Medication adherence and associated factors towards anti-hypertensive medications: A cross- sectional study analysis of patients attending OPD at Government Hospital in North India

Abstract

Introduction: Hypertension is a global public health issue.Hypertensive heart disease is one
of the top ten leading causes of death in the world.Hypertension is also a major contributor to
the global disease burden of cardiovascular and cerebrovascular disease.Poor adherence to
medications is one of the major public health issue and challenge. Only one-third ofthe
population reported successful control of blood pressure.Despite of the availability for
effective treatment, over half of the patients being treated for hypertension drop out of care
entirely within a year of diagnosis.Recent research suggests that poor adherence and poor
complianceto antihypertensive medication (AHM) is a major hurdle in the management of
hypertension and is usually associated with bad outcome of the disease and wastage of
limited health care resources.Adherence to antihypertensive medication isa very effective step
for controlling blood pressure and preventing complications.To prevent some of the
complications of hypertension regular intake of the prescribed treatment in the form of
medicines (pills) is very essential and important.The current study aimed to assess the level
of compliance of hypertensive patients to their anti-hypertensive medications and to
determine the socio-demographic correlates of compliance. Methods: A total of 512 patients
were enrolled from the Department of Internal Medicine at King George's Medical University
(KGMU), Lucknow according to the American Heart Association ( AHA ) guidelines. Both
male and female patients of age between 35-75 years on anti – hypertensive medications ,
providing written consent were included in the study.An institutional-based descriptive crosssectional study was conducted among hypertensive patients.A simple random sampling
technique was used to select the study participants from the study population.
Sociodemographic data, medication adherence, factors affecting adherence were collected
using a structured questionnaire and an 8-item Morisky Medication Adherence Scale
questionnaire was used to assess the level of adherence. The questionnaire had 8 questions
and a score of 7 or 8 was classified as good adherence, 6 as moderate, and less than 6 as non
adherence. On each visit at the OPD the questionnaire was provided to the patients. Results:
A total of 62 patients were lost to follow-up, resulting in 450 patients out of 512 having hypertension further completed the study.The mean (±SD) age of the study participants was
54.5 (±10.6) years.Medication adherence was good among 115 (25.6%) patients and
moderate among 165 (36.7%); 170 (37.8%) patients were nonadherent. Most patients
(72.7%) had uncontrolled hypertension. Nearly half (49.6%) were unable to afford monthly
medication.In bivariate analysis, nonadherence was associated with female sex (odds ratio
[OR], 1.44; P = .003) and long waiting times in the health care facility (OR, 2.93; P = .005);
the presence of comorbidities (OR, 0.62; P = .01) was associated with good adherence. In
multivariate analysis, nonadherence was associated with unaffordability of treatment (OR,
2.25; P = .002) and uncontrolled hypertension (OR, 3.16; P < .001). Good adherence
determinants included adequate counseling (OR, 0.29; P < .001) and education (OR, 0.61; P =
.02).The analysis was done using proportions and Chi-square test . Binary logistic regression
analysiswas performed to determine covariates associated with medication adherence.
Conclusion: Low level of knowledge regarding hypertensionrelated complications or
associated risk factors was also noted.Patient education, family counselling, social support
networks and also the use and importance of gadgets should be strengthened in health
promotion programs in order to enhance compliance of hypertensive patients with the
therapeutic regimen and to improve their quality of life. The level of poor adherence to antihypertensive medications and low level of knowledge on hypertension was a point of
concern.The status of blood pressure control was significantly associated with the pattern of
adherence.The barriers to adherence were cost of drug and more number of pills per day .