What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Hypertension (n=150). Intervention: Poor adherence to antihypertensive medications vs. Good adherence. Primary outcome: Left ventricular hypertrophy (LVH) on ECG (OR 0.02, 95% CI 0.006 to 0.080, p=<0.001).

January 1, 2013Open Access

Adherence to Antihypertensive Medications and Some of Its Clinical Implications in Patients Seen At a Tertiary Hospital in Nigeria

Q: What are the key findings of this study?

Poor adherence to antihypertensive medications was associated with a significantly higher rate of left ventricular hypertrophy compared to good adherence (47.0% vs 4.5%, OR 0.02, p<0.001).

Key Result

Poor adherence to antihypertensive medications was associated with a significantly higher rate of left ventricular hypertrophy compared to good adherence (47.0% vs 4.5%, OR 0.02, p<0.001).

Study Design

Type

Cross-Sectional (n=150)

Multicenter

Structured PICO

Does good adherence to antihypertensive medications reduce the prevalence of left ventricular hypertrophy in hypertensive patients?

Population

150 hypertensive outpatients (mean age 61.5 years, 58% female) on antihypertensive medications were assessed for drug adherence and its clinical implications.

Exposure

Good adherence to antihypertensive medications (Morisky Medication Adherence Scale [MMAS-4] score ≥2)

Comparator

Poor adherence to antihypertensive medications (MMAS-4 score <2)

Outcome

Left ventricular hypertrophy (LVH) determined by resting 12-lead electrocardiogram (Sokolow-Lyon criteria)surrogate

Poor adherence to antihypertensive medications is highly prevalent and strongly associated with left ventricular hypertrophy in Nigerian outpatients.

Main Result

Odds Ratio: 0.02 (95% CI 0.006–0.08)

Absolute Event Rate: 47% vs 4.5%

p-value: p=<0.001

Limitations

MMAS-4 has the disadvantage of recall bias and eliciting socially acceptable responses, tending to overestimate adherence
Carried out in a tertiary health care setting, findings may not be applicable to the general population

Abstract

Background: Adherence to antihypertensive is crucial to treatment success in subjects with hypertension. This study is aimed at assessing antihypertensive drug adherence using validated tool and its relationship with some demographic and clinical parameters in outpatient hypertensive subjects. Methods:The Morisky Medication Adherence Scale (MMAS-4) was used to assess drug adherence status in 150 hypertensive patients who were consecutively recruited in a Medical Outpatient Department of a Tertiary Health Centre. All the patients had resting 12-lead electrocardiogram (ECG) done to determine left ventricular hypertrophy (LVH). Data were analyzed with SPSS 13 and statistical significance of p< 0.05 was used. Results: One hundred and fifty hypertensive patients with a mean age of 61.53 9.72years were recruited over a period of 6 months. Sixty seven (44.7%) were good drug adherers while 55.3% were not. Patients with poor antihypertensive adherence had higher p= 0.07) as well as longer P wave duration on ECG (0.15 0.03 vs. 0.12 0.04; p= 0.03). There was higher rate of ECG LVH among patients with poor drug adherence (47.0%) compared to patients with good drug adherence (4.5%). Significant correlates of poor drug adherence were age p=0.022) and BMI (r= 0.431; P<0.001).

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