Abstract
BACKGROUND: Hypertension and chronic pain frequently co-occur in older adults. However, research on this association in older hypertensive patients is scarce. Self-perceptions of aging (SPA)-one's concept about aging-correlates with pain-related quality of life (pQOL) and predicts medication adherence, a pillar of blood pressure (BP) control. This study examined the association between pQOL and uncontrolled BP in older hypertensive patients, exploring whether SPA and medication adherence mediate it: a novel exploration of psychological-behavioral pathways in pain-hypertension association. METHODS: The study involved 622 hypertensive patients aged 60 and above in Suzhou, China. Variables were compared using ANOVA and χ2 tests, respectively. Adjusted binary logistic regression models examined the pQOL-uncontrolled BP relationship, while Spearman correlation analyzed associations between pQOL, medication adherence, and negative control. We performed chain mediation analysis (PROCESS Macro) with bootstrapping. RESULTS: Higher pQOL scores significantly predicted uncontrolled BP (Q2, Q3, Q4; odds ratio [OR]=2.77, 5.50, 3.45; p=0.002, <0.001, 0.001, respectively). Negative control mediated the relationship between pQOL (b=-0.007, p<0.001) and uncontrolled SBP (OR=0.670, p<0.01, respectively), while the chain mediation of negative control and medication adherence contributed to both uncontrolled SBP (mediation effect=0.017, p<0.01) and uncontrolled DBP (mediation effect=0.018, p<0.01). CONCLUSION: Higher pQOL scores was associated with higher prevalence of uncontrolled BP. The mediating role of negative control and medication adherence was identified in the relationship between pQOL and uncontrolled BP (SBP/DBP) in older hypertensive patients.