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Predictors of Antihypertensive Drug Adherence and Blood Pressure Control Among Hypertensive Patients: A Multicenter
Tamrat Petros Elias1, Asteraye Tsige Minyilshewa2, Mengesha Akale Tekle2
1Department of Internal Medicine, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Insights
Antihypertensive drug adherence was 72.5% in Addis Ababa, but blood pressure control was only 23.4%. Medication adherence alone is insufficient for managing hypertension effectively.
Area of Science:
- Cardiology
- Public Health
- Pharmacology
Background:
- Hypertension is a major risk factor for cardiovascular, cerebrovascular, and renal diseases.
- Effective control of elevated blood pressure relies heavily on patient adherence to antihypertensive medications.
- This study investigates factors influencing medication adherence and blood pressure control in hypertensive patients within Addis Ababa's public hospitals.
Purpose of the Study:
- To determine the prevalence of antihypertensive drug adherence and blood pressure control.
- To identify factors associated with antihypertensive drug adherence.
- To identify factors associated with blood pressure control among hypertensive patients.
Main Methods:
- A hospital-based cross-sectional study was conducted from November 2022 to February 2023.
- 393 hypertensive patients were recruited via systematic random sampling from public hospitals in Addis Ababa.
- Data were collected through electronic medical records and structured patient questionnaires, analyzed using logistic regression.
Main Results:
- Antihypertensive drug adherence was 72.5%, while blood pressure control was achieved in only 23.4% of patients.
- Uncontrolled blood pressure was linked to lower adherence (AOR=0.59). Nonadherence to diet (AOR=3.31) and presence of chronic kidney disease (AOR=3.85) were associated with good adherence.
- Use of single antihypertensive drugs (AOR=0.53) and nonadherence to exercise (AOR=0.30) correlated with poor adherence. Male sex (AOR=1.95) and home BP monitoring (AOR=0.59) predicted controlled BP. Alcohol consumption (AOR=1.92) was inversely associated with BP control.
Conclusions:
- Despite relatively good medication adherence, blood pressure control remains suboptimal, highlighting the inadequacy of adherence alone.
- Integrated hypertension management strategies are crucial, encompassing lifestyle counseling, dietary support, and improved access to medications and monitoring.
- Public health policies should prioritize strengthening primary care for comprehensive hypertension management.
Abstract:
Background: Hypertension or elevated blood pressure is a serious medical condition that significantly increases the risk of diseases of the heart, brain, kidneys, and other organs. Antihypertensive drug adherence is key to controlling blood pressure. This study aimed to assess factors associated with antihypertensive drug adherence and blood pressure control among hypertensive patients in selected public hospitals under the Addis Ababa City Administration. Method: A hospital-based cross-sectional study was conducted among hypertensive patients on follow-up in randomly selected public hospitals under the Addis Ababa City Administration from November 1, 2022, to February 28, 2023. The study population included 393 patients who fulfilled the eligibility criteria and were selected by systematic random sampling. Data collection was conducted from the electronic medical records and by interviewing patients with a structured questionnaire. The data were entered into Epi-Info 7.2.1 and exported to SPSS version 25 software for analysis. Logistic regression analysis was performed to determine the associations between the dependent and independent variables. Results: The rates of antihypertensive drug adherence and blood pressure control were 72.5% and 23.4%, respectively. Participants with uncontrolled blood pressure were 41.7% less adherent than those with controlled blood pressure (AOR = 0.59; 95% CI, 0.36-0.97). Nonadherence to dietary restriction (AOR, 3.31; 95% CI, 1.84-5.96) and chronic kidney disease (AOR = 3.85; 95% CI, 1.41-10.52) were associated with good adherence, whereas the use of a single antihypertensive drug (AOR = 0.53; 95% CI, 0.30-0.94) and nonadherence to moderate physical exercise (AOR = 0.30; 95% CI, 0.20-0.65) were associated with poor adherence to antihypertensive medications. Male sex (AOR = 1.95; 95% CI, 1.04-3.28) and blood pressure measured at home (AOR = 0.59; 95% CI, 0.36-0.99) were found to be independent predictors of controlled blood pressure. Drinking alcohol (AOR = 1.92; 95% CI, 1.05-3.49) was inversely associated with blood pressure control. Conclusion: Although adherence to antihypertensive medications was relatively good, blood pressure control remained low, indicating that medication adherence alone is insufficient. Public health policies should focus on strengthening primary care systems to deliver integrated hypertension management, including lifestyle counseling, dietary support, and improved access to medications and monitoring tools.
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