Translate this page into:
Factors Contributing to Anti-Hypertensive Medication Adherence Among Patients With Chronic Hypertension
*Corresponding author: Assoc Prof. Priya Pereira, Department of Community Health Nursing, Father Muller College of Nursing, Kankanady, Mangaluru 575002, Karnataka, India. prdsouza86@fathermuller.in
-
Received: ,
Accepted: ,
How to cite this article: Reetha B, Abraham A, Rodrigues DE, Pereira P. Factors Contributing to Anti-Hypertensive Medication Adherence Among Patients With Chronic Hypertension. J Health Allied Sci NU. 2025;16:253-9. doi: 10.25259/JHS-2024-7-11-(1471)
Abstract
Objectives
Medication adherence is a complex issue among patients with chronic health conditions. Several factors affect medication adherence, such as the patient’s income, co-morbidities, psychosocial factors, and health care. Addressing the problem and effective strategies for promoting sustained behaviour change are essential in chronic health conditions. The aim of the study was to investigate medication adherence and factors contributing to antihypertensive medication adherence among patients.
Material and Methods
This hospital-based cross-sectional study was conducted in a medicine outpatient department of a tertiary care hospital in Mangaluru after obtaining ethical permission from the Institutional Ethics Committee. The data were collected from 354 subjects, who were selected by a convenience sampling technique. The validated and pretested tool has 22 items on factors contributing to medication adherence, and a single question enquiring about medication adherence was administered to the subjects after obtaining their written consent. The data were collected using a pretested questionnaire and a face-to-face structured interview technique. The tool had three major aspects: the enumerators imported the data into the statistical package for Social Science version 23, and then the data for statistical tests like frequency, percentage, and Chi-square were in line with the pre-determined study objectives.
Results
Out of 354 subjects, 49.4% (175) of the subjects found non-adherence to the prescribed medications, and 50.6% (179) were adherent to medications. The mean age of the subjects was 61.19 ± 11.04; the study had 52.8% (187) males and 47.2% (167) females. The adherence status of male was 50.7% (94), which was higher than that of their female counterparts at 48.5% (81).This study found education χ2=10.64, (p = 0.03), smoking status χ2=7.19, (p = 0.024), income χ2 =9.30 (p = 0.01), availability of the emotional support χ2=11.6, (p = 0.001), availability of financial support χ2 =11.08 (p = 0.004), medication reminder χ2 = 4.19, (p = 0.04), exposure in the past for counselling χ2=5.81, (p = 0.01) and home BP monitoring χ2=4.52, (p = 0.03) as predictors of medication adherence.
Conclusion
The findings indicate that only half the proportion of the study subjects adhered to the prescribed medications, and urged hospitals to embrace multiple interventions to motivate the patients to show compliance towards the prescribed therapeutic regimen.
Keywords
Chronic diseases
Compliance
Counselling
Non-communicable diseases
Therapeutic effect
INTRODUCTION
Hypertension is a major health concern worldwide, affecting individuals at global, regional, national, and local levels.[1] Nearly 1.3 billion people worldwide are affected by hypertension, with two-thirds of them from low and middle-income nations.[2] In India, approximately 22% of women and 24% of men aged 15 years and above have hypertension. In Karnataka, the prevalence is slightly higher, affecting 26.9% of men and 25.9% of women in the same age group.[3] Medication adherence is the degree of conformity to the instructions about treatment dosage, medicine, timings, and frequency.[4] A review article indicates medication adherence in India varies from 19% to 96%, a substantially varied result of 10 studies.[4] Poor adherence to anti-hypertensive medication is linked with negative consequences of the disease.[5] Nurses must consider nurse-led interventions to help clients become treatment adherents. Different studies revealed that age,[6-8] sex,[9,7] marital status,[6] educational level,[6] economic status,[1,6] number of visits,[7] co-morbidities,[2,5] income,[6] BP monitoring,[6,10] family support,[7] duration of treatment,[7] medication price,[1] number of tablets,[8] and frequency of medications,[1] were the predictors of medication adherence. The factors contributing to medication adherence vary from one country to another. No two studies show the same factors. Perhaps this difference is due to the existing healthcare system, accessible treatment facilities, purchasing ability, and insurance coverage. In India, insurance broadly does not cover medication expenses for chronic health conditions. Therefore, the study was designed to understand existing predictors for medication adherence among patients visiting the OPD of a tertiary hospital and to suggest specific interventions for future researchers to build up adherence to therapeutic regimens. Numerous studies have delved into medication adherence and have revealed a diverse range of factors influencing it. This has spurred researchers to further explore similar studies to identify a multitude of potential factors and ascertain which ones are strongly linked to medication adherence.
MATERIAL AND METHODS
A hospital-based cross-sectional study was conducted among adults with chronic HT conditions visiting the medicine outpatient units of Father Muller Charitable Institute, Mangaluru, from 26th September 2023 to 06th October 2023. The data collection was initiated after obtaining ethical approval from the institutional ethics committee, ref. number FMIEC/CCM/387/2023 dated 19.06.2023.
Inclusion and exclusion criteria
Adults having hypertension for >3 months with allopathic medications prescribed by their doctors, and those who were able to converse in Kannada and English were included. The population with neurological impairments like dementia, hearing impairment, psychiatric conditions, confusion, and depression was excluded.
Sample size and sampling procedure
The sample size for the study estimation we used n = Zα2*P[1-P]/e2 formula with a margin error of 0.5%, power 80%, and a prevalence rate 36%.[11] This provided a sample size of 354. The sampling technique we used was convenience sampling.
Data collection
The interviewer collected data using a pretested questionnaire using a face-to-face structured interview technique. The investigators prepared the tool in English and translated it into Kannada by healthcare language experts, and back translation to English ascertained the completeness of the instruments. The online literature[11] aided in the tool formulation on the factors contributing to medication adherence, with 22 items on a nominal scale. The tool had three major aspects. The patient-related aspects, such as age, sex, education, marital status, family structure, and smoking status. The second aspect is related to socio-economic factors such as employment status, income, and emotional and financial support. The third aspect related to disease and therapy included duration of illness, number of medications per day, frequency of taking medications, medication reminders, frequency of doctor visits, past exposure to counselling on medication adherence, BP monitoring at home, and morbidity (associated morbidity, number of morbidities, and name of morbidity). Tool 2 on medication adherence had a single question: “Do you take medications as per the instructions of your doctor?” The response “Yes” indicates adherence to the medication in terms of correct dosage/time/frequency, and “No” denotes non-adherence. These tools were subjected to validation by three physicians and four nursing educators. Based on their suggestions, modifications were made, and the tools were finalised. There was 100% agreement on all the items except for some changes suggested, which were implemented. A pilot study on 30 subjects ensured the feasibility of data collection. On meeting the patients in the OPD, the interviewers explained the purpose of the study to those who were able to read, gave a typed participation information sheet (PIS), and for those who could not read, they explained the single details of the data collection procedure, questionnaire, and time required to complete the data, ensuring no risk and discomfort. Those who agreed were given a consent form and obtained their approval. The assigned subject code retained the subjects’ anonymity in the data collection form and throughout the study proceedings.
Statistical analysis
After data collection, the data profile was checked for completeness, and coded data were imported into a statistical package for the social science statistical software version 23 for analysis. The individual factors contributing to medication adherence were analysed in terms of frequency and percentage, and a χ2 test for associating predictors with medication adherence. The medication adherence is graded as non-adherence and adherence by asking a single question: “Do you take anti-hypertensive drugs as per the instructions of your doctor?”
RESULTS
A total of 49.4% (175) of the subjects were found non-adherent to the prescribed medications, and 50.6% (179) were adherent to medications.
Predictors of medication adherence
Patient-related factors: The mean age was 61.19 ± 11.04, more than half of the patients (57.9%, 205) were aged 60-89 years. The study subjects had more male subjects than females; it was 52.8% (187) and 47.2% (167), respectively. Majority (43.2%, 153) of subjects had primary education, 95.5% (338) were married, 98.0% (347) lived in a nuclear family structure, and 2.0% (7) were part of a joint or extended family structure. Most were either non-smokers or those who stopped smoking (89.5%, 317). However, 7.9% (28) were still smoking, and some had a passive smoking status (2.5%, 9).
Socio-economic factors
The employed status was 46.6% (165), not working, including the retired category, was 53.4% (189), and 58.2% (206) were earning a monthly income between Rs 5001-15000. Most (90.7%, 321) had received emotional support, and of that, 96.57% (310) had continuous support and 3.43% (11) had on and off. Most (92.1%, 326) said they receive financial aid, and 85.9% (280) said they have continuous financial support.
Disease, therapy, and the health care system
Majority (45.2%, 160) had hypertension for <5 years, and 39% (138) for 6-10 years. Hypertension alone without associated morbidity was 72.6% (257), hypertension with one associated condition was 24.0% (85), with two associated morbidities was 2.55% (9), and with three conditions was 0.84% (3). More than half (67.8%, 240) were consuming one tablet per day, and 0.6% (2) were taking 6 tablets per day, 78% (276) were taking medication once a day, and 3.1% (11) were taking medication more than twice. The subjects kept reminders to take their medications were 30.8% (109). Most (48.6%, 172) were going for follow-up once every 3 months. A small proportion (26.3%, 93) had received exclusive counselling sessions on medication adherence from the health personnel. Subjects accustomed to blood pressure monitoring at home were 20.6% (73).
Association between medication adherence and its contributing factors
From the table, it can be inferred that age (p = 0.73), sex (p = 0.74, marital status (p = 0.96), type of family (p = 0.28), current employment status (p = 0.8), emotional support (p = 0.9), and financial support (p = 0.21) were not a statistically significant association with medication adherence.
In our study, we found the following significant factors in medication adherence: education, income status, smoking status, consistent emotional support, consistent financial support, medication reminders, and BP checking at home. The data is further interpreted and explained below.
Education: In our study, education was one of the significant factors in medication adherence (p = 0.03); the subjects with primary education showed the highest adherence rate (91 adherent vs. 62 non-adherent). This might indicate that basic education positively influences adherence. The higher non-adherence among non-formal and high school education categories indicates these subjects may need focused interventions.
Smoking status: The p = 0.024 (<0.05); there is a statistically significant association between smoking status and adherence. Smokers appear to be the least adherent; as seen from the data, focused interventions might be needed for smokers and passive smokers to improve their adherence rates. Adherence was found to be better among non-smokers/who quit smoking.
Income: There is a significant difference in adherence behaviour across the income groups. The p value (0.01) indicates a significant association between economic status and medication adherence. Those with <5000/month had better adherence despite lower financial resources. The group with revenue of Rs 5,001-15,000 (115 non-adherent vs. 91 adherent) reveals challenges in adherence in this middle-income category. The third category of financial income >15,000 group shows a balance, with slightly more adherent individuals (40 adherent vs. 33 non-adherent).
Emotional support: 321 had emotional support, and those who had continuous emotional support were 148 (47.4%) non-adherent vs 162 (52.6%) adherent. This indicates continuous support seems to promote adherence but is not fully protective against non-adherence. On the other end, those who had on-and-off emotional support were 11, and all were non-adherent to medication. Emotional support type and its consistency strongly influence medication adherence (p = 0.001)
Financial support: 326 had financial support, out of that 134 were non-adherent and 146 were adherent to medications, and had continuous support; reverse in case of on and off financial support. The type and consistency of financial support significantly influence medication adherence, as indicated by p = 0.004.
Medication Reminders: The data showed that setting reminders significantly improves medication adherence (p = 0.04). The proportion is 41.2% non-adherent vs. 58.8% adherent among those accustomed to medication reminders.
Received counselling: Similarly, those who received some counselling during their therapy had better medication adherence than those who did not. The proportion of adherence vs. non-adherence among those who had counselling, 38.7% vs. 61.3%, indicates that counselling influences medication adherence. Obtained p = 0.01 indicates statistical significance.
Monitoring BP at home appears to be associated with better medication adherence. Individuals monitoring their BP at home are more likely to adhere to their medication regimen. The significant p value (0.03) suggests that BP monitoring may play a role in promoting adherence [Table 1a-c].
| n = 354 | |||||
|---|---|---|---|---|---|
| Sl. No | Variable | Non-adherent | Adherent | χ2 | p |
| 1 | Age (Years): mean (61.19 ± 11.04) | ||||
| 30-39 | 4 | 8 | 2.78 | 0.73 | |
| 40-49 | 22 | 18 | |||
| 50-59 | 51 | 46 | |||
| 60-69 | 60 | 61 | |||
| 70-79 | 28 | 35 | |||
| 80-89 | 10 | 11 | |||
| 2 | Sex: | ||||
| Male | 94 | 93 | 0.11 | 0.74 | |
| Female | 81 | 86 | |||
| 3 | Education: | ||||
| No formal education | 20 | 16 | 10.64 | 0.03* | |
| Primary | 62.0 | 91 | |||
| High school | 57.0 | 36 | |||
| PUC/Diploma | 28 | 28 | |||
| Graduation | 8 | 8 | |||
| 4 | Marital status | ||||
| Married | 167 | 171 | 0.002 | 0.96 | |
| Unmarried | 8 | 8 | |||
| 5 | Type of family | ||||
| Nuclear | 170 | 177 | Fishers exact | 0.28 | |
| Extended/Joined | 5 | 2 | |||
| 6 | Current-smoking status: | ||||
| Smokers | 20 | 8 | 7.19 | 0.024* | |
| Quit smoking/non-smokers | 149 | 168 | Fishers exact | ||
| Passive smokers | 6 | 3 | |||
p = 0.05*significant.
| n = 354 | |||||
|---|---|---|---|---|---|
| Sl. No | Variable | Non-adherent | Adherent | χ2 | p |
| 1 | Current employment status: | ||||
| Employed | 83 | 82 | .09 | 0.8 | |
| Not working & retired | 92 | 97 | |||
| 2 | Monthly income (Rs): mean (12,076.27 ± 11306.83) | ||||
| ≤5000 | 27 | 48 | 9.30 | 0.01** | |
| 5001-15,000 | 115 | 91 | |||
| ≥15,001 | 33 | 40 | |||
| 3 | Emotional support: | ||||
| Yes | 159 | 162 | 0.01 | 0.9 | |
| No | 16 | 17 | |||
| 4 | If yes, availability of the emotional support: (n=321) | ||||
| Continuous | 148 | 162 | 11.6 | 0.001*** | |
| On and off | 11 | 0 | |||
| 5 | Financial support: | ||||
| Yes | 158 | 168 | 1.55 | 0.21 | |
| No | 17 | 11 | |||
| 6 | If yes, availability of financial support: (n=326) | ||||
| Continuous | 134 | 146 | 11.08 | 0.004** | |
| On and off | 32 | 14 | |||
p = 0.01** highly significant, p = 0.001*** very highly significant
| n = 354 | |||||
|---|---|---|---|---|---|
| Sl. No | Variable | Non adherent | Adherent | χ2 | p |
| 1 | Subjects with associated morbidity: | ||||
| Yes | 45 | 52 | 0.5 | 0.5 | |
| No (hypertension alone) | 130 | 127 | |||
| 2 | Having hypertension since: | ||||
| 3 months-5 years | 85 | 75 | 2.32 | 0.51 | |
| 6-10 years | 62 | 76 | |||
| 11-15 years | 18 | 20 | |||
| ≥16 years | 10 | 8 | |||
| 3 | Number of tablets consumed per day | ||||
| 1 | 116 | 124 | 2.55 | 0.64 | |
| 2 | 38 | 34 | |||
| 3 | 13 | 12 | |||
| 4 | 8 | 7 | |||
| 5 | 0 | 0 | |||
| 6 | 0 | 2 | |||
| 4 | Frequency of daily medications | ||||
| Once a day | 133 | 143 | 2.60 | 0.27 | |
| Twice a day | 34 | 33 | |||
| More than twice | 8 | 3 | |||
| 5 | Sets reminders of any form to take medication: | ||||
| Yes | 45 | 64 | 4.19 | 0.04* | |
| No | 130 | 115 | |||
| 6 | Frequency of follow-up visits: | ||||
| Monthly | 34 | 34 | 4.65 | 0.32 | |
| Once every 3 months | 87 | 85 | |||
| Once every 6 months | 48 | 45 | |||
| Annually | 6 | 13 | |||
| As of now, whenever needed | 0 | 2 | |||
| 7 | Received any counselling sessions from any health personnel formerly | ||||
| Yes | v | 57 | 5.81 | 0.01** | |
| No | 139 | 122 | |||
| 8 | Assessment of blood pressure monitoring at home: | ||||
| Yes | 28 | 45 | 4.52 | 0.03* | |
| No | 147 | 134 | |||
| 9 | Number of morbidity: | ||||
| Hypertension alone | 130 | 127 | 4.48 | 0.2 | |
| Hypertension with one additional morbidity | 37 | 48 | Fishers exact | ||
| Hypertension with Two | 7 | 2 | |||
| Hypertension with Three | 1 | 2 | |||
| 10 | Name of morbidity along with hypertension: | ||||
| One morbidity: | |||||
| Diabetes mellitus | 24 | 37 | 16 | 0.5 | |
| Respiratory (COPD) | 3 | 3 | |||
| Atherosclerosis | 2 | 0 | |||
| Skin (Psoriasis) | 1 | 0 | |||
| Thyroid | 2 | 2 | |||
| Cardiac (CAD) | 4 | 4 | |||
| Arthritis | 1 | 0 | |||
| Renal (CRF) | 0 | 1 | |||
| Parkinson’s | 0 | 1 | |||
| Two morbidity: | |||||
| Diabetes and respiratory (COPD) | 1 | 0 | |||
| Diabetes and varicose veins | 2 | 0 | |||
| Diabetes and CAD | 1 | 0 | |||
| Diabetes and thyroid | 1 | 1 | |||
| Diabetes and renal | 2 | 1 | |||
| Three morbidity: | |||||
| Diabetes, varicose veins, and CAD | 1 | 0 | |||
| Diabetes, varicose veins, and CRF | 0 | 1 | |||
| Diabetes, thyroid, and varicose veins | 0 | 1 | |||
p = 0.05* significant, p = 0.001** highly significant, p = 0.001*** very highly significant. CAD: Coronary artery disease. CRF: Chronic renal failure, COPD: Chronic obstructive pulmonary artery disease.
DISCUSSION
We have discussed the study findings mainly on those factors that had an association with medication adherence.
Medication adherence level
Most studies indicate that nearly half of the study patients are non-adherent to medication. This is perhaps due to chronic disease conditions, which demand a daily intake of multiple tablets. The pill burden itself causes frustration and reduces medication adherence. The current study findings are on par with Shi et al., which indicated 63.6% with low adherence.[12] The prevalence of low medication adherence was 32.7% by Yuvraj of Puducherry.[7] The study conducted in the primary health centres of Saudi Arabia by Thirunavukkarasu et al. is on par with the current study, which indicates only 36.3% with high medication adherence.[13] The study findings of Liquori in Italy contradicted this by stating a high adherence rate of 71.43%.[14]
Medication adherence and its contributing factors
Age: The analysis conducted by Ayodapo[6] is consistent with the current study (χ2 = 3.760, p = 0.052). Their study found that very old and very young had less medication adherence compared to those aged 56-65 years. This is perhaps due to early adulthood, and middle-aged adults may struggle to balance medication adherence with work, family, and other responsibilities. After retirement, individuals will have more time to think and care for themselves, which may increase their chances of adherence.
Sex: Our study found no association (χ2 = 0.11, p = 0.74) between sex and medication adherence. Chepulis[15] highlighted similar study results, p = 0.127. Previous studies have shown mixed results regarding sex differences in medication adherence.
Education: The current study denotes non-adherence more among those with no formal education and the high school categories. This is significant χ2 = 10.64, p = 0.03. Similar observations were made by Thirunavukkarasu et al., they disclosed that age (p = 0.021), marital status (p = 0.001), and monthly income (p = 0.001) were associated with medium to low medication adherence and found no association with high medication adherence.[13] Individuals with lower education may have difficulty understanding medical information, including medication instructions, leading to confusion and non-adherence. That is why, in our study, the individual with no formal education showed non-adherence to medication.
Current smoking status: The current study shows an association (χ2 =7.19, p = 0.024) between current smoking status and medication adherence. A study carried out by Abbas et al. found that subjects who smoked cigarettes (OR = 2.62, 95% CI [1.17-6.76]) presented non-adherence to medication.[5] Smokers may prioritise nicotine over medication adherence. Smoking may alter memory and attention and reduce the likelihood of adhering to the medication.
Monthly income: A study conducted by Noreen et al. showed that non-adherence among patients was associated with unaffordability of treatment (OR, 2.25; p = 0.002).[16] Low-income individuals may struggle to afford the medication expenses.
Availability of emotional support: The current study shows an association (χ2 =11.6, p = 0.001) between availability of emotional support and medication adherence. The systematic study published by Shahin et al. indicates that of their 14 reviewed papers, 11 studies found a positive impact of family and peer support on medication adherence.[17] This implies that emotional support is one of the critical factors in ensuring medication adherence. The study conducted by Khadoura et al. highlighted social support’s significant association with medication adherence (OR, 2.26; 95% CI, 2.82-5.11).[18] When patients understand there are people around them to give emotional support, they feel accountable to significant others, which may increase their ability to adhere to medications.
Availability of financial support: The study conducted by Shen et al. has given a similar outlook to our study results. Their study says the financial support from the spouse/partner has a positive impact on medication adherence (AOR = 1.439; 95% CI = [1.069-1.937]).[9] Financial support can improve medication access, especially for those with limited financial resources.
Reminder for medication: Fenerty et al. study supports the current study, stating medication adherence was significantly increased by reminder-based interventions (65.94% in the reminder groups vs. 54.71% in the control groups, p = 0.04).[19] Alarms encourage patients to take ownership of their treatment plan and minimise forgetfulness, which is a common reason that may help them adhere to the prescribed medication doses.
Received any counselling formerly from any health personnel on medication adherence: The study findings of Ayodopo et al., published in 2020, support our findings. They found medication adherence was two times (OR = 2.30, 95% CI =1.16,4.62) higher among those with adequate knowledge than those with poor knowledge of treatment.[6] Health literacy can be established via counselling sessions, contributing to medication adherence.
Home blood pressure monitoring: BP monitoring is a significant predictor for medication adherence χ2=4.52, p = 0.03. This study’s results are compatible with the investigation conducted by Trefond et al.[10] (OR: 0.51, 95% CI: 0.29-0.88, p = 0.02). The proper way of BP monitoring had better adherence to medication, p = 0.001. BP monitoring instantly helps the patient know their blood pressure parameters, which itself becomes a motivational factor for adhering to the medication schedule.
Limitation: The study measured adherence using a single setting and a single subjective question in the tool for measurement of compliance. Medication strips, frequency of refilling medication boxes, medication prescriptions, and such measurements were not considered. The non-adherence may be intentional or non-intentional; hence, the authors suggest that future researchers bring insight into this.
CONCLUSION
The study conducted by us has shown that education, income, financial support, emotional support, medication reminder, counselling, BP monitoring at home, and current smoking status are the critical factors for medication adherence. Both subjective and objective medication adherence measurements have shown their limitations in past studies. A future study with dual medication adherence measurements may be more practical.
Acknowledgement
The investigators thank the Hospital authority and the principal of the College of Nursing for giving an opportunity to carry out the study. Also, thanking the subjects for their wholehearted participation.
Ethical approval
The research/study was approved by the Institutional Review Board at the Institutional Ethics Committee, number FMIEC/CCM/387/2023, dated 19th June 2023.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given consent for clinical information to be reported in the journal. The patient understands that the patient’s names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
References
- An assessment o hypertensive medication adherence among hypertensive patients attending the outpatient clinics in the University of Uyo Teaching hospital, Uyo. Nigerian Med J. 2020;61:120.
- [Google Scholar]
- Antihypertensive medication adherence and associated factors among adult hypertensive patients at Jimma University specialized Hospital, southwest Ethiopia. BMC Res Notes. 2018;11:27.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Yasmeen A. Southern States have a higher prevalence of hypertension than the national average: NFHS-5 report. The Hindu. Published May 7, 2022. Available from: https://www.thehindu.com/news/national/karnataka/southern-states-have-a-higher-prevalence-of-hypertension-than-the-national-average-nfhs-5-report/article65392207.ece#:∼:text=Afshan%20Yasmeen-,Southern%20States%20have%20a%20higher%20prevalence%20of%20hypertension%20than%20the,above%2015)%20who%20have%20hypertension. [Last accessed 2025 December 10].
- Therapeutic adherence in hypertension: Current evidence and expert opinion from India. Indian Heart J. 2021;73:667-73.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Factors associated with antihypertensive medication non-adherence: A cross-sectional study among lebanese hypertensive adults. Patient Prefer Adherence. 2020;14:663-7.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Patient education and medication adherence among hypertensives in a tertiary hospital, South Western Nigeria. Ethiop J Health Sci. 2020;30:243-50.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Prevalence of medication adherence and its associated factors among patients with noncommunicable disease in rural Puducherry, South India – A facility-based cross-sectional study. J Family Med Prim Care. 2019;8:701.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Impact of number of medications and age on adherence to antihypertensive medications. Medicine. 2019;98:e17825.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Medication adherence and perceived social support of hypertensive patients in China: A community-based survey study. Patient Prefer Adherence. 2022;16:1257-68.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Home blood pressure monitoring and adherence in patients with hypertension on primary prevention treatment: A survey of 1026 patients in general medicine in the Auvergne region. BMC Prim Care. 2022;23:131.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Uncontrolled hypertension and associated factors among adult hypertensive patients. J Pharm Negative Results. 2023;14:1687-88.
- [Google Scholar]
- Association between medication literacy and medication adherence among patients with hypertension. Front Pharmacol. 2019;10:822.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Medication adherence among hypertensive patients attending different primary health centers in Abha, Saudi Arabia: A Cross-Sectional Study. Patient Prefer Adherence. 2022;16:2835-44.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Medication adherence in chronic older patients: an Italian observational study using medication adherence report scale (MARS-5I) Int J Environ Res Public Health. 2022;19:5190.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Metformin adherence in patients with type 2 diabetes and its association with glycated haemoglobin levels. J Prim Health Care. 2020;12:318-26.
- [CrossRef] [PubMed] [Google Scholar]
- Determinants of adherence to antihypertension medications among patients at a tertiary care hospital in Islamabad, Pakistan, 2019. Prev Chronic Dis. 2023;20:E42.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- The association between social support and medication adherence in patients with hypertension: A systematic review. Pharm Pract (Granada). 2021;19:2300.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Determining the prevalence of and the factors associated with antihypertensive medication non-adherence in the Gaza strip. Korean J Fam Med. 2021;42:150-8.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- The effect of reminder systems on patients’ adherence to treatment. PPA. 2012;6:127-35.
- [Google Scholar]