The issue of non-adherence among patients prescribed beta blockers for hypertension is well known. One of the reasons for this is that the condition may be asymptomatic and thus from the patient's perspective does not require treatment. The aim of this preliminary study was to determine the feasibility of using pulse rate as an estimator of adherence in patients taking beta blockers
Patients taking beta blockers were interviewed to determine demographic details and their drug history then their pulse rate and blood pressure readings were taken. Adherence to their medication was also measured by the Morisky self-reported questionnaire. Those patients meeting the criteria for selection had their pulse rate compared with a group of controls and the results were analysed statistically using a t-test.
In those patients taking beta blockers there was a normal distribution of the pulse rate with a mean value of 60.6 (SD = 6.80), a median value of 60 and a modal value of 64. In the control group, there was no pattern in the distribution of the pulse rates and the mean value was 75.1 (SD = 8.53). A statistically significant difference was found in the pulse rate of patients taking beta blockers and the control subjects (t=-8.19, p<0.05).
The results suggest that the pulse rate in patients taking beta blockers is significantly lower compared to a group of control subjects. Therefore pulse could be used as measure of adherence in patients taking beta blockers assuming that when patients did not adhere their pulse rate was similar to that of the control subjects. There are limitations in that pulse rates of 65 and under are only detected in 77% of patients taking beta blockers hence a pulse may be normal yet there is good control of blood pressure. A further limitation is that the pulse cannot be used if the patient is taking any other medication that affects pulse. However, taking a pulse reading in a community pharmacy setting is a simple, cheap and fast measurement which enhances the role of the pharmacist in the pharmaceutical care of patients. The act of thing a physical measurement allows the pharmacist to communicate with the patient on a more intimate basis, breaking down barriers there may be to patient contact.