Association Between Caregiver Strain and Self-Care Among Caregivers With Hypertension: Findings From the REGARDS Study

Abstract

Background: Self-care for adults with hypertension includes adherence to lifestyle behaviors and medication. For unpaid caregivers with hypertension, the burden of family caregiving may adversely impact self-care. We examined the association between caregiver strain and hypertension self-care among caregivers with hypertension.

Methods and results: We included participants of the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study who identified as caregivers and had hypertension. Caregiver strain, assessed by self-report, was categorized as "none/some" or "high." Hypertension self-care was assessed individually across 5 domains (Dietary Approaches to Stop Hypertension [DASH] diet, physical activity, alcohol use, cigarette smoking, and medication adherence) and a composite self-care score summing performance across them. The association between caregiver strain and hypertension self-care was examined with multivariable linear regression. Among the 2128 caregivers with hypertension, 18.1% reported high caregiver strain. Caregivers with high strain versus those with none/some were less adherent to the DASH diet (50.8% versus 38.9%, P<0.002), physically inactive (44.4% versus 36.2%, P<0.009), current smokers (19.7% versus 13.9%, P<0.004), and had lower overall self-care scores (6.6 [SD 1.7] versus 7.0 [SD 1.7], P<0.001). In an age-adjusted model, high caregiver strain was associated with worse hypertension self-care (β=-0.37 [95% CI, -0.61 to -0.13]); this remained significant but was reduced in magnitude after adjustment for sociodemographics (β=-0.35 [-0.59 to -0.11]), comorbidities (β=-0.34 [-0.57 to -0.10]), caregiving intensity (β=-0.34 [-0.59 to 0.10]), and psychological factors (β=-0.26 [-0.51 to 0.00]).

Conclusions: High caregiver strain was associated with worse hypertension self-care overall and across individual domains. Increased awareness of caregiver strain and its potential impact on hypertension self-care is warranted.

Keywords: caregivers; cohort study; hypertension; self‐care.

Figure 1. Exclusion cascade for caregiver strain and hypertension self‐care in the reasons for geographic and racial differences in strokes study.

*Caregiver defined as participant who answered yes to, “Are you currently providing care on an ongoing basis to a family member with a chronic illness or disability? This would include any kind of help such as watching your family member, dressing or bathing this person, arranging care, or providing transportation.” Self‐reported hypertension defined as participant who answered yes to, “Has a doctor or other health professional ever told you that you have high blood pressure?” DASH indicates Dietary Approaches to Stop Hypertension; and REGARDS, Reasons for Geographic and Racial Differences in Stroke study.

Figure 2. Distribution of hypertension self‐care composite score by caregiver strain.

A, Displays distribution of self‐care score among participants with no/some caregiver strain. B, Displays distribution of self‐care score among participants with a lot of caregiver strain.