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

Abstract

Background: Hypertension drives the global burden of cardiovascular disease and its prevalence is estimated to increase by 30% by the year 2025. Nonadherence to chronic medication regimens is common; approximately 43% to 65.5% of patients who fail to adhere to prescribed regimens are hypertensive patients. Nonadherence to medications is a potential contributing factor to the occurrence of concomitant diseases.Objective: This systematic review applied a meta-analytic procedure to investigate the medication nonadherence in adult hypertensive patients.Methods: Original research studies, conducted on adult hypertensive patients, using the 8-item Morisky medication adherence scale (MMAS-8) to assess the medication adherence between January 2009 and March 2016 were included. Comprehensive search strategies of 3 databases and MeSH keywords were used to locate eligible literature. Study characteristics, participant demographics, and medication adherence outcomes were recorded. Effect sizes for outcomes were calculated as standardized mean differences using random-effect model to estimate overall mean effects.Results: A total of 28 studies from 15 countries were identified, in total comprising of 13,688 hypertensive patients, were reviewed. Of 25 studies included in the meta-analysis involving 12,603 subjects, a significant number (45.2%) of the hypertensive patients and one-third (31.2%) of the hypertensive patients with comorbidities were nonadherent to medications. However, a higher proportion (83.7%) of medication nonadherence was noticed in uncontrolled blood pressure (BP) patients. Although a higher percentage (54%) of nonadherence to antihypertensive medications was noticed in females (P < 0.001), the risk of nonadherence was 1.3 times higher in males, with a relative risk of 0.883. Overall, nearly two-thirds (62.5%) of the medication nonadherence was noticed in Africans and Asians (43.5%).Conclusion: Nonadherence to antihypertensive medications was noticed in 45% of the subjects studied and a higher proportion of uncontrolled BP (83.7%) was nonadherent to medication. Intervention models aiming to improve adherence should be emphasized.Abbreviations: BP = blood pressure, CHD = coronary heart disease, CVD = cardiovascular disease, MMAS = Morisky medication adherence scale, PRISMA = Preferred Reporting Items for Systematic review and Meta-Analysis, STROBE = Strengthening the Reporting of Observational Studies in Epidemiology.

Psycho-behavioural factors associated with medication adherence among male out-patients with hypertension in a Ghanaian hospital

“…Poor adherence to prescribed medications has been reported among patients with hypertension with a number of factors being implicated to play various roles in this health outcomes [26,37,38]. To the best of our knowledge, no study has reported the associations among patient characteristics, psycho-behavioural factors and medication adherence in male patients with hypertension in Ghana.…”

Conceptual Model of Medication Adherence in Older Adults with High Blood Pressure-An Integrative Review of the Literature

“…Medication adherence (MA) can control HBP and its complications more effectively [3] but Medication non-adherence is the most common cause of uncontrolled BP [4]. Despite the critical role of MA in controlling HBP, 30-93% of patients do not take their medication as prescribed [5-7].…”

“…Older adults, because of reduced functional abilities, have multiple chronic diseases and polypharmacy that cannot take their medications properly [10]. So they experience more challenges in MA than younger groups [5].…”