower blood pressure. If the patient's blood pressure continues to rise or symptoms such as dizziness, headache, or nausea occur, seek medical attention immediately.

Non-compliance behavior not only affects the control of hypertension, but also affects the quality of life of patients, so prevention is very important. We believe that in the process of treatment, we should grasp the relevant factors of non-compliance behavior, take corresponding measures, through targeted health education, increase patients' knowledge of disease prevention, treatment and life extension, and promote their compliance behavior.

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