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Objective: It is estimated that there are around 220 million adults in India with hypertension and only 12% have their blood pressure under control. Non-adherence in hypertension is a key factor that contributes to uncontrolled blood pressure. The extent of non-adherence in people with hypertension in India is currently unknown. Design and method: A systematic review was carried out using PubMed/MEDLINE to identify relevant studies from inception until July 2022 and included all articles in English of adults with hypertension and any study which had adherence (or equivalent terms) in the title or abstract. Data was analysed using SPPSS28. Results: The initial search identified 433 papers and on screening, 49 papers were found to meet the inclusion criteria. A total of 15,577 patients were studied. The mean age ranged from 26.1 to 69.3 yr. The median percentage of males was 37.5% (range 0% to 86.7%). The median value of patients that had less than primary school education was 25.2% (range 2.3% to 98.5%). The median of patients that had the condition for over 5 years was 40.0% (range 33.6% to 63.0%). 83.35% (30/36) studies took place in tertiary care and 53.3% (8/15) were in a rural setting and rest were either in urban or mixed setting. The vast majority 84.4% (38/45) used standardised questionnaires to assess nonadherence. 45 studies had quantifiable data on non-adherence with the median non-adherence rate of 54.0% (range 4%- 98.5%). Non-adherence was not significantly associated with mean age (P = 0.310), gender (P = 0.800), level of education (P = 0.468), duration of condition (P = 0.823), rural vs. urban setting (P = 0.805) or primary vs. tertiary care setting (P = 0.089). Conclusions: This is the first systematic review to evaluate the extent of non-adherence in patients in India with hypertension. The median nonadherence rate was more than 50% with a wide variation in rates across the studies. There were no factors identified that correlated with the extent of non-adherence. Further standardised studies are needed to understand and address this important issue in India.
Agarwal et al. (Wed,) studied this question.