What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Hypertension (n=669). Intervention: Antihypertensive medications. Primary outcome: Prevalence of non-adherence to antihypertensive medications (95% CI 44.1-51.8).

December 27, 2023Open Access

Predictors of non-adherence to antihypertensive medications: A cross-sectional study from a regional hospital in Afghanistan

MSMuhammad Haroon StanikzaiKandahar University MWMohammad Hashim WafaKandahar University ETEssa TawfiqUNSW Sydney

Key Result

Among hypertensive patients in Afghanistan, 47.9% were non-adherent to their antihypertensive medications, with low income, multiple medications, and depression identified as significant predictors.

Study Design

Type

Cross-Sectional (n=669)

Multicenter

Structured PICO

Population

669 hypertensive patients, aged ≥18 years receiving antihypertensive follow-up treatment at Mirwais Regional Hospital in Kandahar, Afghanistan for at least six months. Mean age 47.5 years, 52% male. Excluded: pregnant women, unconscious and critically ill individuals, and currently hospitalized patients.

Outcome

Prevalence of non-adherence to antihypertensive medications (AHMs) assessed using the Hill-Bone Medication Adherence scale (score ≤80% signifies non-adherence) and its predictors.patient reported

Nearly half of hypertensive patients in a regional Afghan hospital are non-adherent to their medications, driven by socioeconomic factors, complex regimens, and depression, highlighting the need for targeted interventions to improve blood pressure control.

Limitations

Cross-sectional design prevents establishing causal relationships
Reliance on self-reported medication non-adherence might introduce recall or social desirability bias
Did not assess the complex interplay of social and cultural factors
Unknown prevalence of non-adherence among patients lost to follow-up may have introduced bias
Lack of knowledge regarding the specific type of antihypertensive medications participants were taking
Data from a single regional hospital limits generalizability
Deficiency in assessing diverse levels (low, medium, or high) of medication non-adherence

Abstract

BACKGROUND: Non-adherence to antihypertensive medications (AHMs) is a widespread problem. Cardiovascular morbidity and mortality reduction is possible via better adherence rates among hypertensive patients. OBJECTIVES: This study aimed to assess the prevalence of non-adherence to AHMs and its predictors among hypertensive patients who attended Mirwais Regional Hospital in Kandahar, Afghanistan. METHODS: A cross-sectional study using random sampling method was conducted among hypertensive patients, aged ≥18 years in Mirwais Regional Hospital at a 6-month follow-up between October and December 2022. To assess non-adherence to AHMs, we employed the Hill-Bone Medication Adherence scale. A value below or equal to 80% of the total score was used to signify non-adherence. A multivariable binary logistic regression model was used to identify predictors of non-adherence to AHMs. RESULTS: We used data from 669 patients and found that 47.9% (95%CI: 44.1-51.8%) of them were non-adherent to AHMs. The majority (71.2%) of patients had poorly controlled blood pressure (BP). The likelihood of non-adherence to AHMs was significantly higher among patients from low monthly-income households Adjusted odds ratio (AOR) 1.70 (95%CI: 1.13-2.55), those with daily intake of multiple AHMs AOR 2.02 (1.29-3.16), presence of comorbid medical conditions AOR 1.68 (1.05-2.67), lack of awareness of hypertension-related complications [AOR 2.40 (1.59-3.63), and presence of depressive symptoms AOR 1.65 (1.14-2.38). CONCLUSION: Non-adherence to AHMs was high. Non-adherence to AHMs is a potential risk factor for uncontrolled hypertension and subsequent cardiovascular complications. Policymakers and clinicians should implement evidence-based interventions to address factors undermining AHMs adherence in Afghanistan.

اسأل الذكاء الاصطناعي

Bookmark

View Full Paper