Document Type : Original Article
Authors
1 Department of Health Education and Health Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Epidemiology and Biostatistics, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
BACKGROUND: Medication adherence means compliance with patient adherence to medication
orders, including timely and correct consumption of medication prescribed by a physician. The present
study aimed to determine the extent of adherence to hypertension drug medication in patients covered
by comprehensive health service centers of Shahrekord, Iran.
MATERIALS AND METHODS: A cross‑sectional study examined 401 hypertensive patients
registered in the Integrated Health Record System (SIB). SIB is a Persian term related to Health
Record System. To collect data, Morisky Medication Adherence Scale was used. The questionnaire
was completed by the patients and analyzed using SPSS (SPSS Inc., Chicago, Illinois, USA,
version 26), Chi‑square test, independent t‑test, and analysis of variance.
RESULTS: The results indicated that adherence to antihypertensive medication was low in 5.7% of
patients, while 63.3% of patients had sufficient compliance. Forgetting to take medications (52.9%)
was the most common reason for nonadherence to medication in hypertensive patients.
CONCLUSION: Given that forgetting to take medications was the main reason for nonadherence
to medication in hypertensive patients, designing and implementing necessary trainings by
comprehensive health centers to realize the importance of daily use of medication by hypertensive
patients and their families are recommended.
Keywords
Assessing barriers to and level of adherence to hypertension
therapy among Palestinians living in the Gaza strip: A chance
for policy innovation. Int J Hypertens 2020;2020:7650915.
2. Shrivastava SR, Shrivastava PS, Ramasamy J. The determinants
and scope of public health interventions to tackle the global
problem of hypertension. Int J Prev Med 2014;5:807‑12.
3. Arabshahi A, Gharlipour Z. Assessment of adherence to self‑care
behaviors in hypertensive patients in Qom city (Iran).Qom Univ
Med Sci J 2020;14:55‑65.
4. Boutayeb A, Boutayeb S. The burden of non communicable
diseases in developing countries. Int J Equity Health 2005;4:2.
5. Ninomiya T, Ohara T, Hirakawa Y. Midlife and late‑life blood
pressure and dementia in Japanese elderly. J Hisayama Study
Hypertens2011;58:22‑8.
6. Wysocki M, Luo X, Schmeidler J, Dahlman K, Lesser GT,
Grossman H, et al. Hypertension is associated with cognitive
decline in elderly people at high risk for dementia. Am J Geriatr
Psychiatry 2012;20:179‑87.
7. Tel H, Vei H. Anger and depression among the elderly people
with hypertension. Neurol J Psychiatry Brain Res 2013;19:109‑13.
8. Heidenreich P, Trogdon J, Khavjou O, Butler J, Dracup K,
Ezekowitz M, et al. Forecasting the future of cardiovascular
disease in the United States: A policy statement from the American
Heart Association. J Circulatio 2011;123:933‑4.
9. Oori MJ, Mohammadi F, Norozi K, Fallahi‑Khoshknab M,
Ebadi A, GheshlaghRG. Prevalence of HTN in Iran: Meta‑analysis
of Published Studies in 2004‑2018. Curr Hypertens Rev
2019;15:113‑22.
10. De Geest S, Sabaté E. Adherence to long‑term therapies: Evidence
for action. Eur J Cardiovasc Nurs 2003;2:323.
11. Ashoorkhani M, Bozorgi A, MajdzadehR, Hosseini H, Yoonessi A,
Ramezankhani A, et al. Comparing the effectiveness of the
BPMAP (blood pressure management application) and usual
care in self‑management of primary hypertension and adherence
to treatment in patients aged 30‑60 years: Study protocol for a
randomized controlled trial. Trials 2016;17:511.
12. Rash JA, Lavoie KL, Feldman HR, Campbell TS. Adherence
to antihypertensive medications: Current status and future
directions. J Cur Cardio Risk Rep 2014;8:415‑18.
13. ALLHAT Officers and Coordinators for the ALLHAT
Collaborative Research Group The Antihypertensive and
Lipid‑Lowering Treatment to Prevent Heart Attack Trial. Major
outcomes in high‑risk hypertensive patients randomized to
angiotensin‑converting enzyme inhibitor or calcium channel
blocker vs. diuretic: The antihypertensive and lipid‑lowering
treatment to prevent heart attack trial (ALLHAT). JAMA
2002;288:2981‑97.
14. Turnbull F, Neal B, Algert C, Chalmers J, Chapman N, Cutler J,
et al. Effects of different blood pressure‑lowering regimens on
major cardiovascular events in individuals with and without
diabetes mellitus: Results of prospectively designed overviews
of randomized trials. Arch Intern Med 2005;165:1410‑9.
15. Burkhart P, Sabaté E. Adherence to long‑term therapies: Evidence
for action. J Nurs Scholarsh 2003;35:207.
16. Monane M, Bohn RL, Gurwitz JH, Glynn RJ, Levin R, Avorn J. The
effects of initial drug choice and comorbidity on antihypertensive
therapy compliance: Results from a population‑based study in
the elderly. Am J Hypertens 1997;10:697‑704.
17. Jung O, GechterJL, Wunder C, Paulke A, Bartel C, Geiger H, et al.
Resistant hypertension? Assessment of adherence by toxicological urine analysis. J Hypertens 2013;31:766‑74.
18. Matsumura K, Arima H, Tominaga M, Ohtsubo T, Sasaguri T,
Fujii K, et al. Impact of antihypertensive medication adherence
on blood pressure control in hypertension: The COMFORT study.
QJM 2013;106:909‑14.
19. Lewington S, Clarke R, Qizilbash N, PetoR, Collins R; Prospective
Studies Collaboration. Age‑specific relevance of usual blood
pressure to vascular mortality: A meta‑analysis of individual
data for one million adults in 61 prospective studies. Lancet
2002;360:1903‑13.
20. Dragomir A, Côté R, Roy L, Blais L, Lalonde L, Bérard A, et al.
Impact of adherence to antihypertensive agents on clinical
outcomes and hospitalization costs. Med Care 2010;48:418‑25.
21. Shin S, Song H, Oh SK, Choi KE, Kim H, Jang S. Effect of
antihypertensive medication adherence on hospitalization for
cardiovascular disease and mortality in hypertensive patients.
Hypertens Res 2013;36:1000‑5.
22. Chowdhury R, Khan H, Heydon E, Shroufi A, Fahimi S, Moore C,
et al. Adherence to cardiovascular therapy: A meta‑analysis of
prevalence and clinical consequences. Eur Heart J 2013;34:2940‑8.
23. Cutler DM, Long G, Berndt ER, Royer J, Fournier AA, Sasser A,
et al. The value of antihypertensive drugs: A perspective on
medical innovation. Health Aff (Millwood) 2007;26:97‑110.
24. Morisky DE, Ang A, Krousel‑Wood M, Ward HJ. Predictive
validity of a medication adherence measure in an outpatient
setting. J Clin Hypertens (Greenwich) 2008;10:348‑54.
25. Koudhyar H, Shourvazi M, Dalir Z, Hosseini M. Survey of health
literacy with adherence to treatment and quality among diabetes
elders of community. Maz J Univ Mel Sci 2013;23:134‑43.
26. Paczkowska A, Hoffmann K. Impact of patient knowledge on
hypertension treatment adherence and efficacy: A single –center
study in Poland. Int J Med Sci 2021;18:852‑60.
27. Chunhua M. A cross-sectional survey of medication adherence
and associated factors for rural patients with hypertension. Appl
Nurs Res 2016;31:94‑9.
28. Kisokanth G, Ilankoon IM, Arulanandem K. Assesment of
knowledge on the disease, its complications and management
strategies among hypertensive patients attending medical clinics
at teaching hospital, Batticaloa, Sri Lanka. JPGIM 2016;30:1‑11.
29. DiMatteo MR, Giordani PJ, Lepper HS, Croghan TW. Patient
adherence and medical treatment outcomes: A meta‑analysis.
Med Care 2002;40:794‑811.
30. Ezeala‑Adikaibe BA, Mbadiwe N, Okudo G. Factors associated
with medication adherence among hypertensive patients in
a tertiary health center: Across‑sectional study archives of
community medicine. J Public Health 2017;3:24‑311.
31. Hosohata K, Inada A, Oyama S, Doi T, Niinomi I, Wakabayashi T,
et al. Improvement of blood pressure control by adherence check in
patients with apparent treatment‑Resistant hypertension: A case
series. Clin Med Insights Case Rep 2020;13:1179547620904884.
32. Sawicka K, Szczepanska J. Evaluation of the level of knowledge
of patients with hypertensive disease in prevention and
complications of hypertension. J Educ Health Sport 2016;6:296‑321.
33. AkokoBM, FonPN, NguRC, Ngu KB. Knowledge of hypertension
and compliance with therapy among hypertensive patients in the
Bamenda health district of Cameroon: A Cross‑sectional study.
Cardiol Ther 2017;6:53‑67.
34. Al‑Ramahi R. Adherence to medications and associated factors:
A cross‑sectional study among Palestinian hypertensive patients.
J Epidemiol Glob Health 2015;5:125‑32.
35. Brent BM, Zhao Y, Axon RN. US trends in prevalence, awareness,
treatment, and control of hypertension, 1988‑2008. JAMA
2010;303:2043‑50.
36. Shani M, Lustman A, Vinker S. Adherence to oral
antihypertensive medications, are all medications equal? J Clin
Hypertens (Greenwich) 2019;21:243‑8.
37. Haynes RB, Montague P, Oliver T, McKibbon KA, Brouwers MC,
KananiR. Interventions for helping patients to follow prescriptions
for medications. J Cochrane Database Syst Rev. 2005; 19:CD000011.
38. Dimatto MR. Variations in patients adherence to medival
recommendations: A quantitative review of 50 years of research.
J Med Care 2004;42:200‑9.
39. Cheong W, Yim J. The effect of a clinic based incentive program
on medication adherence among patients with hypertension
or diabetes mellitus in Incheon. J Health Policy Manage
2013;23:427‑33.
40. Sun Z, Zheng L, Detrano R, Zhang X, Xu C, Li J, et al. Risk of
progression to hypertension in a rural Chinese women population
with prehypertension and normal blood pressure. Am J Hypertens
2010;23:627‑32.
)