Background: Hypertension is responsible for at least 45% of deaths due to heart disease. The number of people with uncontrolled hypertension is increasing because of population growth and ageing. A very high prevalence rate of hypertension of 29.7% was reported in Cameroon. Hypertension requires long term management and follow-up. Adherence to therapy is a key component of a successful management. Few studies have been done in Cameroon regarding antihypertensive treatment adherence. This study was therefore designed to assess the adherence status and associated factors to antihypertensive therapy in hypertensive patients followed-up at Yaounde General Hospital.

Methods: This was a cross-sectional analytic study conducted at the external consultation service of the cardiology unit of the Yaounde General Hospital. This study was carried out over a period of seven months. Patients admitted into this study were selected consecutively and those that met our inclusion criteria were selected prior to interviewing. Two sitting blood pressure measurements were taken on both arms with a pretested electronic sphygmomanometer. We assessed the adherence level of the study population by using the validated Morisky 8-item medication adherence scale together with other possible factors responsible for poor adherence.

Results: Of the 181 patients screened, 175 were retained for the study. Using the 8-item Morisky Medication Adherence Scale, we noted that 40.6% were medium adherers; and 26.9% were low adherers. This means that, 32.6% of participants had good adherence while 67.4% had poor adherence. After multivariate analysis with logistic regression, several variables were found to be significantly associated with poor adherence: first cycle secondary education (p=0.0209; OR=4.6623), living singly (p=0.0003; OR=4.6623), trip duration of one hour or more (p=0.008; OR=7.3925), middle socioeconomic status (p=0.006; OR=2.6814), uncontrolled blood pressure status (p<0.0001; OR=5.5704), presence of handicap (p=0.0117; OR=4.1222), presence of side effects (p<0.0001; OR=11.5143), and taking medication in the evening (p=0.0399; OR=2.5452).

Conclusion: This study depicted a low level of patient adherence to antihypertensives and the existence of several factors responsible for this status quo. It is of utmost importance that all the hindering factors be addressed by healthcare professionals in order to achieve good blood pressure control. Healthcare professionals need to reinforce sensitization of patients with hypertension on the need to adhere to their treatments which is lifelong in order to avoid comorbidities.

Keywords:Adherence; Antihypertensive; Morisky; Yaounde

References

1. World Health Organization. “A global brief on Hypertension: Silent killer, global public health crisis” (2013): 39.
2. Lim SS., et al. “A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010”. Lancet 380.9859 (2012): 2224-2260.
3. MM Finucanev., et al. “National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5.4 million participants”. Lancet 377.9765 (2011): 557-567.
4. Ambaw AD., et al. “Adherence to antihypertensive treatment and associated factors among patients on follow up at University of Gondar Hospital, Northwest Ethiopia”. BMC Public Health 12 (2012): 282-288.
5. Kingue S., et al. “Prevalence and Risk Factors of Hypertension in Urban Areas of Cameroon: A Nationwide Population-Based Cross-Sectional Study”. The Journal of Clinical Hypertension 17.10 (2015): 819-824.
6. Osterberg L and Blaschke T. “Adherence to Medication”. The New England Journal of Medicine 353.5 (2005): 487-497.
7. World Health Organization. Adherence to long-term therapies: Evidence for action (2003): 194.
8. Charan J and Biswas T. “How to Calculate Sample Size for Different Study Designs in Medical Research?”. Indian Journal of Psychological Medicine 35.2 (2013): 121-126.
9. Mbouemboue OP., et al. “Determinant therapeutic nonadherence to antihypertensive treatment: a hospital-based study outpatients in Northern Cameroon”. International Journal of Medical Science and Public Health 5.3 (2016): 547-554.
10. James PA., et al. “Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eight Joint National Committee”. JAMA 311.5 (2014): 507-520.
11. Raj Guru MS., et al. “Revised socio-economic status scale for urban and rural India - Revision for 2015”. Socioeconimica 4 (2015): 167-174.
12. Morisky DE., et al. “Predictive Validity of A Medication Adherence Measure in an Outpatient Setting”. The Journal of Clinical Hypertension 10.5 (2008): 348-354.
13. Demoner MS., et al. “Factors associated with adherence to antihypertensive treatment in a primary care unit”. Acta Paul Enferm 25.1 (2012): 27-34.
14. Behnood-Rod A., et al. “Adherence to Antihypertensive Medications in Iranian Patients”. International Journal of Hypertension (2016): 1-14.
15. Hedna K., et al. “Adherence to Antihypertensive Therapy and Elevated Blood Pressure: Should We Consider the Use of Multiple Medications?”. PLoS ONE 10.9 (2015): 1-14.
16. Haynes R., et al. “Helping patients follow prescribed treatment: Clinical applications”. JAMA 288.22 (2002): 2880-2883.
17. Lin YP., et al. “Adherence to Antihypertensive Medications among the Elderly: A Community-based Survey in Tainan City, Southern Taiwan”. Taiwan Geriatr Gerontol 2.3 (2007): 176-189.
18. Okwuonu CG., et al. “Adherence to antihypertensive medication and its correlates among individuals with hypertension in a semi-urban community of Southern Nigeria”. JMBR 14.1 (2015): 5-17.
19. Dzudie A., et al. “Prevalence, awareness, treatment and control of hypertension in a selfselected sub-Saharan African urban population: a cross-sectional study”. BMJ Open 2 (2012): e001217.
20. Essomba NE., et al. “Facteurs de Non Observance au Traitement AntiHypertenseur chez les Adultes à Douala”. Health Sciences and Diseases 18.3 (2017): 51-57.
21. Akoko BM., et al. “Knowledge of Hypertension and Compliance with Therapy Among Hypertensive Patients in the Bamenda Health District of Cameroon: A Cross-sectional Study”. Cardiology and Therapy 6.1 (2017): 53-67.
22. Hashmi SK., et al. “Factors Associated with Adherence to Anti-Hypertensive Treatment in Pakistan”. PLoS ONE 2.3 (2007): 1-8.
23. Boima V., et al. “Factors Associated with Medication Nonadherence among Hypertensives in Ghana and Nigeria”. International Journal of Hypertension (2015): 1-8.
24. Hussain S., et al. “Non-Adherence to Antihypertensive Treatment in Essential Hypertensive Patients in Rajshahi, Bangladesh”. AKMMC Journal 2.1 (2011): 9-14.
25. Tufon EN., et al. “Adherence to Antihypertensive Treatment Factors Associated with Adherence Amongst Hypertensive Patients on Follow-up at Mankon Sub-Divisional Health Center, Ntingkang, Bamenda, Cameroon”. VRI Signaling 2.1 (2014): 27-31.
26. Lo SHS., et al. “Adherence to Antihypertensive Medication in Older Adults with Hypertension”. Journal of Cardiovascular Nursing 31.4 (2016): 296-303.
27. Sweetman SC. “Martindale: The Complete Drug Reference”. Thirty-sixth edition. Great Britain: Pharmaceutical Press (2009): 3709.
28. Jackson R and Bellamy M. “Antihypertensive drugs”. BJA Education 15.6 (2015): 280-285.
29. Brunton LL., et al. “Goodman & Gilman’s: The pharmacological basis of therapeutics”. Eleventh Edition. New York 2006.
30. Pepper GA. “Pharmacology of Antihypertensive Drugs”. Journal of Obstetric, Gynecologic and Neonatal Nursing 28.6 (1999): 649-659.

Citation

Citation: Chiabi RM., et al. “An Assessment of Adherence to Antihypertensive Treatment and Associated Factors in Patients at the Yaounde General Hospital”.Acta Scientific Pharmacology 1.1 (2020): 11-19.

Copyright

Copyright: © 2020 Chiabi RM., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.