The association of psychological stress and health related quality of life among patients with stroke and hypertension in Gaza Strip

BACKGROUND: The study was performed to investigate the association of psychological stress and quality of life (QOL) among patients with the cardiovascular disease (CVD) of hypertension plus stroke or hypertension only. METHODS: The WHOQOL-BREF questionnaire was applied to 112 hypertensive patients with hypertension plus stroke and 224 hypertensive patients without stroke. Psychological stress was assessed with SCL-90. Means scale scores were compared using student-t-test and predictors of QOL were calculated with covariance analysis. RESULTS: Patients with stroke had a significant lower QOL than patients without stroke and a significantly higher level of stress (p < 0.01). In analyses of covariance psychological stress was significantly correlated to all domains of QOL among non-stroke patients. The same psychological and sociodemographic factors showed little impact on the stroke patients in these multivariable analyses. In these models psychological stress had a significant impact on the global domain of QOL among stroke patients. Income and gender were the only sociodemographic factors being significantly associated with the physical (education) and social (gender) domains of QOL in stroke patients. CONCLUSION: Psychological stress was strongly correlated with all domains of QOL in patients without stroke and was only partly associated with QOL among patients with stroke. Future studies should investigate if psychological stress is a factor suitable for educational and psychological interventions aiming at stress reduction in CVD patients which might substantially contribute to better health related quality of life in these patients

Factors of non-compliance with the therapeutic regimen among hypertensive men and women: A case-control study to investigate risk factors of stroke

To identify potential risk factors among the therapeutic regimen and life style which may increase the risk for stroke, a pair matched case-control study was conducted in Gaza Strip among 112 patients, who had been hospitalized for acute stroke and history of hypertension, and 224 controls with history of hypertension. Conditional logistic regression models show significant associations between stroke and medication not taking as prescribed (OR = 6.07; 95% CI: 1.53, 24.07), using excessive salt at meals (OR = 4.51; 95% CI: 2.05, 9.90), eating diet high in fat (OR = 4.67; 95% CI: 2.09, 10.40), and high level of stress (OR = 2.77; 95% CI: 1.43, 5.38). No significant association between smoking and the development of stroke (OR = 2.12; 95% CI: 0.82, 5.51) was found. Regular physical exercise was a protective factor (OR = 0.26; 95% CI: 0.12, 0.57). Using excessive salt at meals was a significant risk factor (OR = 16.61; 95% CI: 4.40, 62.80) in people having low level of stress, whereas it was not significant in people having high level of stress. (OR = 1.76; 95% CI: 0.58, 5.33). Smoking in combination with low level of stress was a significant risk factor for stroke (OR = 9.88; 95% CI: 2.52, 38.78), but a non-significant protective factor in combination with high level of stress (OR = 0.52; 95% CI: 0.14, 1.99). An increase in compliance with the pharmacological and non-pharmacological therapeutic regimen might be a key to a reduction of stroke incidence and prevalence among hypertensive patients.B. Th. Baune, Y. Aljeesh & R. Bende

Predictors of quality of life among hyptertensive patients with and without stroke

Compliance with the pharmacological and non-pharmacological therapeutic regimen is essential to prevent occurrence and worsening hypertension and stroke. This study aimed at the identification of predictors of Quality of Life (QOL) among hypertensive patients without stroke and hypertensive patients with stroke. Self-reported QOL was obtained from 112 patients with hypertension and stroke and 224 patients with hypertension only with the WHO-QOL-BREF questionnaire and compliance with the pharmacological and non-pharmacological therapeutic regimen was assessed with a standardized questionnaire. Means of QOL were compared with ANOVA procedures and predictors were estimated using multiple linear regression models. The results of this study showed that selfreported QOL is poorer in patients with stroke than in hypertensive patients. Male gender appears to be a strong predictor of quality of life in patients either with hypertension or stroke. Follow up health care programmes are essential for good quality of life among both patient groups. Diet, physical exercise, low level of stress are important factors for enhanced QOL. Current smoking seems to enhance the psychological and social dimensions for both patients groups. Multiple linear regression models indicate that low level of stress and male gender are genuine predictors of all dimensions of QOL among hypertensive patients, but not in stroke patients. It is concluded in this study that compliance with the pharmacological and non-pharmacological therapeutic regimen is strongly linked with a better QOL among patients with stroke and hypertension or hypertension only.Bernhard T. Baune, Yousef I. Aljeesh and Ina Adria