Poor medication adherence is a public health concern leading to a large burden of cardiovascular disease among persons with hypertension. Using data from 3281 persons with diagnosed hypertension (N = 622,581) from the Panamanian National Health Survey (ENSPA) collected in 2019, we assessed the national prevalence of low-moderate medication adherence in hypertensive individuals using the 4-scale Morisky Medication Adherence Scale (4-MMAS) and identifying gender-specific associated factors. Multivariate logistic regression models were used to estimate the association between possible risk factors and low-moderate medication adherence with odds ratios (OR) and 95% confidence intervals (95% CI) stratified by gender. The national prevalence of low-moderate medication adherence was 78.2% (95% CI: 74.7–81.0%); in men it was 74.4% (95% CI: 67.5–80.3%) and in women it was 81.4% (78.4–84.0%). In women, low-moderate medication adherence was associated with living in indigenous area (OR: 5.15; 95% CI: 1.40–18.98), educational level (OR no formal education: 0.77, 95% CI 0.28–2.14; OR for primary education: 0.76, 95% CI 0.38–1.56; OR for secondary education: 0.90, 95% CI 0.48–1.70; Higher education as reference), increased BMI (normal as reference, OR for overweight: 1.35, 95% CI: 0.73–2.50, OR for obesity: 1.65, 95% CI: 0.90–3.03) and medical diagnosis of anxiety/depression (OR: 4.89, 95% CI: 1.36–17.49). However, in men, it was associated with having secondary education (OR: 2.94; 95% CI: 1.03–8.36), currently smoking (OR: 16.74, 95% CI: 1.83–152.70), taking antihypertensive medication with denial of hypertension diagnosis (OR: 4.35, 95% CI: 1.11–17.11) and having less than three annual check-ups (OR for no health check-ups: 2.97, 95% CI: 0.63–13.88; OR for 1–2 check-ups: 1.61, 95% CI: 0.78–3.32: three or more health check-ups: reference). Time since diagnosis was inversely associated with low-moderate adherence. This study assesses for the first time the national prevalence of low-moderate medication adherence among hypertensive individuals in Panama. Low-moderate medication adherence is an important public health issue that should be addressed to achieve blood pressure control in patients diagnosed with hypertension, taking into account gender-specific factors.

Background Recent estimates of hypertension in Panama remain unknown. We aim to describe the variation in prevalence and unawareness of hypertension in two Panamanian provinces using two different cross-sectional population-based studies and to investigate risk factors associated with hypertension unawareness. Methods Data were derived from a sub-national study conducted in the provinces of Panama and Colon (PREFREC-2010 [2,733 participants]) and from a nationally representative study (ENSPA-2019), in which we restricted our analyses to the same provinces (4,653 participants). Individuals aged 30–75 years who had (a) self-reported history of hypertension or (b) blood pressure (BP) ≥140/90mmHg or (c) a combination or both were classified as hypertensive. Participants with BP≥140/90mmHg who denied a history of hypertension were considered unaware of the condition. Multivariable logistic regression models were used to estimate the association between risk factors and unawareness, expressed as odds ratios (OR) and 95% confidence interval (CI). Findings In 2010, the prevalence and unawareness of hypertension in men were 51.6% (95% CI: 45.7–57.5) and 32.3% (25.4–40.1), respectively, and in women 46.0% (42.1–49.9) and 16.1% (12.6–20.4), respectively. In 2019, the prevalence and unawareness of hypertension in men were 46.5% (42.1–51.0) and 52.3% (45.9–58.6), and in women 42.1% (39.6–44.7) and 33.3% (29.8–37.0). Men (2010 and 2019), age <50 years (2010 and 2019), having no/primary education (2010), and living in a non-urban region (2019) were positively associated with hypertension unawareness, whereas obesity (2010), physical inactivity (2010), family history of hypertension (2019), and BP assessment in the year before study enrollment (2010 and 2019) were inversely associated with hypertension unawareness. Interpretation Benefits of a decrease in the prevalence of hypertension are being undermined by an increase in hypertension unawareness. Actions should be encouraged to strengthen the implementation of the existing healthcare program for cardiovascular risk factor control.