Medication Adherence Among Hypertensive Patients in Kurdistan Region of Iraq: An Observational Follow-Up Study
DOI:
https://doi.org/10.55489/njcm.150120243382Keywords:
Medication adherence, Hypertension, PatientsAbstract
Background: Adherence to medications is a main concern to hypertension control and incidence of CVD complications. This study aimed to measure the level of medication adherence of hypertensive patients after one month follow-up.
Methods: An observational one-month follow-up study was conducted in 93 hypertensive patients in Kurdistan Region.
Results: Patients’ mean age was 55.03 (25-85 years). The mean value of the MARS score of adherences was 7.68 out of 10. The mean values of dimensions of adherence were 3.20 of 4 (medication adherence behavior), 2.92 of 4 (attitude toward taking medication), and 1.55 of 2 (negative side effects and attitudes to medication). We found that the males, single and married, urban, those with no chronic disease, and those with higher levels of education were more likely to adhere to medication. The patients with shorter disease duration and treatment had higher adherence scores. The patients with no experience of the medication side effects had higher levels of medication adherence (8.80 vs. 7.00; P<0.0001) and patients who took fewer tablets/day.
Conclusions: We observed high-adherence level among hypertensive patients. Prolong disease duration, long treatment duration, increase number of tablets/days, and increase number of comorbidities may significantly decrease the medication adherence rate.
References
Wolf-Maier K, Cooper RS, Banegas JR, Giampaoli S, Hense H-W, Joffres M, et al. Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States. Jama 2003;289(18):2363-9. Doi: https://doi.org/10.1001/jama.289.18.2363 PMid:12746359
Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nature Reviews Nephrology 2020;16(4):223-37. Doi: https://doi.org/10.1038/s41581-019-0244-2 PMid:32024986 PMCid:PMC7998524
Burnier M, Egan BM. Adherence in hypertension: a review of prevalence, risk factors, impact, and management. Circulation research 2019;124(7):1124-40. Doi: https://doi.org/10.1161/CIRCRESAHA.118.313220 PMid:30920917
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. The lancet 2005;365(9455):217-23. Doi: https://doi.org/10.1016/S0140-6736(05)17741-1 PMid:15652604
Suchard MA, Schuemie MJ, Krumholz HM, You SC, Chen R, Pratt N, et al. Comprehensive comparative effectiveness and safety of first-line antihypertensive drug classes: a systematic, multinational, large-scale analysis. The Lancet 2019;394(10211):1816-26. Doi: https://doi.org/10.1016/S0140-6736(19)32317-7 PMid:31668726
Sabaté E, Organization WH. Adherence to long-term therapies: policy for action: meeting report, 4-5 June 2001. World Health Organization; 2001.
Ramli A, Ahmad NS, Paraidathathu T. Medication adherence among hypertensive patients of primary health clinics in Malaysia. Patient preference and adherence 2012:613-22. Doi: https://doi.org/10.2147/PPA.S34704 PMid:22969292 PMCid:PMC3437910
Li YT, Wang HH, Liu KQ, Lee GK, Chan WM, Griffiths SM, et al. Medication adherence and blood pressure control among hypertensive patients with coexisting long-term conditions in primary care settings: a cross-sectional analysis. Medicine 2016;95(20). Doi: https://doi.org/10.1097/MD.0000000000003572 PMid:27196458 PMCid:PMC4902400
Matsumura K, Arima H, Tominaga M, Ohtsubo T, Sasaguri T, Fujii K, et al. Impact of antihypertensive medication adherence on blood pressure control in hypertension: the COMFORT study. QJM: An International Journal of Medicine 2013;106(10):909-14. Doi: https://doi.org/10.1093/qjmed/hct121 PMid:23696676
Shin S, Song H, Oh S-K, Choi KE, Kim H, Jang S. Effect of antihypertensive medication adherence on hospitalization for cardiovascular disease and mortality in hypertensive patients. Hypertension Research 2013;36(11):1000-5. Doi: https://doi.org/10.1038/hr.2013.85 PMid:23966057
Thompson K, Kulkarni J, Sergejew A. Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. Schizophrenia research 2000;42(3):241-7. Doi: https://doi.org/10.1016/S0920-9964(99)00130-9 PMid:10785582
Fialko L, Garety PA, Kuipers E, Dunn G, Bebbington PE, Fowler D, et al. A large-scale validation study of the Medication Adherence Rating Scale (MARS). Schizophrenia research 2008;100(1-3):53-9. Doi: https://doi.org/10.1016/j.schres.2007.10.029 PMid:18083007
Lavsa SM, Holzworth A, Ansani NT. Selection of a validated scale for measuring medication adherence. Journal of the American Pharmacists Association 2011;51(1):90-4. Doi: https://doi.org/10.1331/JAPhA.2011.09154 PMid:21247831
De Geest S, Sabaté E. Adherence to long-term therapies: evidence for action. European Journal of Cardiovascular Nursing 2003;2(4):323-. Doi: https://doi.org/10.1016/S1474-5151(03)00091-4 PMid:14667488
Mollaoğlu M, Solmaz G, Mollaoğlu M. Adherence to therapy and quality of life in hypertensive patients. Acta Clinica Croatica 2015;54(4).
Yassine M, Al-Hajje A, Awada S, Rachidi S, Zein S, Bawab W, et al. Evaluation of medication adherence in Lebanese hypertensive patients. Journal of epidemiology and global health 2016;6(3):157-67. Doi: https://doi.org/10.1016/j.jegh.2015.07.002 PMid:26232704 PMCid:PMC7320474
Khayyat SM, Khayyat SMS, Hyat Alhazmi RS, Mohamed MM, Abdul Hadi M. Predictors of medication adherence and blood pressure control among Saudi hypertensive patients attending primary care clinics: a cross-sectional study. PloS one 2017;12(1):e0171255. Doi: https://doi.org/10.1371/journal.pone.0171255 PMid:28135324 PMCid:PMC5279800
Yue Z, Bin W, Weilin Q, Aifang Y. Effect of medication adherence on blood pressure control and risk factors for antihypertensive medication adherence. Journal of evaluation in clinical practice 2015;21(1):166-72. Doi: https://doi.org/10.1111/jep.12268 PMid:25318567
Dennis T, Meera N, Binny K, Sekhar MS, Kishore G, Sasidharan S. Medication adherence and associated barriers in hypertension management in India. CVD Prevention and Control 2011;6(1):9-13. Doi: https://doi.org/10.1016/j.cvdpc.2010.11.001
Yang S, He C, Zhang X, Sun K, Wu S, Sun X, et al. Determinants of antihypertensive adherence among patients in Beijing: application of the health belief model. Patient education and counseling 2016;99(11):1894-900. Doi: https://doi.org/10.1016/j.pec.2016.06.014 PMid:27378081
Jhaj R, Gour PR, Kumari S, Sharma S. Association between medication adherence and blood pressure control in urban hypertensive patients in central India. International Journal of Noncommunicable Diseases 2018;3(1):9-14. Doi: https://doi.org/10.4103/jncd.jncd_29_16
Lee GK, Wang HH, Liu KQ, Cheung Y, Morisky DE, Wong MC. Determinants of medication adherence to antihypertensive medications among a Chinese population using Morisky Medication Adherence Scale. PloS one 2013;8(4):e62775. Doi: https://doi.org/10.1371/journal.pone.0062775 PMid:23638143 PMCid:PMC3636185
Bhusal A, Jadhav PR, Deshmukh YA. Assessment of medication adherence among hypertensive patients: a cross-sectional study. Int J Basic Clin Pharmacol 2016;5(4):1606. Doi: https://doi.org/10.18203/2319-2003.ijbcp20162480
Gutierrez MM, Sakulbumrungsil R. Factors associated with medication adherence of hypertensive patients in the Philippines: a systematic review. Clinical hypertension 2021;27:1-15. Doi: https://doi.org/10.1186/s40885-021-00176-0 PMid:34593047 PMCid:PMC8485436
Khan GM, Thapa RK, Khakurel A, Shrestha G, Katila N, Bhurtel S. Medication adherence and blood pressure control among hypertensive patients of Pokhara valley. Journal of Health and Allied Sciences 2013;3(1):64-7. Doi: https://doi.org/10.37107/jhas.59
Asgedom SW, Atey TM, Desse TA. Antihypertensive medication adherence and associated factors among adult hypertensive patients at Jimma University Specialized Hospital, southwest Ethiopia. BMC research notes 2018;11:1-8.Doi: https://doi.org/10.1186/s13104-018-3674-1 PMid:30115123 PMCid:PMC6094913
Sharma P, Shrestha B. Medication adherence and blood pressure control among hypertensive patients in Salyan Hospital. Journal of General Practice and Emergency Medicine of Nepal 2021;8(11):37-41. Doi: https://doi.org/10.59284/jgpeman68
Teshome DF, Bekele KB, Habitu YA, Gelagay AA. Medication adherence and its associated factors among hypertensive patients attending the Debre Tabor General Hospital, northwest Ethiopia. Integrated blood pressure control 2017:1-7. Doi: https://doi.org/10.2147/IBPC.S128914 PMid:28670137 PMCid:PMC5482403
Inkster ME, Donnan P, MacDonald T, Sullivan F, Fahey T. Adherence to antihypertensive medication and association with patient and practice factors. Journal of human hypertension 2006;20(4):295-7. Doi: https://doi.org/10.1038/sj.jhh.1001981 PMid:16424861
Siegel D, Lopez J, Meier J. Antihypertensive medication adherence in the Department of Veterans Affairs. The American journal of medicine 2007;120(1):26-32. Doi: https://doi.org/10.1016/j.amjmed.2006.06.028 PMid:17208076
Piercefield EW, Howard ME, Robinson MH, Kirk CE, Ragan AP, Reese SD. Antihypertensive medication adherence and blood pressure control among central Alabama veterans. The Journal of Clinical Hypertension 2017;19(5):543-9. Doi: https://doi.org/10.1111/jch.12953 PMid:27917605 PMCid:PMC8031312
Dehghan M, Dehghan Nayeri N. Factors Affecting Hypertensive Treatment Adherence: Development and Preliminary Validation of a New Scale. 2021;2021:6617980. Doi: https://doi.org/10.1155/2021/6617980 PMid:33824763 PMCid:PMC8007347
Van der Feltz-Cornelis CM, Van Oppen P, Van Marwijk HW, De Beurs E, Van Dyck R. A patient-doctor relationship questionnaire (PDRQ-9) in primary care: development and psychometric evaluation. General hospital psychiatry 2004;26(2):115-20. Doi: https://doi.org/10.1016/j.genhosppsych.2003.08.010 PMid:15038928
Krousel-Wood M, Thomas S, Muntner P, Morisky D. Medication adherence: a key factor in achieving blood pressure control and good clinical outcomes in hypertensive patients. Current opinion in cardiology 2004;19(4):357-62. Doi: https://doi.org/10.1097/01.hco.0000126978.03828.9e PMid:15218396
Reckelhoff JF. Gender differences in hypertension. Current opinion in nephrology and hypertension 2018;27(3):176-81. Doi: https://doi.org/10.1097/MNH.0000000000000404 PMid:29406364
Uchmanowicz B, Chudiak A, Uchmanowicz I, Rosińczuk J, Froelicher ES. Factors influencing adherence to treatment in older adults with hypertension. Clinical interventions in aging 2018:2425-41. Doi: https://doi.org/10.2147/CIA.S182881 PMid:30568434 PMCid:PMC6276633
Ambrosioni E, Leonetti G, Pessina AC, Rappelli A, Trimarco B, Zanchetti A. Patterns of hypertension management in Italy: results of a pharmacoepidemiological survey on antihypertensive therapy. Scientific Committee of the Italian Pharmacoepidemiological Survey on Antihypertensive Therapy. J Hypertens 2000;18(11):1691-9. Doi: https://doi.org/10.1097/00004872-200018110-00023 PMid:11081785
Gwadry-Sridhar FH, Manias E, Lal L, Salas M, Hughes DA, Ratzki-Leewing A, et al. Impact of interventions on medication adherence and blood pressure control in patients with essential hypertension: a systematic review by the ISPOR medication adherence and persistence special interest group. Value in health 2013;16(5):863-71. Doi: https://doi.org/10.1016/j.jval.2013.03.1631 PMid:23947982
Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC practice guidelines for the management of arterial hypertension: ESH-ESC the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Blood pressure 2014;23(1):3-16. Doi: https://doi.org/10.3109/08037051.2014.868629 PMid:24359485
Zyoud SeH, Al-Jabi SW, Sweileh WM, Morisky DE. Relationship of treatment satisfaction to medication adherence: findings from a cross-sectional survey among hypertensive patients in Palestine. Health and quality of life outcomes 2013;11(1):1-7. Doi: https://doi.org/10.1186/1477-7525-11-191 PMid:24195638 PMCid:PMC4228307
McDonald HP, Garg AX, Haynes RB. Interventions to enhance patient adherence to medication prescriptions: scientific review. Jama 2002;288(22):2868-79. Doi: https://doi.org/10.1001/jama.288.22.2868 PMid:12472329
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Deldar Morad Abdulah, Saeid Ahmed, Zuhair Rushdi Mustafa
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
The authors retain the copyright of their article, with first publication rights granted to Medsci Publications.