Elizabeth A. Rogers, MD, MAS; Hani Abi, BA; Mark Linzer, MD; David T. Eton, PhD
Corresponding Author: Elizabeth A. Rogers, MD, MAS; Department of Medicine and Department of Pediatrics - University of Minnesota Medical School. Email: earogers@umn.edu
Section: Research Letter
Publication: 11/11/2021
Introduction: New hypertension guidelines in the United States may require more people to take multiple medications or implement lifestyle changes. Increased treatment burden may be an unintended consequence and lead to worse health outcomes. Our study examined whether treatment burden is associated with factors related to self-management in those with hypertension. Methods: We conducted a cross-sectional mailed survey of patients from two medical centers in Minnesota. Participants with 2 or more medical conditions completed the Patient Experience with Treatment and Self-management (PETS), a validated treatment burden questionnaire, as well as measures of confidence in self-management ability, health literacy, healthcare-related financial difficulties, and perception of provider interpersonal skills. We used Partial correlation analyses, controlling for age, sex, race, and education, to test relationships among study variables. Results: Of 254 respondents who had a diagnosis of hypertension, mean age was 67, 54% were female, and 74% were non-Hispanic White. People with hypertension who reported having lower confidence in self-management ability, lower health literacy, more financial difficulties, and healthcare providers with poorer interpersonal skills, reported higher treatment burden scores (PETS scales correlation magnitude range 0.09-0.62, p < 0.05 on all but four). The strongest associations were observed for medical information and physical/mental exhaustion with self-management (correlation magnitudes from 0.25 to 0.54, p<0.01). Discussion: Hypertension treatment guideline stringent blood pressure criteria may lead to more interventions – medical or lifestyle – creating strains on populations already challenged by disease self-management and at risk of experiencing disparities in cardiovascular health outcomes.