To identify clinical factors independently associated with COVID-19–related hospitalization and short-term mortality among hypertensive patients mana

Background/Objectives: Mediterranean diet adherence has been associated with cardiometabolic and psychological health, but evidence integrating these outcomes with health-related quality of life in primary care populations remains limited. This study examined the associations between Mediterranean diet adherence and anthropometric, cardiometabolic, psychological, and health-related quality-of-life outcomes. Methods: This cross-sectional study included 495 adults attending primary care centres in Navarra, Spain. Mediterranean diet adherence was assessed using the validated 14-item Mediterranean Diet Adherence Screener (MEDAS-14). Multivariable linear regression models examined associations between the continuous MEDAS-14 score and study outcomes, adjusting for age, sex, educational attainment, physical activity, and BMI when appropriate. Sensitivity analyses, assessment of non-linearity, false-discovery-rate correction across the nine principal outcomes, and interaction-by-sex analyses were also performed. Results: Each one-point increase in the MEDAS-14 score was associated with lower systolic blood pressure (β = −1.056 mmHg; 95% confidence interval (CI): −1.774 to −0.338; p = 0.004), diastolic blood pressure (β = −0.838 mmHg; 95% CI: −1.261 to −0.415; p < 0.001), fasting blood glucose (β = −0.745 mg/dL; 95% CI: −1.365 to −0.125; p = 0.019), and Goldberg anxiety score (β = −0.249; 95% CI: −0.368 to −0.130; p < 0.001), and with higher EQ VAS scores (β = 1.224; 95% CI: 0.570 to 1.878; p < 0.001). The associations with BMI, systolic and diastolic blood pressure, fasting blood glucose, Goldberg anxiety score, and EQ VAS remained statistically evident after false-discovery-rate correction, and the overall pattern was generally consistent across sensitivity analyses. No adjusted association with Goldberg depression score was observed. BMI was inversely associated with MEDAS-14 in the principal linear model (β = −0.299 kg/m²; 95% CI: −0.521 to −0.077; p = 0.009), whereas the association with waist circumference was not statistically significant (β = −0.475 cm; 95% CI: −1.046 to 0.095; p = 0.102). BMI, waist circumference, and total cholesterol showed evidence of non-linearity. Exploratory interaction analyses showed evidence of interaction by sex for diastolic blood pressure and EQ VAS after false-discovery-rate correction. Conclusions: Higher MEDAS-14 scores were associated with lower blood pressure and fasting blood glucose, fewer anxiety symptoms, and better self-perceived health. Associations for BMI, waist circumference, and total cholesterol showed evidence of non-linearity and should be interpreted cautiously. These cross-sectional findings do not establish temporality or causality and should also be interpreted in light of the lack of adjustment for relevant clinical diagnoses and medication use. Prospective confirmation is warranted.

Introduction Poor long-term adherence to antihypertensive medication remains a major challenge in hypertension management, particularly among older adults, contributing to suboptimal blood pressure control, cardiovascular morbidity and reduced quality of life. Nurse-led educational and behavioural interventions delivered in primary care may improve medication adherence; however, evidence from pragmatic cluster randomised trials integrated into routine clinical practice remains limited. This study aims to evaluate whether a nurse-led multidimensional educational and behavioural intervention improves adherence to antihypertensive treatment among older adults with hypertension in primary care. Methods and analysis NURSE-ADHERE-HTN is an ongoing pragmatic, open-label, cluster randomised controlled trial being conducted in 14 primary care centres of the Navarra Health Service–Osasunbidea, Spain. The trial was prospectively registered in the ISRCTN registry (ISRCTN35559821). Primary care centres were centrally allocated in a 1:1 ratio to the intervention or usual-care group, with seven centres per group and two participating nurses per centre. The target sample size is 280 participants aged 60 years or older with hypertension, prescribed at least one antihypertensive medication and identified as non-adherent using the 4-item Morisky Medication Adherence Scale (MMAS-4). The intervention consists of a nurse-led multidimensional educational and behavioural programme integrated into routine primary care, comprising individualised education, motivational interviewing, review of antihypertensive treatment and medication-taking routines, Mediterranean diet counselling, physical activity support and telephone reinforcement. The primary outcome will be adherence to antihypertensive treatment at 6 months, assessed using the MMAS-4 in accordance with the licensed wording, structure and standardised scoring method. Adherence will also be assessed at baseline and 12 months, with the 12-month assessment used to evaluate whether any intervention effect observed at 6 months is maintained over time. Electronic prescription dispensing records will provide a complementary measure of adherence. Secondary outcomes will include blood pressure assessed using 24-hour ambulatory monitoring, health-related quality of life, cardiovascular-related emergency department visits and hospital admissions, symptoms of anxiety and depression, Mediterranean diet adherence, physical activity, reasons for non-adherence, anthropometric and selected laboratory variables, medication burden and concordance between adherence measures. Outcomes will be assessed at baseline, 6 months and 12 months. Prespecified exploratory analyses will assess effect modification by sex. Statistical analyses will account for clustering at the primary care centre level. Ethics and dissemination The study was approved by the Navarra Clinical Research Ethics Committee (reference PI_2023/92). Written informed consent is obtained from all participants before enrolment. Findings will be disseminated through peer-reviewed publications, conference presentations and reports to healthcare stakeholders. Trial registration number ISRCTN35559821.

Hypertension is common among patients with type 2 diabetes mellitus (T2DM) and represents a major contributor to cardiovascular and renal morbidity. Real-w