Research ArticleOriginal Research

Blood Pressure Medication Side Effect Symptoms and Patient Treatment Satisfaction and Adherence

Karen L. Margolis, A. Lauren Crain, Pamala A. Pawloski, Jeanette Y. Ziegenfuss, Nicole K. Trower, Anna R. Bergdall, MarySue Beran, Christine K. Norton, Patricia K. Haugen, Daniel J. Rehrauer, Beverly B. Green, Leif I. Solberg and JoAnn M. Sperl-Hillen
The Journal of the American Board of Family Medicine March 2025, 38 (2) 312-329; DOI: https://doi.org/10.3122/jabfm.2024.240288R1

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Questions to assess blood pressure medication side effect symptoms.

  • Figure 2.
    Figure 2.

    (A) Association between side effect symptom severity (somewhat/moderate problem vs. big/very big problem) and blood pressure treatment dissatisfaction. (B) Association between perceived relatedness to medication (related vs. unrelated) and blood pressure treatment dissatisfaction.

  • Figure 3.
    Figure 3.

    (A) Association between side effect symptom severity (somewhat/moderate problem vs. big/very big problem) and adherence to blood pressure treatment (changing or stopping medications due to side effects). (B) Association between perceived relatedness to medication (related vs. unrelated) and adherence to blood pressure treatment (changing or stopping medications due to side effects).

Tables

  • Table 1.

    Participant Characteristics by Baseline Survey Response Status (n = 3,071)

    Non-RespondentsRespondentsp
    N1,3521,719
     Age, M (SD)58.3 (14.5)61.7 (14.0)<0.001
     Age <60, n (%)711 (52.6)708 (41.2)<0.001
     Female, n (%)705 (52.1)934 (54.3)0.23
     BMI (kg/m2), M (SD)32.5 (8.1)32.5 (7.8)0.93
    Race
     White, n (%)876 (64.8)1,256 (73.1)<0.001
     Black, n (%)265 (19.6)329 (19.1)0.75
     Asian, n (%)143 (10.6)70 (4.1)<0.001
     All else, n (%)68 (5.0)64 (3.7)0.08
     Diabetes, n (%)340 (25.1)433 (25.2)0.98
     Cardiovascular disease, n (%)192 (14.2)320 (18.6)0.001
     SBP (mm Hg), M (SD)158.1 (16.0)158.0 (14.8)0.82
     DBP (mm Hg), M (SD)93.0 (13.8)90.6 (13.9)<0.001
    Number of BP medications
     0, n (%)235 (17.4)231 (13.4)0.002
     1, n (%)427 (31.6)524 (30.5)0.51
     2, n (%)380 (28.1)520 (30.3)0.19
     3+, n (%)310 (22.9)444 (25.8)0.06
    Drug classes used
     ACE-inhibitor, n (%)402 (29.7)527 (30.7)0.58
     ARB, n (%)294 (21.7)414 (24.1)0.13
     Diuretic, thiazide, n (%)413 (30.5)546 (31.8)0.47
     Diuretic, loop, n (%)82 (6.1)125 (7.3)0.19
     Beta blocker, n (%)466 (34.5)675 (39.3)0.006
     CCB DHP, n (%)342 (25.3)453 (26.4)0.51

    • Abbreviations: ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blocker, BMI, body mass index; CCB, calcium channel blocker; DHP, dihydropyridine.

  • Table 2.

    Severity Rating of Each Hypertension Medication Side Effect Symptom Among Patients Reporting Taking Any Blood Pressure Medications in the Prior 6 Months (n = 1,601)

    Not a ProblemSomewhat/ModerateBig/Very Big
    ANY symptom155 (9.7%)828 (51.6%)618 (38.5%)
    Tiredness, n (%)480 (30.0%)828 (51.7%)293 (18.3%)
    Dizziness, n (%)913 (57.0%)570 (35.6%)118 (7.4%)
    Leg swelling, n (%)1,011 (63.1%)435 (27.2%)155 (9.7%)
    Cough, n (%)1,057 (66.0%)431 (26.90%)113 (7.1%)
    Urinary frequency, n (%)709 (44.3%)702 (43.8%)190 (11.9%)
    Sexual symptoms, n (%)1,214 (75.8%)244 (15.2%)143 (8.9%)

    • Notes: Symptom and Severity: The following questions are about common symptoms that may or may not be related to your blood pressure medicine. Please think back over the past 6 months when answering each of the following questions. Options for severity rating were not at all a problem, somewhat of a problem, moderate problem, big problem, or very big problem.

  • Table 3.

    Associations Between Severity of Symptoms and Perceived Relatedness to Blood Pressure Medications, Among Those Reporting That at Least One Symptom Was at Least Somewhat of a Problem (n = 1,446)

    Total with SymptomSomewhat/Moderate ProblemBig/Very Big Problemp
    Tiredness1,121828293
     Unrelated to meds919 (82.0%)703 (84.9%)216 (73.7%)<0.001
     Related to meds202 (18.0%)125 (15.1%)77 (26.3%)
    Dizziness688570118
     Unrelated to meds4,537 (65.8%)393 (69.0%)601 (50.8%)<0.001
     Related to meds235 (34.2%)177 (31.0%)58 (49.2%)
    Leg swelling590435155
     Unrelated to meds429 (73.0%)338 (77.7%)91 (58.7%)<0.001
     Related to meds161 (27.0%)97 (22.3%)64 (41.3%)
    Cough544431113
     Unrelated to meds427 (78.5%)358 (83.1%)69 (61.2%)<0.001
     Related to meds117 (21.5%)73 (16.9%)44 (38.9%)
    Urinary frequency892702190
     Unrelated to meds596 (66.8%)469 (66.8%)127 (66.8%)0.99
     Related to meds296 (33.2%)233 (33.2%)63 (33.2%)
    Sexual symptoms387244143
     Unrelated to meds281 (72.6%)181 (74.2%)100 (69.9%)0.36
     Related to meds106 (27.4%)63 (25.8%)43 (30.1%)
  • Appendix 1 Table 1.

    Associations Between Severity Ratings of Select Hypertension Medication Side Effect Symptoms and Specific BP Medications Current at the Index Visit, Among Patients Reporting Taking Any Blood Pressure Medications in the Prior 6 Months (n = 1,601)

    Not a ProblemSomewhat/ModerateBig/Very Big
    Tiredness, n (%)
     All480 (30.0%)828 (51.7%)293 (18.3%)
     Not taking beta blocker286 (30.2%)494 (52.1%)168 (17.7%)
     Taking beta blocker194 (29.7%)334 (51.1%)125 (19.1%)
    Cough, n (%)
     All1,057 (66.0%)431 (26.9%)113 (7.1%)
     Not taking ACE inhibitor726 (66.4%)287 (26.2%)81 (7.4%)
     Taking ACE inhibitor331 (65.3%)144 (28.4%)32 (6.3%)
    Leg Swelling, n (%)
     All1,011 (63.1%)435 (27.2%)155 (9.7%)
     Not taking CCB (DHP)770 (66.0%)304 (26.0%)93 (8.0%)
     Taking CCB (DHP)241 (55.5%)131 (30.2%)62 (14.3%)
    Urinary Frequency, n (%)
     All709 (44.3%)702 (43.8%)190 (11.9%)
     Not taking thiazide diuretic479 (44.6%)458 (42.7%)136 (12.7%)
     Taking thiazide diuretic230 (43.6%)244 (46.2%)54 (10.2%)
    Sexual symptoms, n (%)
     All1,214 (75.8%)244 (15.2%)143 (8.9%)
     Not taking thiazide diuretic809 (75.4%)162 (15.1%)102 (9.5%)
     Taking thiazide diuretic405 (76.7%)82 (15.5%)41 (7.8%)
     Not taking beta blocker726 (76.6%)139 (14.7%)83 (8.8%)
     Taking beta blocker488 (74.7%)105 (16.1%)60 (9.2%)

    • Abbreviations: CCB, calcium channel blocker; DHP, dihydropyridine.

  • Appendix 1 Table 2.

    Associations Between Symptom Severity and Perceived Relatedness to Medication to Blood Pressure Treatment Dissatisfaction (n = 1,365)

    Symptom SeverityPerceived Relationship to Medications
    Total with SymptomSomewhat or ModerateBig orVery BigpUnrelated to MedsRelated to Medsp
    ANY symptom1,365779586<0.0017376280.001
     Somewhat or very satisfied712 (52.2%)443 (56.9%)269 (45.9%)402 (54.6%)310 (49.4%)
     Neither satisfied nor dissatisfied329 (24.1%)185 (23.7%)144 (24.6%)198 (26.9%)131 (20.9%)
     Somewhat or very dissatisfied324 (23.7%)151 (19.4%)173 (29.5%)137 (18.6%)187 (29.8%)
    Tiredness10607792810.01869191<0.001
     Somewhat or very satisfied533 (50.3%)408 (52.4%)125 (44.5%)454 (52.2%)79 (41.4%)
     Neither satisfied nor dissatisfied265 (25.0%)193 (24.8%)72 (25.6%)222 (25.5%)43 (22.5%)
     Somewhat or very dissatisfied262 (24.7%)178 (22.8%)84 (29.9%)193 (22.2%)69 (36.1%)
    Dizziness6505381120.024222280.006
     Somewhat or very satisfied325 (50.0%)276 (51.3%)49 (43.7%)222 (52.6%)103 (45.2%)
     Neither satisfied nor dissatisfied141 (21.7%)124 (23.0%)17 (15.2%)100 (23.7%)41 (18.0%)
     Somewhat or very dissatisfied184 (28.3%)138 (25.6%)46 (41.1%)100 (23.7%)84 (36.8%)
    Leg swelling5534111420.164011520.003
     Somewhat or very satisfied276 (49.9%)214 (52.1%)62 (43.7%)210 (52.4%)66 (43.4%)
     Neither satisfied nor dissatisfied138 (25.0%)96 (23.4%)42 (29.6%)108 (26.9%)30 (19.7%)
     Somewhat or very dissatisfied139 (25.1%)101 (24.6%)38 (26.8%)83 (20.7%)56 (36.8%)
    Cough5174101070.064031140.03
     Somewhat or very satisfied252 (48.7%)205 (50.0%)47 (43.9%)202 (50.1%)50 (43.9%)
     Neither satisfied nor dissatisfied132 (25.5%)110 (26.8%)22 (20.6%)110 (27.3%)22 (19.3%)
     Somewhat or very dissatisfied133 (25.7%)95 (23.2%)39 (35.5%)91 (22.6%)42 (36.8%)
    Urinary frequency8456681770.415652800.04
     Somewhat or very satisfied410 (48.5%)327 (48.9%)83 (46.9%)280 (49.6%)130 (46.4%)
     Neither satisfied nor dissatisfied219 (25.9%)176 (26.3%)43 (24.3%)161 (28.5%)58 (20.7%)
     Somewhat or very dissatisfied216 (25.6%)165 (24.7%)51 (28.8%)124 (22.0%)92 (32.9%)
    Sexual symptoms3742351390.012711030.04
     Somewhat or very satisfied167 (44.7%)119 (50.6%)48 (34.5%)128 (47.2%)39 (37.9%)
     Neither satisfied nor dissatisfied113 (30.2%)60 (25.5%)53 (38.1%)83 (30.6%)30 (29.1%)
     Somewhat or very dissatisfied94 (25.1%)56 (23.8%)38 (27.3%)60 (22.1%)34 (33.0%)
  • Appendix 1 Table 3.

    Associations Between Symptom Severity and Perceived Relatedness to Medication Adherence to Blood Pressure Treatment Adherence (Changing or Stopping Medications Due to Side Effects) and (n = 1,423)

    Symptom SeverityPerceived Related to Medication
    Total with SymptomSomewhat or ModerateBig or Very BigpUnrelated to MedsRelated to Medsp
    Any symptom1,423811612<0.001769654
     No adherence issue1,090 (76.6%)664 (81.9%)426 (69.6%)661 (86.0%)429 (65.6%)<0.001
     Yes adherence issue333 (23.4%)147 (18.1%)186 (30.4%)108 (14.0%)225 (34.4%)
    Tiredness1,1028122900.006905197<0.001
     No adherence issue826 (75.0%)626 (77.1%)200 (69.0%)706 (78.0%)120 (60.9%)
     Yes adherence issue276 (25.0%)186 (22.9%)90 (31.0%)199 (22.0%)77 (39.1%)
    Dizziness675560115<0.001442233<0.001
     No adherence issue467 (69.2%)406 (72.5%)61 (53.0%)336 (76.0%)131 (56.2%)
     Yes adherence issue208 (30.8%)154 (27.5%)54 (47.0%)106 (24.0%)102 (43.8%)
    Leg swelling5834311520.344251,589<0.001
     No adherence issue435 (74.6%)326 (75.6%)109 (71.7%)339 (89.8%)96 (60.8%)
     Yes adherence issue148 (25.4%)105 (24.4%)43 (28.3%)86 (20.2%)62 (39.2%)
    Cough5414281130.06424117<0.001
     No adherence issue392 (72.5%)318 (74.3%)74 (65.5%)323 (76.2%)69 (59.0%)
     Yes adherence issue149 (27.5%)110 (25.7%)39 (34.5%)101 (23.8%)48 (41.0%)
    Urinary frequency8866961900.195922940.08
     No adherence issue662 (74.7%)527 (75.7%)135 (71.0%)453 (76.5%)209 (71.1%)
     Yes adherence issue224 (25.3%)169 (24.3%)55 (29.0%)139 (23.5%)85 (28.9%)
    Sexual symptoms3842421420.07278106<0.001
     No adherence issue278 (72.4%)183 (75.6%)95 (66.9%)214 (77.0%)64 (60.4%)
     Yes adherence issue106 (27.6%)59 (24.4%)47 (33.1%)64 (23.0%)42 (39.6%)
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