Researchers studied 646 people in Croatia who have high blood pressure to understand why it’s hard to control. They found that most people weren’t following their Mediterranean diet, half weren’t taking their medications as prescribed, and three-quarters were overweight or obese. Men and women showed different patterns of high blood pressure problems. The study suggests that doctors should check whether patients are actually taking their medicines, eating healthy, and maintaining a healthy weight to better manage high blood pressure and prevent heart disease.

The Quick Take

  • What they studied: Why high blood pressure is difficult to control in people living in the Dalmatian region of Croatia, and what factors like diet, weight, and medication use might be involved.
  • Who participated: 646 adults from Croatia who either had high blood pressure or were already taking blood pressure medication. About 38% were overweight and 39% were obese.
  • Key finding: Only half of the patients were taking their blood pressure medications correctly, and only 7% were following a healthy Mediterranean diet. These two factors made it much harder to control their blood pressure.
  • What it means for you: If you have high blood pressure, taking your medicine exactly as prescribed and eating a Mediterranean diet (lots of vegetables, fish, and olive oil) may help control it better. However, this study only looked at one region in Croatia, so results may differ elsewhere.

The Research Details

This was a cross-sectional study, which means researchers looked at a large group of people at one point in time rather than following them over months or years. They recruited 646 people from a high blood pressure clinic in Croatia who were either already taking blood pressure medication or had been diagnosed with high blood pressure using a special 24-hour blood pressure monitor.

Each person answered questionnaires about whether they were taking their medicines correctly and how well they followed a Mediterranean diet. Researchers also measured their body weight and composition, and used a special 24-hour monitor to track their blood pressure throughout the day and night.

This approach allowed researchers to get a clear picture of the current situation in this population without waiting years for results, though it doesn’t show cause-and-effect relationships.

Understanding why blood pressure is hard to control in a specific population helps doctors create better treatment plans. By measuring actual medication use and diet patterns, researchers could see the real-world challenges people face, not just what happens in ideal conditions.

This study is reliable because it used objective measurements like 24-hour blood pressure monitors rather than relying only on patient memory. The large sample size of 646 people makes the findings more trustworthy. However, because it only looked at one moment in time and one region of Croatia, we can’t be sure these patterns apply everywhere or how things might change over time.

What the Results Show

The study revealed three major problems in this Croatian population with high blood pressure. First, weight was a significant issue: 77% of participants were either overweight or obese, with a median body mass index of 28.6. Second, medication adherence was poor, with only 50% of people taking their blood pressure medicines correctly as prescribed. Third, diet was a major concern, with only 7% of people following Mediterranean diet recommendations.

When researchers looked at blood pressure control patterns, they found important differences between men and women. Men had higher blood pressure readings in their arms and were more likely to have uncontrolled diastolic blood pressure (the bottom number). Women were more likely to have isolated systolic elevation (high top number only) and had faster heart rates.

These findings suggest that the combination of poor medication adherence, unhealthy diet, and excess weight creates a perfect storm for uncontrolled blood pressure in this population.

Women showed higher heart rates and a measurement called augmentation index, which relates to how stiff their arteries were becoming. This suggests women in this population may be at particular risk for future heart problems. The study also showed that body composition (how much muscle versus fat someone has) varied significantly, which can affect blood pressure control independently of weight alone.

Previous research has shown that medication adherence and diet are important for blood pressure control worldwide. This study confirms those findings in a Croatian population and adds new information about how common these problems are in this specific region. The very low Mediterranean diet adherence (7%) is notably lower than in other Mediterranean countries, suggesting unique challenges in this area.

This study only looked at people at one point in time, so we can’t determine whether poor diet and medication adherence caused the high blood pressure or resulted from it. The study only included people from one region of Croatia, so results may not apply to other parts of Croatia or other countries. People who agreed to participate might be different from those who didn’t, which could affect the results. The study doesn’t explain why only 7% followed the Mediterranean diet, so we don’t know what barriers people face.

The Bottom Line

If you have high blood pressure, take your medications exactly as prescribed (moderate confidence). Eat more Mediterranean diet foods like vegetables, fish, olive oil, and whole grains (moderate confidence). Maintain a healthy weight through balanced eating and physical activity (moderate confidence). These changes may help control your blood pressure and reduce your risk of heart disease.

People with high blood pressure should pay attention to these findings, especially those living in Mediterranean regions or similar populations. Healthcare providers in Croatia and similar areas should consider screening for medication adherence and diet problems as part of routine blood pressure management. This study is less directly relevant to people living in very different climates or cultures where Mediterranean diet may not be practical.

It typically takes 2-4 weeks to see changes in blood pressure after improving medication adherence. Diet changes may take 4-8 weeks to show effects. Weight loss benefits usually appear after 8-12 weeks of consistent effort. However, individual results vary significantly.

Want to Apply This Research?

  • Track daily medication adherence by logging each dose taken and weekly Mediterranean diet meals (count servings of vegetables, fish, and olive oil). Monitor weight weekly and blood pressure readings if you have a home monitor.
  • Set daily reminders for medication times. Plan one Mediterranean-style meal per day using the app’s recipe suggestions. Log one new Mediterranean food to try each week.
  • Create a weekly adherence score combining medication compliance percentage, Mediterranean diet meal count, and weight trend. Review monthly to identify patterns and adjust strategies as needed.

This research describes patterns in a Croatian population and should not be used for self-diagnosis or to replace medical advice from your doctor. If you have high blood pressure, consult with your healthcare provider before making changes to your medication or diet. The findings may not apply to all populations or individuals. Always follow your doctor’s specific recommendations for your blood pressure management.