LOST PILL, LOST CONTROL: INVESTIGATING NON-ADHERENCE TO ANTIHYPERTENSIVE THERAPY IN HYPERTENSIVE PATIENTS
Main Article Content
Keywords
Hypertension, non-adherence, antihypertensive medications, cardiovascular morbidity, blood pressure control, smoking cessation, adherence predictors, clinical outcomes, essential hypertension, patient-centered interventions.
Abstract
Background: Non-adherence to antihypertensive medications is a significant barrier to achieving optimal blood pressure control and reducing cardiovascular morbidity and mortality. Despite advancements in hypertension management, poor adherence remains a persistent challenge influenced by multiple demographic, clinical, and behavioral factors.
Objective: This single-center prospective cohort study aimed to identify predictors of non-adherence to antihypertensive medications and evaluate their impact on clinical outcomes in patients with essential hypertension.
Methods: This study included 350 participants recruited from a tertiary care hospital in Pakistan. Data were collected through structured interviews, clinical evaluations, and reviews of medical and pharmacy records. Adherence was assessed using patient self-reports, pharmacy refill data, and clinical documentation. Demographic and clinical variables, including age, sex, smoking status, diabetes, and BMI, were analyzed. Multivariate logistic regression was employed to identify predictors of non-adherence, while clinical outcomes were evaluated using comparative statistical analyses.
Results: Non-adherence was observed in 24.3% of the participants and was significantly associated with older age, male sex, and smoking status. Adherent participants demonstrated better blood pressure control (78.6% achieving target BP <140/90 mmHg vs. 48.2%, p < 0.001) and lower hospitalization rates (9.2% vs. 23.5%, p < 0.001) than non-adherent participants. Multivariate logistic regression identified smoking as the strongest predictor of non-adherence (OR: 2.45; 95% CI: 1.72–3.12, p < 0.001).
Conclusion: This study highlights the significant impact of non-adherence on clinical outcomes in patients with essential hypertension. These findings underscore the importance of addressing modifiable risk factors, such as smoking, through targeted, patient-centered interventions. By improving adherence, healthcare providers can optimize hypertension management and reduce the burden of hypertension-related complications.
References
2. Mills, K. T., Stefanescu, A., & He, J. (2020). The global epidemiology of hypertension. Nature Reviews Nephrology, 16(4), 223–237. https://doi.org/10.1038/s41581-019-0244-2
3. Oparil, S. (2014). Low Sodium Intake — Cardiovascular Health Benefit or Risk? New England Journal of Medicine, 371(7), 677–679
4. Whelton PK, Carey RM, Aronow WS, et al.: 2017 ACC/AHA guideline for teh prevention, detection, evaluation, and management of high blood pressure in adults. J Am Coll Cardiol. 2018, 71:127-248. 10.1001/jama.2017.18209IF: 63.1 Q1
5. Burnier M, Egan BM: Adherence in hypertension: A review of prevalence, risk factors, impact, and management. Circ Res. 2019, 124:1124-1140. 10.1161/CIRCRESAHA.118.313220IF: 16.5 Q1
6. Dragomir, A., Lalonde, L., Roy, L., Blais, L., Bérard, A., Côté, R., & Perreault, S. (2010). Impact of Adherence to Antihypertensive Agents on Clinical Outcomes and Hospitalization Costs. Medical Care, 48(5), 418–425. https://doi.org/10.1097/mlr.0b013e3181d567bd
7. Nieuwlaat R, Wilczynski N, Navarro T, et al.: Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2014, 11:10.1002/14651858.CD000011.pub4IF: 8.8 Q1
8. Krousel-Wood M, Thomas S, Muntner P, et al.: Medication adherence: A key factor in achieving blood pressure control and good clinical outcomes in hypertensive patients. Curr Opin Cardiol. 2004, 19:357-362. 10.1097/01.hco.0000134353.82580.96
9. Kamran A, Ahari SS, Biria M, et al.: Determinants of patient adherence to antihypertensive medications: Application of health belief model among rural patients. Ann Med Health Sci Res. 2014, 4:922-927. 10.4103/2141-9248.144914
10. Mazzaglia G, Ambrosioni E, Alacqua M, et al.: Adherence to antihypertensive medications and cardiovascular morbidity among newly diagnosed hypertensive patients. Circulation. 2009, 120:1598-1605. 10.1161/CIRCULATIONAHA.108.830299IF: 35.5 Q1
11. Chow CK, Teo KK, Rangarajan S, et al.: Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA. 2013, 310:959-968. 10.1001/jama.2013.184182IF: 63.1 Q1
12. Mills KT, Bundy JD, Kelly TN, et al.: Global disparities of hypertension prevalence and control: A systematic analysis of population-based studies from 90 countries. Circulation. 2016, 134:441-450. 10.1161/CIRCULATIONAHA.115.018912IF: 35.5 Q1
13. Sabate E: Adherence to Long-term Therapies: Evidence for Action. World Health Organization. 2003, 10.1111/j.1547-5069.2003.tb00001.xIF: 2.4 Q1
14. Kini V, Ho PM: Interventions to improve medication adherence: A review. JAMA. 2018, 320:2461-2473. 10.1001/jama.2018.19271IF: 63.1 Q1
15. Zolnierek KB, DiMatteo MR: Physician communication and patient adherence to treatment: A meta-analysis. Med Care. 2009, 47:826-834. 10.1097/MLR.0b013e31819a5accIF: 3.3 Q1
16. Kronish IM, Ye S: Adherence to cardiovascular medications: Lessons learned and future directions. Prog Cardiovasc Dis. 2013, 55:590-600. 10.1016/j.pcad.2013.02.001IF: 5.6 Q1
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr Fahad Raja khan
Fellow Interventional Cardiology Peshawar, Pakistan
Dr Syed Alishan
Assistant Professor of Cardiology, Intervention Cardiologist Peshawar Institute of Cardiology, Pakistan,
Dr Naveed Yaqoob
Associate Professor of Cardiology, FG Polyclinic (NUST School of Health Sciences), Islamabad, Pakistan,
Dr Atif Ahmed Khan
Assistant Professor, Intervention Cardiology, Sindh Institute of Cardiovascular Diseases Hyderabad, Sindh, Pakistan,
Dr Jamil Hussain
Assistant Professor Cardiology, Gambat Institute of Medical Science, Pakistan
Dr Sauda Usmani
Associate Professor, Department of Physiology, Pak Red Crescent Medical and Dental College Lahore, Pakistan,