Factors associated with non-adherence to antihypertensive therapy and blood pressure control in Iraq

Hypertension is a major global public health concern, affecting approximately 1.28 billion people worldwide, with a disproportionate burden in low- and middle-income countries. Poor adherence to antihypertensive therapy is widely recognized as a key factor associated with inadequate blood pressure control and increased cardiovascular risk. Understanding the factors associated with non-adherence among hypertensive patients is essential for informing context-specific strategies to improve medication-taking behavior and clinical outcomes.

A cross-sectional study was conducted among 585 hypertensive patients in Iraq. Sociodemographic, medication-related, economic, and self-care characteristics were collected using standardized questionnaires. Medication adherence was assessed through patient self-report. Factors associated with non-adherence were examined using multivariable logistic regression, with results reported as adjusted odds ratios (ORs) and 95% confidence intervals (CIs).

Non-adherence was more prevalent among younger patients (18-30 years, 33.3%) compared with older patients (>60 years, 1.9%) (p < 0.001). Increasing age was associated with lower odds of non-adherence (adjusted OR 0.37, 95% CI: 0.24-0.56, p < 0.001). Student status was associated with higher odds of non-adherence (OR 2.43, 95% CI: 1.36-4.35, p = 0.002). Regular home blood pressure monitoring was associated with reduced odds of non-adherence (OR 0.54, 95% CI: 0.29-0.98, p = 0.047). Gender, place of residence, financial barriers, and provider communication were not significantly associated with adherence.

In this Iraqi cohort, non-adherence to antihypertensive therapy was associated with younger age, student status, and limited self-care practices. These findings help identify subgroups that may benefit from consideration in the design and evaluation of patient-centered support strategies, including adherence-focused education, structured follow-up, and promotion of home blood pressure monitoring. Given the cross-sectional nature of the study, causal relationships cannot be inferred, and future longitudinal and interventional research is warranted to determine the effectiveness of such approaches in improving medication adherence and blood pressure management in resource-constrained settings.