Treatment Adherence and Blood Pressure Outcome Among Hypertensive Out-patients
Condition: Hypertension
MeSH terms: Hypertension
Study type: Observational

Summary: 
      It is estimated that more than 70% of patients on antihypertensive medications do not take
      them as prescribed. Treatment non-adherence practice may be particularly higher in developing
      countries where there is poor accessibility to medicines and healthcare services, coupled
      with low level of awareness of the lifelong nature of hypertension treatment among patients.
      Optimal control of blood pressure has been reported to reduce the incidence of morbidity and
      mortality associated with hypertension. Thus, adoption of healthy lifestyle as well as
      ensuring regular and continuous adherence to prescribed medications are integral to
      successful management of hypertension to achieve the target blood pressure goals.

      The present study comprehensively evaluated adherence to pharmacotherapy and
      non-pharmacological measures among ambulatory hypertensive patients attending two healthcare
      institutions in Sokoto, Northwestern Nigeria. Reasons for treatment non-adherence were
      evaluated, while perception and beliefs about hypertension and its management were also
      explored, with pharmacist-led patient-specific adherence education provided as appropriate to
      resolve the knowledge gap(s). Association between treatment adherence and blood pressure
      outcome at contact and the subsequent 2-months clinic appointment were investigated.

      Patients aged 18 years and above, with a primary diagnosis of hypertension, and who were on
      antihypertensive medications for at least 3-months were recruited from the medical outpatient
      clinic of Usmanu Danfodiyo University Teaching Hospital and the Specialist Hospital, both
      within Sokoto metropolis, Sokoto state, Northwestern Nigeria. Newly diagnosed patients,
      in-patients and those who declined participation were excluded from the study.
    

Detailed description: 
      Background: Hypertension is a common cardiovascular disease worldwide, contributing 4.5% of
      the global disease burden and 12.8% premature deaths annually. Despite recent advances in
      drug therapy, majority of diagnosed hypertensive patients are poorly controlled. Reasons for
      inadequate control of hypertension are heterogeneous including low adherence to
      antihypertensive medications and lifestyle changes, low compliance with scheduled follow-up
      visits and suboptimal pharmacotherapy. This study evaluated adherence to pharmacotherapy and
      non-pharmacological measures among ambulatory hypertensive patients, reasons for treatment
      non-adherence were evaluated, while perception and beliefs about hypertension and its
      management were also explored, with pharmacist-led patient-specific adherence education
      provided as appropriate to resolve the knowledge gap(s). Association between treatment
      adherence and blood pressure outcome at contact and the subsequent 2-months clinic
      appointment were investigated.

      Method: This study involved a cross-sectional questionnaire-guided interview and
      retrospective review of medical records of 605-patients from two hospitals. Nine-item
      modified adherence predictor scale was used to assess medication adherence. Overall adherence
      score to lifestyle modifications was obtained from the total scores from 4-domains of
      non-pharmacological measures including cigarette smoking and alcohol cessation,
      salt-restriction and exercise. Patient-specific adherence education was provided at contact
      to resolve the knowledge gap(s). Clinical-parameters especially the blood pressure values
      were retrieved at contact and subsequent 2-months appointment. Data were summarised using
      frequency, percentage, 50th percentile and mean ± standard deviation. Chi-square test was
      used to evaluate association between socio-demographic variables and adherence to
      antihypertensive medication and lifestyle recommendations. Student's t-test was used to
      investigate relationship between treatment adherence and blood pressure outcome at p < 0.05
      considered significant.
    

Intervention name(s): Adherence Education
Intervention type(s): Other
Intervention description(s): Patients were given adherence education to resolve the identified deficits
Observational model: Other
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Ambulatory hypertensive patients
      
Keywords: Treatment adherence; Ambulatory hypertensive patients; Blood pressure; Non-pharmacological measures