Introduction
For many years, cardiovascular diseases have been the main cause of human health problems and even death, and their morbidity is due to many reasons [1]. Significant factors in the incidence of cardiovascular diseases, despite high blood pressure values, are also smoking, reduced physical effort, excess body weight, high cholesterol levels, diabetic diseases, unhealthy lifestyle, including unhealthy eating, stressful situations and factors. non-modifiable, genetic predisposition and environmental factors [2]. Among Poles, 9.9 million people suffered from hypertension in 2018, which accounted for 31.5% of the adult population and compared to 2013, this number increased by almost 200 000 people. The most numerous groups of patients with arterial hypertension (AH) in 2018 were women aged 65–74, among men the largest group was those aged 55–64 [3]. According to the data of the World Health Organization (WHO), today in approximately 1.28 billion adults aged 30–79 years around the world, AH was diagnosed, and 46% of these people are not aware of their disease [4].
Hypertension
Arterial hypertension remains the primary modifying factor for both cardiac and central nervous system diseases, despite the passage of time and the development of medicine [5]. Arterial hypertension is defined as measured systolic blood pressure ≥ 140 mm Hg and/or diastolic blood pressure ≥ 90 mm Hg [6]. In modern times, this disease is called the disease of civilization, it is very widespread due to the progress of urbanization and globalization, as a result of which people lead unhealthy lifestyles and emerging comorbidities. The disease can sometimes “bloom” for many years practically asymptomatically, although it leads to serious health effects, e.g. stroke, ischaemic heart disease, or heart failure, the consequence of which may be death. According to available data, 8.5 million people die each year due to hypertension [7]. In selecting the appropriate treatment for hypertension, it is important to obtain the results of self-monitoring and correct blood pressure measurements at home in combination with blood pressure testing in the office. When talking about treatment, it should be borne in mind that this disease is chronic and is accompanied by treatment for the rest of the patient’s life, so it is important at this point to treat the patient holistically. Most often, treatment involves taking specific, well-matched medications to maintain optimal blood pressure, which significantly extends life, but may have an impact on quality of life (QoL) [8].
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2013 |
2018 |
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Number of hypertensive patients in Poland |
9.7 mln |
9.9 mln |
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Percent of the adult population in Poland |
30.9% |
31.5% |
Determining the quality of life in the bio-sycho-social model of health
Modern medicine is more and more often talking about assessing the QoL of a sick patient. The purpose of introducing a given concept was to obtain accurate health information, considering not only the physical health of a given person, but also various spheres of a person: mental, social, and spiritual. This methodology is often called a holistic approach to the patient. This approach allows you to gain knowledge about the multidimensional determinants of health and disease, recognizing the bio-psycho-social distinctiveness of each patient and allowing you to choose the treatment best suited to the individual needs of the patient, adopting the thesis about the uniqueness of each life. Since the QoL is a broad concept and covers a wide range of problems, from a medical point of view, researchers of the QoL of patients focus mainly on this concept, which is conditioned by the state of health [9]. The holistic health perspective is in line with the WHO’s health perspective, which defines it as a state of mental, physical and social well-being, not just the absence of disease or disability. Until now, according to the biomedical concept of health, the human body was treated as a machine, and the disease was a verifiable deviation from the norm, and health was defined as the lack of disturbances in the sphere of biological human functioning and grouped the subjective states of the organism. The bio-psycho-social model of health was created from the need to look at the patient’s life situation from a different perspective, considering those areas of human functioning that were so far ignored in the clinic [10].
Definition of the quality of life in disease
The concept of QoL was defined, among others, by the WHO, according to which the QoL is an individual perception by an individual of his or her life position in the cultural context and value system in which he lives, and in relation to tasks, expectations and standards determined by environmental conditions. The indicators of QoL are the ability to play the current life roles, the ability to adapt, mental well-being or functioning within given social groups [11]. In everyday medical practice, the QoL in terms of health is of great importance, considering the impact of disease and treatment on the patient’s physical, mental and social functioning. Examination and assessment of the patient’s QoL allow you to get to know his point of view, understand his condition, communicate with him or solve psychosocial healing problems. The aim here is to determine the effectiveness of treatment not only in terms of avoiding death, but also to assess the health and lifestyle that are relevant in chronic diseases. Testing the QoL in medical terms is the recognition of problems resulting from the disease and the treatment applied. It also seems important to define human activity in the physical, mental and social sense and to describe the patient’s views on health and subjective well-being [12].
The contemporary concept of QoL was defined in the 1970s by Campbell, who proved the relationship between objective living conditions and life satisfaction [13]. Research on the QoL in medicine was first started by Rosser, who was the first to publish a method of measuring the QoL of patients. It exerted a great influence on subsequent works undertaken in this area, thus, in the following years, many definitions of QoL were created, focusing on the phenomena of health and disease [14]. Health-related (HR) QoL in 1990 defined Schipper as the functional effect of a physical, mental and social response to illness and treatment, perceived subjectively by the patient, and the assessment of the patient’s life situation during the treatment period. The most important four aspects of the patient’s functioning are the physical and motor skills, mental state, social and economic conditions, and somatic sensations. HRQoL allows you to look at the phenomena related to the disease in a broader aspect, both medical (e.g., testing the effectiveness of drugs) and non-medical (functioning in the family or society). Moreover, health examinations contributed to the possibility of a better assessment of the general subjective QALY level as a measure of the QoL [15].
Factors determining the quality of life during arterial hypertension
Arterial hypertension is a significant change in a person’s life, which presents a sick person with many challenges that must be dealt with. The struggle is not a short-term process but often stretches over many years or until death [16]. Improving the QoL is an integral part of the treatment of AH. Pharmacological and non-pharmacological treatment of hypertension should prevent the deterioration of the QoL of patients in the long term. Improperly selected drugs may worsen the QoL, reducing the chance of a good prognosis and effective treatment of hypertensive disease [17]. It was observed that patients who complained about complications of pharmacological treatment most often did not follow the doctor’s recommendations for pharmacotherapy. And effective treatment, which would improve the QoL and alleviate the course of the disease, depends largely on compliance with the physicians’ recommendations. The factors determining the patient’s QoL also include material status, age, gender, socioeconomic variables of a person, housing conditions, education and many others, which contribute to QoL [18]. In some of the studies, it was shown that the above factors account for 32.7% of the variability in the quality-of-life level in patients with diagnosed hypertension [19]. And in many research studies it was concluded that in terms of the sense of well-being, a subjective assessment of health is a better determinant than an objective assessment of health. In the same studies, it was concluded that the QoL depends on clinical factors, such as blood pressure values (the higher the value, the worse the quality), overweight and organ complications, as well as the number and type of drugs used, e.g., over 4 types of drugs (all this makes the QoL deteriorate) [20]. It is also impossible not to include among these factors determining the QoL, the patient’s beliefs and attitude towards his disease. In patients with long-term disease, higher levels of depression, stress, low mood, decreased energy and a higher level of social isolation are observed [21].
The quality of life of patients with arterial hypertension — a review of studies in the literature
Sawicka et al. found that the duration of the disease has an impact on the QoL of the respondents in the physical aspect, as well as the number of drugs used. The shorter the duration of the disease, the better the QoL, and the subjects who took one drug had a better QoL. The authors claim that the individual general perception of the QoL and own health is better among women and that men indicate a better QoL in terms of physical and environmental aspects [23]. The analysis of the literature shows that one of the factors having a significant impact on the QoL of people with hypertension is the level of education. According to Bień, the level of education is in a high position in the ranking of the independent factor influencing health. Hypotonic people with higher education are characterized by a higher QoL, and a low level of education is associated with higher incidence and mortality due to hypertension and a lower QoL [24]. Kocowska et al. [20] proved a significant relationship between compliance with the doctor’s recommendations and the QoL. Lack of knowledge about the disease, and thus not following the doctor’s recommendations, worsens the patient’s QoL [20–22]. On the other hand, the results relating to the relationship between physical activity and QoL should be related to the observations of Cegła et al. [25], which conducted a study aimed at determining the impact of physical activity on the QoL of patients with confirmed AH. The analysis of the test results showed that a quarter of the patients (24,8%) with AH are not physically active and lead a passive lifestyle. Only 34% of the respondents declared that they are physically active. Therefore, it was concluded that the patients lead a less active lifestyle and that the lack of physical activity significantly deteriorates the daily functioning and QoL of patients with hypertension, and their QoL depends on the physical activity practised, its type and regularity [25, 26]. Paczkowska et al. concluded that the socio-demographic factors significantly differentiating the assessment of the QoL of the respondents included: gender, age, education, source of income, and financial situation [27]. Arterial hypertension significantly impairs the QoL of patients, regardless of sex and age, which is confirmed by many studies [27–30].
Conclusions
Arterial hypertension, as a chronic disease, affects the patient’s QoL and the discomfort in the bio-psycho-social sphere in people suffering from this disease, especially in those patients who are not aware of their disease and do not have proper knowledge about its treatment. In the treatment of AH, pharmacotherapy is indicated, and often psychological support and psychoeducation.
Conflict of interest
None declared.
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Streszczenie Nadciśnienie tętnicze stanowi przyczynę obniżenia jakości życia, wywierając wpływ nie tylko na jej wymiar subiektywny, związany z pogorszeniem samopoczucia, ale również na wymiar obiektywny, uniemożliwiając pełnienie dotychczasowych funkcji społecznych i obniżając zdolność indywidualnego przystosowania się, czy też pogarszając status ekonomiczny z powodu konieczności rezygnacji z pracy zawodowej i izolacji społecznej. Celem pracy jest przedstawienie, na podstawie przeglądu literatury, jakości życia pacjentów z nadciśnieniem tętniczym w wymiarze bio-psycho-społecznym zdrowia. Powyższe trzy komponenty zdrowia wpływają na przebieg choroby, a jednocześnie warunkują jakość życia pacjentów. Słowa kluczowe: jakość życia, nadciśnienie tętnicze, kardiologia Folia Cardiologica 2022; 17, 6: 351–355 |
