Understanding Nonadherence to Antihypertensive Medications: Patterns, Predictors, Barriers, and Access challenges in a Tertiary Care Setting in Libya

Adherence to medications is crucial to achieving optimal control in chronic diseases, including hypertension. This study describes the characteristics of adherent and non-adherent patients on antihypertensive medication in a tertiary care setting in Libya. It further examines the subtypes of non-adherence, the perceived barriers related to each subtype, the key predictors of non-adherence, and reports medication access difficulties faced by all patients regardless of their adherence. The study utilized data from a larger cross-sectional study in one of the largest tertiary hospitals in Libya. The cohort for this analysis consisted of 320 antihypertensive patients who had been on antihypertensive agents for more than 6 months. Data were obtained using structured interviews and medical records. The mean age of this cohort was 54.32 years (SD=10.39), and 60.3% were females. The prevalence of medication nonadherence was 34.9%. The most common subtype was unintentional non-adherence, accounting for 66.7% of non-adherents. Among the unintentional barriers, forgetfulness (55.0%) was the most frequently reported, whereas feeling well (21.6%) was the most prevalent intentional barrier. Overall, 68.5% of patients reported experiencing problems in accessing their medications, irrespective of their adherence status, with the majority reporting high cost as the main problem (93.1%). Predictors of medication nonadherence were irregular follow-up (P <0.001, OR=3.540, 95% CI: 1.982- 6.326), and no Home Monitoring of Blood Pressure (HMBP) (P = 0.006, OR=2.326, 95% CI: 1.275-4.244). In conclusion, medication non-adherence, predominantly the unintentional subtype, is considerable among hypertensive patients, with forgetfulness and feeling well-being the most prevalent barriers. Educational interventions about the importance of regular follow-up and HMBP, improving access to affordable medications, may improve medication adherence.