Is there a nonadherent subtype of hypertensive patient? A latent class analysis approach
Ranak B Trivedi1, Brian J Ayotte2, Carolyn T Thorpe3, David Edelman4, Hayden B Bosworth5
1Northwest Health Services Research and Development Service Center of Excellence, VA Puget Sound Health Care System, Seattle, Washington; 2Boston VA Health Care System, Boston, Massachusetts; 3Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin; 4Department of Medicine, Duke University Medical Center, Durham, North Carolina; 5Research Professor, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
Abstract: To determine subtypes of adherence, 636 hypertensive patients (48% White, 34% male) reported adherence to medications, diet, exercise, smoking, and home blood pressure monitoring. A latent class analysis approach was used to identify subgroups that adhere to these five self-management behaviors. Fit statistics suggested two latent classes. The first class (labeled “more adherent”) included patients with greater probability of adhering to recommendations compared with the second class (labeled “less adherent”) with regard to nonsmoking (97.7% versus 76.3%), medications (75.5% versus 49.5%), diet (70.7% versus 46.9%), exercise (63.4% versus 27.2%), and blood pressure monitoring (32% versus 3.4%). Logistic regression analyses used to characterize the two classes showed that “more adherent” participants were more likely to report full-time employment, adequate income, and better emotional and physical well-being. Results suggest the presence of a less adherent subtype of hypertensive patients. Behavioral interventions designed to improve adherence might best target these at-risk patients for greater treatment efficiency.
Keywords: adherence, hypertension, latent class analysis, self-management
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