FACTORS INFLUENCING TREATMENT NONCOMPLIANCE IN HYPERTENSION MANAGEMENT AMONG RURAL AND URBAN RESIDENTS
Authors: Cherkun M.P. 
Published: May 2023

Introduction: Hypertension is a prevalent health concern in both rural and urban populations, with varying rates of prevalence and treatment outcomes. This study aims to examine the factors contributing to decreased adherence to antihypertensive therapy among patients living in rural and urban areas. Essential arterial hypertension or hypertension is the most common cardiovascular cause of death in the population. It develops in more than half of the world's population over the age of 50, and affects 65% of men and 75% of women over the age of 70. The prevalence of hypertension is higher among rural residents (36.3%) compared to urban residents (29.6%). However, achieving target blood pressure values is a challenge for both groups, with only 8% of rural patients and 15% of urban patients reaching their treatment goals as reported in 2010. According to practicing doctors, the main reason for failing to reach target blood pressure levels is the low adherence of patients to their prescribed antihypertensive therapy. This noncompliance with treatment poses a significant obstacle to effective hypertension management.

The article presents findings from an analysis of treatment adherence among 152 patients categorized into three groups: essential arterial hypertension (Group 1), hypertension and coronary heart disease (Group 2), and comorbidity between hypertension, coronary heart disease and type 2 diabetes (Group 3). The study included both urban and rural residents. Adherence to treatment was assessed using the 2008 8-item Morisky Medication Adherence Scale (MMAS-8) questionnaire.

The analysis revealed distinct factors influencing adherence based on the patient's territorial affiliation. In the rural setting (Group 1), the primary reason for decreased adherence was patients independently discontinuing antihypertensive medication without notifying their doctor. In the urban setting (Group 1), patients tended to forget to take their medication as prescribed.

In Group 2 (urban), challenges were observed in remembering the correct time for taking antihypertensive drugs, while rural patients in the same group tended to independently alter the dosage or discontinue medication. In Group 3 (urban), urban residents reported forgetting to take medication when away from home, whereas rural residents faced fewer difficulties in remembering their medication schedule.

The research findings indicate that low adherence to antihypertensive therapy is not solely influenced by territorial affiliation or the specific course of hypertension. However, a notable factor affecting treatment adherence among both rural and urban residents is the more mobile lifestyle commonly observed in urban areas.

Addressing the issue of low adherence to antihypertensive therapy requires tailored interventions that consider the unique challenges faced by rural and urban populations. Strategies should focus on improving patient education, enhancing medication reminders, and promoting better communication between patients and healthcare providers. By addressing these factors, it is possible to improve treatment adherence and subsequently enhance hypertension management outcomes for both rural and urban residents.