Factors associated with antihypertensive medication non-adherence: a systematic review

Abstract

Non-adherence to antihypertensive medication is the most important cause of uncontrolled blood pressure and is influenced by multiple interrelating factors. Understanding the complexity of medication non-adherence and its associated factors is important to determine intervention strategies. Therefore, a systematic review was performed aimed to identify factors associated with antihypertensive medication non-adherence. Different databases were searched for observational studies reporting on factors associated with non-adherence to antihypertensive medication. Titles, abstracts and full texts were reviewed by three researchers. Subsequently, the methodological quality of each study was assessed. Factors that were extracted from the included studies were categorised as factors with consistent or inconsistent evidence to put their potential importance into perspective. Forty-four studies were included. Higher co-payment, side effects and a poor patient-provider relationship were identified as factors with consistent evidence since consistent significant relationships were found for these factors whenever studied. The relationships between non-adherence and multiple other factors were inconsistent among the reviewed studies. However, some of these factors deserve some consideration. Since multiple potentially relevant factors were identified, patient-tailored interventions focussing on identifying and addressing patients' specific barriers to adherence are needed. Further research should clarify the influence of inconsistent factors on adherence and their potential to be addressed in interventions.

Modifiable Factors Associated with Non-adherence to Antihypertensive or Antihyperlipidemic Drugs Are Dissimilar: a Multicenter Study Among Patients with Diabetes in Indonesia

“…This is in line with conflicting results regarding gender in previous studies. 30,40,41 In general, it seems that gender is not a very meaningful factor associated with non-adherence.…”

“…24 The item about experienced side effects was included because of its expected additional role in non-adherence. 30,31 Sociodemographic factors included as non-modifiable factors were age at the completion of the questionnaire, gender, highest level of education completed (no formal education/ elementary school, junior high school, senior high school, or university), and type of health insurance. Type of health insurance was classified as those whose insurance premium was paid by the government (BPJS-PBI), those whose insurance premium was paid by the patients themselves (BPJS-Non PBI), or those without health insurance.…”

Patients’ and caregivers’ perspectives on factors that influence understanding of and adherence to hospital discharge instructions: a qualitative study

“…19,20 The importance that perceived relationships with health care providers may play in the patient's level of engagement and adherence to instructions has previously been described as important for adherence to medications. 21 This factor is of timely importance given recent work showing that both inpatient and outpatient physicians rarely feel responsible for patient care and adherence after discharge. 22,23 Providers who feel a sense of responsibility are more likely to spend the necessary time at discharge to optimize the transition from hospital to home.…”

A survey study to measure the practice of patient counselling and other community pharmacy services in Jordan

“…This is similar to the results of a systematic review conducted in 2017. [29] Forgetfulness was the second non-adherence reason according to 33.4% of the Jordanian Pharmacists and side effects of the medication the first. However, in a previous study, conducted in 2011, on hypertensive patients, forgetfulness and being too busy were the most common reasons given for non-adherence, and the side effects of the medication wereas the second reason.…”