A Systematic Review of Factors Influencing Medication Adherence to Hypertension Treatment in Developing Countries

Abstract

Background: Coronary heart disease (CHD), a complication of hypertension, is one of the most important and common causes of morbidity, hospitalisation, and mortality among hypertensive population. In recent decades, increased urbanisation and changes to lifestyle, diet and physical activity in developing countries have led to a major increase in the population incidence of chronic diseases including CHD. Poor medication adherence is one of the leading causes of failure to achieve hypertension control. The objective of this systematic review is to describe the prevalence of non-adherence to antihypertensive medications among hypertensive population in developing countries and identify factors associated with it. Methods: A literature search was conducted using the following scholarly electronic databases: Proquest, PubMed, JSTOR and Science Direct. The online search engine, Google Scholar was also used to search for and identify relevant papers. Peer-reviewed fulltext articles published in English on hypertensive adults in developing countries that measured adherence to antihypertensive medications and their associations with different factors were eligible for inclusion. The review followed the PRISMA reporting and analytical guidelines for systematic reviews. Results: In all, 42 studies conducted across 19 developing countries were selected for the review. The mean prevalence of medication non-adherence (MNA) among the select hypertensive population was 47.34%. Very few studies were conducted in community settings and except for one, no study examined gender differences in MNA factors. The analysis revealed a range of factors that can influence MNA including low household income and socioeconomic status; knowledge and beliefs of hypertension and its management; avoiding side effects of medications; cost of medication; use of herbal preparations; absence of symptoms; irregular follow-up; and dissatisfaction with the treatment and health services provided. There was a general lack of consideration of role of health system in health care delivery, self-efficacy, cultural barriers, per- There was also a lack of gender-specific research which is necessary at community settings given the social and economic vulnerabilities faced by women in developing countries that may affect adherence to antihypertensive medications. Conclusions: Future research in developing countries should consider individual risk perceptions, cultural barriers, gender and the role of local health system in health care delivery when assessing MNA among hypertensive population at community settings.

Adherence to antihypertensive medications and associated factors among hypertensive patients in Ethiopia: Systematic review and meta-analysis

“…20,21,24,25,30 Even if a weak health system is one of the major obstacles to tackle hypertension in developing countries, little attention has been given to assess the role of local health systems in the delivery of care for the control of hypertension. 13 Factors associated with antihypertensive medication adherence reported in studies included in this review were diverse and described in different ways across the studies. Since only a limited number of studies reporting comparable factors, it was not possible to make an MA for the main factors affecting adherence.…”

“… 12 In developing countries, the prevalence of medication non-adherence among the hypertensive population ranged from 23% to 67.6% with the mean being 47.34%. 13 …”

Hypertension Trends in Asia

“…[35] A systematic review evaluating medication adherence factors for hypertension in developing countries cited other factors such as cost barriers, irregular follow-ups, and competing availability of traditional herbal remedies. [36] When it comes to the treatment of hypertension, a key challenge especially among the less educated is the reconciliation of the disease's asymptomatic nature and its downstream life-threatening complications. Moreover, the undertaking of educating about the importance of hypertension control in the Southeast Asian context is further complicated by differing pathogenetic models in the fields of traditional, complementary, and alternative medicine pervasive in the region.…”

Nonadherence to Drugs among the Hypertensive Patients in Outpatient Department of a Secondary Hospital of Bangladesh

“…Suggestion by unqualified doctors (village doctors) in Bangladesh is also an important cause of stopping taking drugs. 29 Use of herbal medicine is also an important cause of nonadherence among the patients in developing countries, 18 though we haven't studied the use of herbal medicine in our patient population.…”

“…In a systemic review involving the studies in developing countries, it was concluded that low household income and socioeconomic status; knowledge and beliefs of hypertension and its management; avoiding side effects of medications; cost of medication; use of herbal preparations; absence of symptoms; irregular follow-up; and dissatisfaction with the treatment and health services provided. 18 A study of the Prevalence, Awareness, Treatment and Control of Hypertension among Elderly in Bangladesh and India found that 45% of elderly people in these two countries suffer from hypertension, 40% of the patients are aware of their disease diagnosis and 10% of them are adhering to treatment. 19 A number of studies were conducted in different regions of Bangladesh in different institutions and field levels.…”