Factors associated with hypertensive patients' compliance with recommended lifestyle behaviors

Background: A crucial element in controlling blood pressure is non-pharmaceutical treatment. However, only a few studies specifically address the question of hypertensive patients' compliance with physicians' recommendations for a healthy lifestyle. Objectives: To explore factors associated with hypertensive patients' compliance with lifestyle recommendations regarding physical activity, smoking cessation and proper diet. Methods: We performed a secondary data analysis of a representative sample of 1125 hypertensive patients in Israel's two largest health funds. Data were collected in 2002-2003 by telephone interviews using structured questionnaires. The response rate was 77%. Bivariate and multivariate analysis was conducted. Results: About half of the hypertensive patients reported doing regular exercise and adhering to a special diet; 13% were smokers. About half reported receiving counseling on smoking cessation and diet and a third on physical exercise. A quarter reported receiving explanations regarding selfmeasurement of blood pressure and signs of deterioration. Multivariate analysis revealed that patients' beliefs about hypertension management, their knowledge on hypertension and its management, and physician counseling on a healthy lifestyle and self-care, have an independent effect on compliance with recommended lifestyle behaviors. Conclusions: The low counseling rates suggest that there may be a need to improve physicians' counseling skills so that they will be more confident and effective in delivering this service to their patients. A model based on educating both physicians and patients may contribute to improving the care of hypertensive patients.