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Journal of Vascular Nursing 41 (2023) 81–88
Contents lists available at ScienceDirect
Journal of Vascular Nursing
j o u r n a l h o m e p a g e: w w w . s c i e n c e d i r e c t . c o m / j o u r n a l / j o u r n a l - o f - v a s c u l a r - n u r s i n g
The relationship between hypertensive patients’ satisfaction with
hypertension care and their antihypertensive medication adherence
Gönül Kara Söylemez
a , ∗, Rabia Hacıhasano
˘
glu A ¸s ılar, PhD
b
a
Department of Surgical Diseases Nursing, Faculty of Health Sciences, Hatay Mustafa Kemal University, Hatay, Türkiye
b
Department of Public Health Nursing, Faculty of Health Sciences, Yalova University, Ya lova, Türkiye
Background: Hypertension is a common chronic disease that causes serious complications. Therefore, its
management is critical. Many factors affect the management of hypertension, such as care satisfaction
and antihypertensive medication adherence.
Aim: This study investigated the relationship between hypertensive patients’ satisfaction with hyperten-
sion care and their antihypertensive medication adherence.
Materials and Methods: This descriptive-correlational study was conducted between October 2016 and
February 2017. A total of 407 patients meeting the inclusion criteria were enrolled in the study. The data
were collected using the descriptive questionnaire, the Patient Assessment of Chronic Illness Care (PACIC)
to determine care satisfaction, and the Medication Adherence Self-Efficacy Scale-Short Form (MASES-SF).
Blood pressure, body height, and weight were also measured.
Results: Patients had a low mean PACIC score and a good mean score on the MASES-SF. Their PACI C scores
differed by age, gender, number of daily antihypertensive medications, time since last examination due
to hypertension, getting information about hypertension, and blood pressure control status ( p < 0.05).
Their MASES-SF scores differed by perceived economic status, time since hypertension diagnosis, du-
ration of antihypertensive medication use, time since last examination due to hypertension, and blood
pressure control status. In addition, there was a weak positive and significant correlation between PACIC
and MASES-SF scores ( p < 0.001).
Conclusions: Patients have low satisfaction with hypertension care and good antihypertensive medication
adherence. As satisfaction with hypertension care increases, adherence to antihypertensive medication
increases.
© 2023 Society for Vascular Nursing, Inc. Published by Elsevier Inc. All rights reserved.
Introduction
Hypertension is a common chronic disease that causes serious
complications. It is defined as increased arterial blood pressure.
1
It is a risk factor for the development of cerebrovascular, cardio-
vascular, and renal diseases and the leading cause of preventable
deaths.
2 , 3 It is estimated that one-third of the world’s population
will have hypertension by 2025.
4 According to the hypertension
prevalence study (PatenT2) conducted in Türkiye (2012), the preva-
lence of hypertension is 30.3%.
5
The fact that hypertension is com-
mon worldwide, damages, vital organs, and causes serious health
problems highlights the importance of optimal hypertension man-
agement.
1
∗Corresponding author.
E-mail addresses: gonulsoylemez11@gmail.com , gonul.karasoylemez@mku.edu.tr
(G.K. Söylemez).
Chronic disease management, including hypertension, is based
on the early detection of risk factors and health conditions, a
combination of pharmacological and psychological interventions,
regular follow-up, and long-term adherence to treatment.
6 Good
chronic disease management reduces the number of emergency
admissions and hospitalizations and helps improve physical and
mental function.
7
There are several models for chronic disease management, and
the most popular one is the Chronic Care Model (CCM). In this
model, patients are diagnosed regularly, and their active partici-
pation in treatment is ensured. They are also given detailed in-
formation, and their self-management is encouraged. In this way,
effective management of chronic diseases, an increase in quality
of care, a decrease in costs, and an increase in patient satisfaction
are ensured.
8 The CCM is used in diseases such as diabetes, car-
diovascular system diseases, and respiratory system diseases, and
it reduces the number of emergency/hospital admissions in these
disease groups while increasing the quality of life and patient sat-
https://doi.org/10.1016/j.jvn.2023.05.002
1062-0303/© 2023 Society for Vascular Nursing, Inc. Published by Elsevier Inc. All rights reserved.
82 G.K. Söylemez and R.H. A ¸s ılar / Journal of Vasc ular Nursing 41 (2023) 81 –88
isfaction.
9 , 10 Although studies with only hypertensive patients are
limited, two studies have reported that the CCM is effective in re-
ducing blood pressure and improving patient health.
11 , 12 Various
tools have been developed to evaluate the effects of CCM on care
and treatment outcomes. One of these tools is the Patient Assess-
ment of Care for Chronic Diseases (PACIC), which evaluates the sat-
isfaction of patients with the care they receive.
13
High satisfaction with hypertension care is an important com-
ponent of hypertension management. Previous studies have found
differing levels of satisfaction with hypertensive care,
11 , 14 , 15 one
study reported that there is a significant relationship between high
satisfaction with hypertension care and blood pressure control.
11
However, in other studies, it was reported that patients had a mod-
erate level of satisfaction with hypertension care.
14 , 15 Therefore,
the satisfaction and needs of patients with hypertension should be
determined, and care should be planned in this direction.
Antihypertensive medication adherence is another significant
component of hypertension management. Antihypertensive medi-
cation non-adherence or poor antihypertensive medication adher-
ence hinders hypertension management and poses a risk for com-
plications. It also increases the number of hospital admissions and
care costs.
16 It is clinically important to recognize and understand
medication non-adherence because it leads to inadequate blood
pressure control and adverse effects.
17 One study reported that
78.7% of patients were not adherent to their antihypertensive med-
ications, and their blood pressure was not under control.
18
Another
study found that patients with good antihypertensive medication
adherence had their blood pressure under control.
19
According to the International Council of Nurses (ICN), nurses
are responsible for supporting patients with chronic diseases, in-
cluding hypertension, to better manage their condition.
20 Nurses
are there not to solve all the health problems of patients with
chronic diseases but to support them in disease management.
7
Therefore, if patients evaluate the care they receive, nurses can
use that information to revise their care plans according to the pa-
tient’s needs and keep their hypertension under control.
14
To our knowledge, no study has evaluated the association be-
tween hypertension satisfaction and adherence to antihypertensive
medication; nevertheless, this relationship has been studied using
studies on other chronic conditions. One study with patients with
different chronic conditions found that those who were satisfied
with their care had improved medication adherence.
10 Therefore,
the relationship between care satisfaction and medication adher-
ence should be further investigated in hypertension patients.
The aim of this study was to investigate the relationship be-
tween patients’ satisfaction with hypertension care and their anti-
hypertensive medication adherence.
Study questions
(1) What is the level of satisfaction with hypertension care and an-
tihypertensive medication adherence among patients?
(2) Is there a correlation between satisfaction with hypertension
care and antihypertensive medication adherence?
(3) What descriptive characteristics of patients are related to their
satisfaction with hypertension care?
(4) What descriptive characteristics of patients are related to their
antihypertensive medication adherence?
Materials and methods
Study design and sample
This descriptive-correlational study was conducted between Oc-
tober 2016 and February 2017 at five family health centers (FHC)
in Erzincan, a city in eastern Türkiye. The study population con-
sisted of all patients with hypertension aged 18 or over who were
admitted to the FHCs for any reason. No sampling was conducted.
The sample included 407 patients who met the inclusion criteria.
The inclusion criteria were (1) being 18 or over and (2) being diag-
nosed with hypertension at least a year ago and starting an antihy-
pertensive medication. The exclusion criteria were (1) having phys-
ical (hearing, speech impairment), neurological, and mental condi-
tions (psychotic disorder) that might affect data collection, (2) hav-
ing a mental disability, (3) being cancer, and (4) being pregnant.
Data collection instruments
The data were collected using a descriptive questionnaire, the
Patient Assessment of Care for Chronic Diseases (PACIC), and the
Medication Adherence Self-Efficacy Scale-Short Form (MASES-SF).
Blood pressure, body height, and body weight were also measured.
Descriptive questionnaire
The descriptive questionnaire consisted of 16 questions inquir-
ing about age, gender, marital status, education level, employment
status, perceived economic status, comorbidity, time since hyper-
tension diagnosis, duration of antihypertensive medication use, the
number of daily antihypertensive medications, admission to the
emergency department for hypertension in the past six months,
time since last examination due to hypertension, receiving social
support, getting information about hypertension, body mass index
(BMI), and blood pressure control.
The patient assessment of care for chronic diseases (PACIC)
The Patient Assessment of Care for Chronic Diseases (PACIC)
was developed by Glaskow et al.
9 and adapted to Turkish by
˙
Incirku ¸s and Nahcivan.
13 Based on the CCM, PACIC focuses on
patient-provider interaction involving self-management support. It
consists of 20 items and five sub-scales: (1) patient activation,
(2) decision support, (3) goal setting, (4) problem-solving, and (5)
follow-up/coordination.
9 , 13 The items are scored on a five-point
Likert-type scale (1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Usually,
5 = Always). The highest and lowest scores to be obtained are 5
and 1. Higher scores indicate higher satisfaction with care and bet-
ter chronic disease management. Incirku ¸s and Nahcivan
13 reported
Cronbach’s alpha for the PACIC to be 0.91. They also found that
the Cronbach alpha for the PACIC "patient involvement", "decision
making", "goal setting", "problem-solving", and "follow-up and co-
ordination" subscales was 0.72, 0.72, 0.71, 0.75, and 0.79, respec-
tively. In this study, the PACIC Cronbach alpha was found to be
0.82. The PACIC “patient participation,” “decision making,” “goal
setting,” “problem-solving,” and “follow-up and coordination” sub-
scales had a Cronbach’s alpha of 0.49, 0.55, 0.51, 0.46, and 0.59,
respectively.
The medication adherence self-efficacy scale-short form (MASES-SF)
The Medication Adherence Self-Efficacy Scale-Short Form
(MASES-SF) was developed by Ogedegbe et al.,
21 revised by Fer-
nandez et al.,
22 and adapted to Turkish by Hacıhasano
˘
glu et al.
23
The MASES-SF is used to assess the level of antihypertensive med-
ication adherence self-efficacy/confidence in patients. The scale
consists of 13 items scored on a scale of 1 to 4. The total score
ranges from 13 to 52. Higher scores indicate better antihyperten-
sive medication adherence. The Cronbach’s alpha is 0.93
23 for the
original scale and 0.98 for this study.
G.K. Söylemez and R.H. A ¸s ılar / Journal of Vasc ular Nursing 41 (2023) 81 –88 83
Data collection
The data were collected by the first author in the waiting rooms
of the FHCs three to four days a week, in a certain order. The data
were collected through face-to-face interviews using a descriptive
questionnaire, the PACIC, and the MASES-SF. Blood pressure, body
height, and body weight were also measured. Data collection lasted
15–25 min.
Arterial blood pressure measurement
After the patients rested for 10–15 min, their blood pressure
was measured on the right arm in the sitting position. Their blood
pressure was measured again 5–10 min after the first measure-
ment. The average of the two measurements was recorded. The pa-
tients were told not to smoke and consume caffeine (coffee, coke,
etc.) 30 min before measurement. The measurements were per-
formed using a sphygmomanometer (ERKA Perfect Aneroid Model,
Series No: 16026759). Systolic blood pressure (SBP) and diastolic
blood pressure (DBP) were measured by listening to the Korotkoff
sounds. Blood pressure control was defined as SBP < 140 mmHg
and DBP < 90 mmHg.
16
Body height
The patients stood in an upright position on a flat surface with
their heads, shoulders, hips, and heels touching a flat wall. Height
was measured in centimeters using a tape measure.
Body weight
The body weight was measured while standing barefoot and
with their coats and jackets removed on a standard scale placed
flat on a hard surface and recorded in kilograms (kg).
Body mass index (BMI)
The BMIs were classified according to the ranges recommended
by the World Health Organization (WHO): Underweight = < 18.5 ;
normal weight = 18.5-24.9; overweight = 25-29.9; and obese = 30
or more.
24
Data analysis
The data were analyzed using the Statistical Package for Social
Science for Windows (SPSS, v.17). Numbers, percentages, the mean,
and the standard deviation were used for descriptive data. Kurto-
sis and Skewness coefficients were used for normality testing.
25
For normally distributed data, an analysis of variance (ANOVA) was
used for more than two groups. An independent t-test was used
for two independent groups. LSD was used as a further analysis to
determine the difference. For non-normally distributed data, me-
dian (25-75%) values were used. The Kruskal-Wallis test was used
for more than two groups. The Mann-Whitney-U test was used for
paired groups and further analysis. Spearman’s correlation coeffi-
cient was used to determine the relationship between PACIC and
MASES-SF scores. Internal consistency was determined using Cron-
bach’s alpha coefficient ( α). PACIC sub-scales were not used be-
cause they had Cronbach’s alpha coefficient values of less than
0.60. The analysis was based on the PACIC total score.
Ethical considerations
The study was approved by the ethics committee of Erzin-
can Binali Yıldırım University (Date: 10/10/2016 & No: 4 4 495147-
050.01.04-E.40225). Written permission was obtained from the Di-
rectorate of Public Health (Date: 28/10/2016 & No: 72999705-
771). Patients who met the inclusion criteria were informed of
the research purpose, plan, and benefits. They were also in-
formed that they could withdraw from the study at any stage.
Written/verbal consent was obtained from those who agreed to
participate.
Results
More than half the participants were married females aged 50
and over. Most of them were literate or primary school graduates.
The majority perceived their economic status as moderate and had
comorbidities. The majority used one hypertensive medication per
day and had been examined recently for hypertension. Most of
them had social support and had received information about hy-
pertension. The majority were obese or overweight. Blood pres-
sures were not under control in more than half of them ( Table 1 ).
Patients had a total mean PACI C and MASES-SF score of
1.6 8 ±0.40 and 41.54 ±9.45, respectively. The Spearman correlation
analysis showed that the mean PACIC score had a weak posi-
tive and significant correlation with the mean MASES-SF score
( Table 2 ).
The PACIC scores significantly differed by age, gender, the num-
ber of daily antihypertensive medications, time since last exami-
nation due to hypertension, receiving information about hyperten-
sion, and blood pressure control status. In further analysis (U), it
was determined that the difference was because the 37-50 age
group had a higher score than groups above 50, the group using
two antihypertensive medications daily had a higher score than
the group using one antihypertensive medication, and the group
whose last examination was less than 3 months ago had a higher
score than the groups whose last examination was over 3 months
ago. In addition, female patients had significantly higher PACIC
scores than male patients, those who received information about
hypertension had a higher score than those who did not, and those
with blood pressure under control had a higher score than those
with blood pressure not under control ( Table 3 ).
The PACIC scores did not differ by marital status, education
level, employment status, perceived economic status, comorbid-
ity, time since hypertension diagnosis, duration of antihypertensive
medication use, admission to an emergency for hypertension in the
past six months, receiving social support, or BMI ( p > 0.05).
The MASES-SF scores significantly differed by perceived eco-
nomic status, time since hypertension diagnosis, duration of an-
tihypertensive medication use, time since last examination due to
hypertension, and blood pressure control status. In further anal-
ysis (LSD), it was determined that the difference was due to the
fact that the mean score of the group with a high perception of
economic status was higher than the groups with a moderate and
low perception of economic status, and the group with a diagnosis
time of hypertension and the duration of antihypertensive med-
ication use of 11 years or more was higher than in the groups
with 1-10 years. In LSD, it was found that the difference was be-
cause the mean score of the group whose last examination was six
months ago, or more was significantly lower than the group with
five months or less. In addition, patients with blood pressure un-
der control had higher MASES-SF scores than those whose blood
pressure was not under control ( Table 4 ).
The MASES-SF scores did not differ by age, gender, marital sta-
tus, education level, employment status, comorbidity, the number
of daily antihypertensive medications, admission to an emergency
for hypertension in the past six months, receiving social support,
getting information about hypertension, or BMI (p > 0.05).
84 G.K. Söylemez and R.H. A ¸s ılar / Journal of Vasc ular Nursing 41 (2023) 81 –88
Tabl e 1
Distribution of descriptive characteristics of hypertensive patients.
Descriptive characteristics N %
Age
37- 50 44 10.8
51-64 194 47.7
≥65 169 41.5
Gender
Female 256 62.9
Male 151 37.1
Marital status
Married 316 77.6
∗Single 91 22.4
Education level
Illiterate 101 24.8
Literate/primary school 206 50.6
Secondary/high school 75 18.4
University 25 6.2
Employment status
Employed 30 7.4
Unemployed 377 92.6
Perceived economic status
High 65 16.0
Moderate 281 69.0
Low 61 15.0
Comorbidity
Yes 291 71.5
No 116 28.5
Time since hypertension diagnosis (years)
1-5 99 24.3
6-10 136 33.4
≥11 172 42.3
Duration of antihypertensive medication use (years)
1-5 102 25.0
6-10 137 33.7
≥11 168 41.3
Number of daily antihypertensive medications
1 319 78.4
2 79 19.4
≥3 9 2.2
Admission to an emergency department for hypertension in the past six months
Yes 87 21.4
No 320 78.6
Time since last examination due to hypertension (months)
< 3 252 61.9
3-5 141 34.7
≥6 14 3.4
Receiving social support
Yes 334 82.1
No 73 17.9
Getting information about hypertension
Yes 374 91.9
No 33 8.1
∗∗ BMI kg/m
2
Normal 30 7.4
Overweight 156 38.3
Obese 221 54.3
Blood pressure control
Yes 195 47.9
No 212 52.1
Age (years) (min: 37; max: 88) Mean ±SD 62.75 ±9.74
∗Widows and divorced included;
∗∗ No underweight patient; SD, Standard deviation
Tabl e 2
Distribution of the mean PACIC score, the mean MASES-SF score and obtained values, and the relationship between PACIC and MASES-SF.
Scales MASES-SF
(Mean ±SD) (41.54 ±9.45)
Obtained score interval (min: 13; max: 52)
PACIC total
(Mean ±SD) (1.68 ±0.40)
Obtained score interval (min: 1; max: 3.5)
∗r 0.345
p < .001
∗Spearman Correlation
PACIC, Patient Assessment of Chronic Illness Care; MASES-SF, Medication Adherence Self-Efficacy Scale-Short Form.
G.K. Söylemez and R.H. A ¸s ılar / Journal of Vasc ular Nursing 41 (2023) 81 –88 85
Tabl e 3
Comparison of descriptive characteristics and PACIC scores (n = 407).
Descriptive characteristics N PACIC Test and significance
Median 25%-75%
Age
37-50
51-64
≥65
44
194
169
1.80 1.51-2.19 x
2
KW
= 12.294
p = 0.002
∗
1.60 1.40-1.90
1.55 1.35-1.80
Gender
Female
Male
256
151
1.65 1.45-1.95 U = 16349.500
p = 0.009
∗
1.55 1.35-1.85
Number of daily antihypertensive medications
1 319 1.60 1.40-1.85 x
2
KW
= 6.406
p = 0.041
∗∗
2 79 1.70 1.45-2.00
≥3 9 1.65 1.45-2.22
Time since last examination due to hypertension (months)
< 3 252 1.65 1.45-1.95 x
2
KW
= 7.803
p = 0.020
∗∗
3-5 141 1.60 1.40-1.85
≥6 14 1.40 1.25-1.68
Getting information about hypertension
Yes 374 1.65 1.45-1.90 U = 2281.500
p<0.001
No 33 1.25 1.15-1.40
Blood pressure control
Yes 195 1.70 1.50-2.00 U = 14505.500
p<0.001
No 212 1.55 1.35-1.75
∗p < 0.01;
∗∗ p < 0.05.
PACIC, Patient Assessment of Chronic Illness Care; U , Mann-Whitney-U test; x
2
KW
, Kruskal-Wallis test.
Tabl e 4
Comparison of descriptive characteristics and MASES-SF scores (n = 407).
Descriptive
characteristics
N MASES-SF Test and significance
Mean SD
Perceived economic status
High 65 44.09 8.10 F = 4.324
p = 0.014
∗∗
Moderate 281 41.45 9.52
Low 61 39.19 9.92
Time since hypertension diagnosis (years)
1-5 99 38.99 10.10 F = 9.284
p < 0.001
6-10 136 40.60 9.92
≥11 172 43.74 8.17
Duration of antihypertensive medication use (years)
1-5 102 38.99 10.07 F = 9.067
p < 0.001
6-10 137 40.73 9.86
≥11 168 43.73 8.20
Time since last examination due to hypertension (months)
< 3 252 41.85 8.67 F = 13.785
p < 0.001
3-5 141 42.23 9.76
≥6 14 28.93 11.69
Blood pressure control
Yes 195 44.96 7.95 t = 7.476
p < 0.001
No 212 38.38 9.65
∗∗ p < 0.05.
MASES-SF, Medication Adherence Self-Efficacy Scale-Short Form; F, Variance Analysis (ANOVA); SD, Standard Deviation
Discussion
This study investigated the relationship between patients’ satis-
faction with hypertension care and their antihypertensive medica-
tion adherence. To the best of our knowledge, no other study has
investigated these relationships in hypertensive patients, so our
findings are discussed in relation to similar studies conducted in
patients with hypertension and/or other chronic diseases.
Patients had a mean PACIC and MASES-SF score of 1.68 ±0.40
and 41.54 ±9.45, respectively. These results showed that patients
had low satisfaction with hypertension care and good antihyper-
tensive medication adherence. This result answered the first research
question . Öncü et al.
26 conducted a field study in Türkiye and
found that patients with hypertension had a mean PACIC score of
2.84 ±0.96. Kaya et al.
15 also reported patients had a mean PACIC
score of 2.36 ±0.75. The result of the present study is lower than
what has been reported in other studies. This result may be due to
differences in personal characteristics, expectations from care, and
healthcare institutions. Various studies showed that elderly pa-
tients (MASES-SF = 45.05 ±6.06)
27 and inpatient patients (MASES-
SF = 47.12 ±7.81)
28 had high medication adherence, which is con-
sistent with the findings of this study.
In this study, a weak positive and significant correlation was
determined between the mean PACIC and MASES-SF scores. As sat-
isfaction with hypertension care increased, antihypertensive medi-
cation adherence also increased. This result answers the second re-
search question . Mackey et al.
10 also found that the better the care
assessment, the higher the medication adherence in patients with
86 G.K. Söylemez and R.H. A ¸s ılar / Journal of Vasc ular Nursing 41 (2023) 81 –88
diabetes and other chronic diseases in primary care health services.
Ku and Kegels
29
also reported a positive correlation between PACIC
scores and medication adherence in patients with diabetes. These
results show that patients who are satisfied with their care have
better medication adherence.
There was a significant correlation between descriptive charac-
teristics (age, gender, the number of daily antihypertensive medi-
cations, time since last examination due to hypertension, receiving
information about hypertension, and blood pressure control) and
PACIC scores. This result answered the third research question .
Patients 37-50 years of age had higher PACIC scores than those
over 50 years of age. Öncü et al.
26 also reported that patients be-
low 45 years of age had higher PACIC scores than those over 45. In
another study evaluating the care given to individuals with chronic
diseases, it was determined that the total PACIC score decreased as
the age of the patients increased,
14 which is consistent with the
results of the present study.
Females had a higher total PACIC score than their male counter-
parts. Glaskow et al.
9 also found that female patients with chronic
diseases had higher PACIC scores. However, some studies showed
that male patients with coronary heart diseases
30 and chronic dis-
eases
31
had higher PACIC scores than females. Similar and different
results have been reported in studies. The current study’s findings
could be attributed to various social, geographical, cultural, and in-
dividual characteristics.
Patients using two antihypertensive medications daily had sig-
nificantly higher PACIC scores than those using one antihyperten-
sive medication daily. Karabulutlu et al.
14 evaluated the care pro-
vided to patients with chronic diseases. Almost a quarter (20.7%)
of the sample consisted of patients with cardiovascular system dis-
eases. The researchers found no relationship between the number
of daily antihypertensive medications and PACIC scores. The result
of the present study suggests that patients on two medications a
day may be feeling more confident in terms of hypertension con-
trol.
Patients whose last examination was less than three months
ago due to hypertension had a higher PACIC score than those
whose last examination was over three months ago. Ludt et al.
30
also reported that patients with coronary heart disease who vis-
ited a doctor more than seven times a year had higher PACIC scores
than those who visited a doctor less than four times a year. These
results indicate that patients who visit healthcare professionals
more often are likely to have higher levels of trust and satisfaction
with the care they receive.
Patients who received information about hypertension had
higher mean PACIC scores than those who did not. Üstünova and
Nahcivan
32 also determined that patients with chronic obstruc-
tive pulmonary disease (COPD) who were informed of their con-
dition had higher PACIC scores than those who were not in-
formed of their condition. These results indicate that patients who
know about hypertension are likely to manage their condition
better.
Patients with their blood pressure under control had higher
PACIC scores than those without it. Pilipovic-Broceta et al.
11 also
reported that patients with controlled blood pressure had a higher
PACIC score. However, Öncü et al.
26 found no relationship between
blood pressure control and PACIC scores in patients. The difference
in the results may be due to differences in personal characteristics
and expectations of care.
Marital status, education level, employment status, perceived
economic status, comorbidity, time since hypertension diagno-
sis, duration of antihypertensive medication use, admission to an
emergency for hypertension in the past six months, receiving social
support, and BMI did not affect patients’ PACIC scores. Research
on different groups of patients with hypertension as a comorbidity
also shows no relationship between PACIC scores and marital sta-
tus,
14 , 15 , 32 , 33 education,
15 , 31 employment status,
26 , 32 , 33 frequency
of admission to an emergency,
32
receiving social support,
14
or body
weight,
34 like the result of the present study.
There was a significant correlation between descriptive charac-
teristics (perceived economic status, time since hypertension diag-
nosis, the duration of antihypertensive medication use, time since
last examination due to hypertension, and blood pressure control
and MASES-SF scores. This result answered the fourth research ques-
tion .
Patients with high economic status had higher MASES-SF scores
than those with moderate and low economic status, which is con-
sistent with the literature.
18 , 35
Vawter et al.
36
reported that hyper-
tensive patients with low incomes had difficulty affording antihy-
pertensive medications, inevitably reducing medication adherence.
These results suggest that patients with high economic status are
more likely to have high medication adherence because they have
less difficulty accessing their medication.
The MASES-SF mean score was found to be significantly higher
in the group with a diagnosis time of hypertension and a duration
of antihypertensive medication use of 11 years and above, com-
pared to the other groups under this period. However, in two dif-
ferent studies conducted in China, it was reported that patients
with a shorter time since hypertension diagnosis had higher anti-
hypertensive medication adherence.
18 , 37 On the other hand, Mah-
moud
38
detected no relationship between diagnosis time and med-
ication adherence. Selçuk et al.
39 also did not find a relationship
between diagnosis time and medication adherence among patients
with hypertension. The difference in the results may be due to dif-
ferences in individual, cultural, and geographic characteristics and
the perceived impact and severity of the disease.
Patients whose last examination was over six months ago due
to hypertension had a significantly lower mean score on the
MASES-SF than those whose last examination was less than six
months ago. Vawter et al.
36 found that patients who had their
blood pressure checked more than six months ago had more dif-
ficulty taking their antihypertensive medications regularly than
those who had their blood pressure checked within the last six
months. Mohammad et al.
40 indicated that patients who had their
blood pressure checked regularly had higher medication adher-
ence levels than those who avoided having their blood pressure
checked. These results suggest that more frequent visits to health
care providers are associated with higher medication adherence
levels.
Patients whose blood pressure was under control had higher
MASES-SF scores than those without it. Emre et al.
19 determined
that patients with good antihypertensive medication adherence
had better blood pressure control. According to Lali
´
c et al.,
41 two
out of ten patients with high medication adherence and six out of
ten with low medication adherence had a blood pressure of greater
than 140/90 mmHg. These results are consistent with the results of
the present study.
Age, gender, marital status, education level, employment sta-
tus, comorbidity, the number of daily antihypertensive medica-
tions, admission to an emergency for hypertension in the past six
months, receiving social support, getting information about hyper-
tension, and BMI had no effect on participants’ MASES-SF scores.
Likewise, other studies report no relationship between MASES-SF
scores and age,
28 , 38 gender,
28 , 35 , 39 , 41 marital status,
28 , 35 , 38 , 39 edu-
cation,
28 , 35 , 39 employment status,
35 , 39 comorbidity,
35 , 38 the num-
ber of daily antihypertensive medications used,
28 admissions to an
emergency in the past year, and receiving training on hyperten-
sion,
28 and BMI.
35 , 39 However, patients receiving more social sup-
G.K. Söylemez and R.H. A ¸s ılar / Journal of Vasc ular Nursing 41 (2023) 81 –88 87
port were reported to have higher medication adherence.
18 , 37 , 38
The difference in the results may be due to differences in personal
characteristics and the source and style of social support.
Conclusion
Patients have low satisfaction with hypertension care and good
antihypertensive medication adherence. It was determined that as
the satisfaction score with hypertension care increased, the anti-
hypertensive medication adherence score also increased. The sat-
isfaction scores of patients with hypertension care were signifi-
cantly higher in the 37-50 age group, females, those who used
two antihypertensive medications daily, those whose last examina-
tion was less than 3 months ago due to hypertension, those who
received information about hypertension, and those whose blood
pressure was under control. The antihypertensive medication ad-
herence scores were significantly higher in those with a high per-
ception of economic status, those with a diagnosis of hypertension
and an antihypertensive medication use duration of 11 years or
more, and those with blood pressure under control. However, the
antihypertensive medication adherence score is significantly lower
in patients whose last examination was 6 months or more ago due
to hypertension.
In conclusion, it is recommended that nurses determine pa-
tients’ satisfaction levels with hypertension care to improve hyper-
tension care and hypertension control. They should also evaluate
the diseases of patients and their antihypertensive medication ad-
herence and give them patient-centered and holistic care in line
with their needs.
Limitations
PACIC subscales had low Cronbach’s alpha coefficients for our
sample. The results are sample-specific and, therefore, cannot be
generalized to a large population.
Author Contributions
R.H.A. and G.K.S. planned the research and formed the research
questions. G.K.S. collected the data. Each analytical step was scru-
tinized and discussed by authors (R.H.A and G.K.S) until agreement
was established. R.H.A. and G.K.S. have read and approved the final
manuscript for submission.
Funding
This research did not receive any specific grants from funding
agencies in the public, commercial, or not-for-profit sectors.
Declaration of Competing Interest
Both authors declare that they have no competing interests.
This was not an industry supported study. All authors have re-
ported no financial conflicts of interest.
Acknowledgments
This study was produced from the master’s thesis of the first
author. It was presented at an oral presentation at the Sixth In-
ternational and 17t h National Nursing Congress, December 19-21,
2019, in Ankara, Türkiye. We thank the participants who con-
tributed to this research.
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