Predictors of Medication Adherence and Blood Pressure Control among Saudi Hypertensive Patients Attending Primary Care Clinics: A Cross-Sectional Study

Abstract

PurposeTo assess the level of medication adherence and to investigate predictors of medication adherence and blood pressure control among hypertensive patients attending primary healthcare clinics in Makkah, Saudi Arabia.Patients and methodsHypertensive patients meeting the eligibility criteria were recruited from eight primary care clinics between January and May 2016 for this study. The patients completed Arabic version of Morisky Medication Adherence Scale (MMAS-8), an eight-item validated, self-reported measure to assess medication adherence. A structured data collection form was used to record patients’ sociodemographic, medical and medication data.ResultsTwo hundred and four patients, of which 71.6% were females, participated in the study. Patients’ mean age was 59.1 (SD 12.2). The mean number of medication used by patients was 4.4 (SD 1.89). More than half (110; 54%) of the patients were non-adherent to their medications (MMAS score < 6). Binary regression analysis showed that highly adherent patients (MMAS score = 8) were about five times (OR 4.91 [95%CI: 1.85–12.93; P = 0.01]) more likely to have controlled blood pressure compared to low adherent patients. Female gender (OR 0.40 [95% CI: 0.20–0.80; P = 0.01]), Age > 65 years (OR 2.0 [95% CI: 1.0–4.2; P = 0.04]), and being diabetic (OR 0.25 [95% CI: 0.1–0.6; P = 0.04]) were found to be independent predictors of medication adherence.ConclusionMedication adherence is alarmingly low among hypertensive patients attending primary care clinics in Saudi Arabia which may partly explain observed poor blood pressure control. There is a clear need to educate patients about the importance of medication adherence and its impact on improving clinical outcomes. Future research should identify barriers to medication adherence among Saudi hypertensive patients.

Investigation of variables associated with medication nonadherence in patients with hypertension

“…In agreement with earlier research findings, [22,23,27] the current study revealed poor blood pressure control among patients who reported poor medication adherence. Therefore, it was deemed necessary to identify obstacles to medication adherence in the present study.…”

“…Both, receiving more than one medication for blood pressure control and increasing the number of prescribed medications were associated with medication nonadherence in the current study. This finding is in agreement with earlier research findings and opposite to other findings . Based on these findings, simplifying dosage regimen via reducing the number of medications taken per day should be considered when developing future pharmaceutical care programs aim at improving blood pressure control in patients with hypertension in Jordan.…”

“…findings. [27,33] Based on these findings, simplifying dosage regimen via reducing the number of medications taken per day should be considered when developing future pharmaceutical care programs aim at improving blood pressure control in patients with hypertension in Jordan. Consistent with findings from previous studies, [13,22,34] patients who had concerns about the potential side effects of the prescribed antihypertensive medications, such as cough induced by ACE inhibitors or fatigue induced by beta blockers, were found more likely to be nonadherent to their medications.…”

Determinants of adherence to anti-hypertensive medications among adult hypertensive patients on follow-up in Hawassa Referral Hospital: A case–control study

“…12,25,26 Non-adherence in younger patients might be due to the lack of symptoms at early stages of the illness or more concerns about medication side effects. In contrast, some researchers have also found better adherence among older patients, 23 in which patients in the age group of >40 but not > 60 and >65 were more adherent than younger age patients. 23,24 The better adherence to treatment found in elderly patients has been explained by the presence of co-morbidities, which make the patients perceive themselves as very ill and take the prescribed treatment seriously, and elderly patients in the study area might have received better care by their caregivers.…”

Risk for Medication Nonadherence Among Medicaid Enrollees With Fibromyalgia: Development of a Validated Risk Prediction Tool

“…To date, only 1 predictive model, called the Prescription Medication Adherence Prediction Tool for Diabetes Medications (RxAPT‐D), which predicts nonadherence to oral antidiabetic drugs using Medicare claims data, has been developed by Mhatre and colleagues . Their model focused only on antidiabetic drugs and did not have gender as a significant predictor, which is a limitation because gender has been identified as a strong predictor of nonadherence in several studies . As opposed to this model, our model may be more applicable to patients with chronic pain who are likely to be multimorbid and face higher risk for nonadherence …”