Four decades of clinical trials have produced an enormous body of evidence showing that controlling hypertension improves cardiovascular and renal outcomes (Chobanian et al., 2003; Psaty et al., 2003; The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group, 2002). The mechanisms for achieving control, including following medication regimens and lifestyle recommendations (e.g., diet, exercise, smoking cessation), are well known and widely accepted (Chobanian et al., 2003; Elmer et al., 1995; Lichtenstein et al., 2006; Miller et al., 2002; Sacks et al., 2001; Whelton et al., 1998). However, many patients do not adhere to these recommendations. Non-adherence to antihypertensive medications may be as high as 50% (Garfield & Caro, 1999), and has been cited as the principal reason behind poor hypertension control in the population (Burnier, 2006). Estimates of lifestyle recommendations also reflect high degrees of non-adherence. In a primary care setting, (Burt et al., 1995) estimated that only 67% patients reported adherence to any one of four lifestyle recommendations (weight management, dietary sodium reduction, moderate alcohol consumption, and regular exercise).
While a variety of psychosocial factors are thought to influence treatment adherence and blood pressure (BP) control, the effects of emotional well-being are relatively understudied. Of the studies examining the dimension of mental health, the focus has been largely on clinical depression or depressive symptoms. A recent meta-analysis suggested that depressed patients were three times more likely to be non-adherent to medical treatment, across medical conditions (M. R. DiMatteo, Lepper, & Croghan, 2000). Less attention has been paid to subclinical emotional distress and emotional well-being in medical illness in general, and hypertension in particular. One study examined the impact of emotional well-being on medication adherence (Wang et al., 2002). They found that for each point change on a depression scale, hypertensive patients were 7% less likely to adhere to their medications. Similar to medication adherence, the impact of emotional health on adherence to lifestyle changes in hypertension is relatively unknown. This is despite strong evidence in other chronic illnesses that emotionally healthy patients show greater adherence to maintaining lifestyle changes (Daly et al., 2002; M. R. DiMatteo et al., 2000; Koertge et al., 2003; Sherbourne, Hays, Ordway, DiMatteo, & Kravitz, 1992). Lastly, little is known about the impact of emotional well-being on BP in hypertensives although clinical depression has been shown to reduce BP control (Simonsick, Wallace, Blazer, & Berkman, 1995). The sparseness of the literature belies the importance of establishing the impact of emotional well-being in hypertension since hypertensives appear to have a poorer quality of life compared to normotensives (Banegas et al., 2006; Bardage & Isacson, 2001; Dimenas et al., 1989; Moum, Naess, Sorensen, Tambs, & Holmen, 1990).
In addition to emotional well-being, marital status may play an important role in hypertension. Marital status is considered a measure of social network, and is associated with improved hypertension control (Caldwell et al., 1983; He et al., 2002). It is speculated that married hypertensives may have better hypertension control partly through improved adherence to recommendations. While some studies support this relationship (Kulkarni, Alexander, Lytle, Heiss, & Peterson, 2006; Kyngas & Lahdenpera, 1999), others have not found a relationship between marital status and adherence to treatment recommendations in hypertensives (Cummings, Becker, Kirscht, & Levin, 1982). A recent meta-analysis of the general medical literature concluded that adherence to medical recommendations were higher in married patients (M.R. DiMatteo, 2004). In light of the evidence in the general medical literature, the relationship between marital status and treatment adherence deserves closer scrutiny in hypertension. Furthermore, it is important to investigate whether marital status is related to pharmacological and lifestyle recommendations separately examined within the same sample, as the current state of literature is unable to answer this question.
The purpose of this study was to examine whether emotional well-being and marital status were related to baseline BP levels and adherence to medications and lifestyle recommendations. Results can be used to further our understanding regarding psychosocial factors which may impact adherence to medication and lifestyle changes.