Antihypertensive medications adherence among Nigerian hypertensive subjects in a specialist clinic compared to a general outpatient clinic

Abstract

Background:Poor adherence to antihypertensive medications has been linked with increased cardiovascular risk and mortality in many population. Africans have been shown to have a worse prognosis from hypertension, poorer blood pressure control, and increased risk of complications arising from hypertension compared to Caucasians.Aim:The aim was to describe the level of adherence to antihypertensive medications, its determinants and whether any difference exist between those attending specialty clinic or general outpatient department (GOPD) Clinic in a Nigerian University Teaching Hospital.Subjects and Methods:An analytical cross-sectional study. The Morisky scale was used to assess for adherence to antihypertensive medications. Clinical and demographic data were taken. Statistical analysis was performed using SPSS 17.0. (Chicago, IL, USA). P < 0.05 was taken as statistically significant.Results:A total of 114 hypertensive subjects were recruited for this study. Seventy-nine were from the cardiology clinic whereas 35 were from the GOPD. They consisted of 60 males (52.6%, 60/114) and 54 females (47.4%, 54/110). The mean age was 63.6 (14.1) years. High adherence, low adherence and medium adherence as defined by Morisky scale was found in 36.8% (42/114), 23.9% (27/114) and 39.5% (45/114), respectively. Adherence level was higher among those attending specialty clinic despite shorter duration of hypertension and use of more medications. More than four-fifth of those attending cardiology clinic had at least medium level of adherence compared to a little bit over half of those attending GOPD clinic. Those with good adherence were likely to be older, had a higher level of education and higher average monthly income than those with poor adherence.Conclusion:Poor adherence to medications is very common in the hypertensive Nigerians. Hypertensive subjects attending specialty clinic seems to have a better adherence to antihypertensive medications possibly due to the level of health education and information provided to patients. Effective health education and regular screening for compliance and adherence is a potential way to reduce cardiovascular risk associated with uncontrolled hypertension.

Non-Adherence to Antihypertensive Drugs: A Systematic Review and Meta-Analysis

“…Finally, 28 articles were included in the systematic review and 25 of these were included in the meta-analysis. [9,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][27][28][29][30][31][33][34][35][36] …”

“…[35] However, 8 studies did not specify the type of MMAS-8 questionnaire administered. [9,11,12,15,16,19,27,28] Except 1 study, [22] all the included studies met the quality criteria and showed high quality (>75%). [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][29][30][31][32][33][34][35][36] …”

“…Nine of the studies were conducted in the United States, [11,12,15,26,29,30,32,33,35] and 2 each in China, [11,17] Nigeria, [16,22] Hong Kong, [21,25] and Iran. [10,18] Countries such as Uganda, Lebanon, Kenya, Republic of Korea, Peru, Ethiopia, Ghana, Malaysia, Palestine, Brazil, and Italy were represented with a single study.…”

“…[9,13,19,20,23,24,27,28,31,34,36] These studies were conducted on hypertensive patients to assess medication adherence using MMAS-8 between January 2009 and March 2016. Twenty-four studies were cross-sectional [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] and others were cohort, [35] observational, [36] and interventional studies. [32] Only 1 randomized controlled trial (RCT) was found.…”

Treatment compliance and retention in care among out-patient clients in a tertiary health institution in plateau state North Central Nigeria

“…In study slightly below half of the respondents were adjudged as having satisfactory level of treatment compliance which is in keeping with findings of other studies conducted in Nigeria. [15][16][17][18][19] …”