| Description |
Hypertension is a common diagnosis for American veterans. Despite years of research investigating how to improve antihypertensive medication adherence, suboptimal adherence still results in uncontrolled blood pressure leading to hospitalizations and complications. Connelly's model of Self-Care in Chronic Illness was used to compare veterans with hypertension, with and without post-traumatic stress disorder (PTSD) for health motivation, perceptions of the seriousness of illness, psychological status, and social support. Alcohol intake was added due to previous research suggesting it influences medication adherence in veterans with PTSD. A cross-sectional design was conducted among 428 veterans. 1,199 surveys were mailed with good response (n=428, 35.7%). The sample was comprised of 417 (97.4%) males and 11 (2.6%) females. Mean age was 76 years for participants with HTN and 66.7 years for participants with both HTN and PTSD (p<.01). Veterans with PTSD had higher rates of divorce or separation (28.8%), and higher mean blood pressure readings of 94.04 (p=.01). Medication adherence was very high in both groups with means of 7.14 (SD=1.30) and 6.48 (SD=1.97), respectively, for veterans with HTN and veterans with PTSD. Path analysis was used to evaluate associations of variables with medication adherence. However, the data did not fit the proposed model, thus modification indices were used with improved model fit. Among veterans with PTSD, less alcohol intake (β = -15), less health distress (β = -.36), and more social support (β = .27) were indirectly associated with medication adherence. Among veterans without PTSD the degree of comorbidity (β = -.15), less health distress (β = -.27), and more social support (β = .26), were indirectly associated with medication adherence. The path model explained a very small amount of the variance on medication adherence therefore nurses caring for veterans with HTN should assess for these variables but also be alert to other issues that may impact antihypertensive medication adherence. Future studies on antihypertensive medication adherence should recruit less adherent participants, and include more female veterans and other military subgroups at risk for PTSD to enhance the cardiovascular health of those who have served and protected our country. |
